American health care professionals must realize that emphasis on the importance of self-care is not always the result of medical necessity, but rather the influence of American values and social structure on health care practices. Self-care is important to Americans, in part because independence is valued so highly. Furthermore, self-care may be a practical necessity because there may be no one to help with daily tasks. In contrast, the emphasis in Asian cultures is on family interdependence over independence. Many Asians live in large extended family households, where someone is usually at home to care for the patient.

Another significant factor in caring for Japanese Americans is the difference between egalitarian and hierarchic cultures. In an egalitarian culture such as found in the United States, everyone theoretically is equal and no one in the family is considered subservient to anyone else. In hierarchic Asian cultures, some members of the family are clearly dominant (men and elders) while others are clearly subordinate (women and children). The Tanakas demonstrated the proper roles of wife and children in hierarchic cultures. It is their duty to obey and care for the dominant family member—the husband and father.

Control may also play a role in the failure to care for oneself, especially in cultures where men are dominant. When reduced to a state of physical weakness by a medical condition, men who issue orders and have their family attend to their every need demonstrate their dominance. It may masquerade as helplessness, but it is a way of maintaining control.

Japanese Americans, particularly women, tend to be modest with family members, especially their elders, and those of the opposite sex. It is best to assign same sex caregivers.²

Cleanliness and hygiene are of great importance. They are linked to the belief in and importance of the purification of the body to help restore health. Daily tub baths are the preferred method of bathing, in the evening before bedtime. Use of the bathroom is primarily for privacy. Hair washing occurs daily or several times per week, and nails are generally kept short and clean. Washing after using the toilet is customary.

Personal hygiene is generally performed by the patient, if able. A family member, particularly a spouse or elder daughter, may be able to provide assistance and may be preferred by the patient over a health care professional. Older adults may be more dependent on family members when ill.

Special clothing or amulets may be desired. For example, Issei (first generation Japanese in the United States) may use prayer beads, particularly if the individual is Buddhist.