Cultural Appropriateness in Health Communication: A Review and A Revised Framework

A revised framework for cultural appropriateness is offered on the basis of a systematic review of operationalizations in 44 cancer screening interventions for Asian Americans. Studies commonly conveyed the epidemiological bases of the intervention (97.7%) and used the language of the population (95.5%). Less commonly reported were strategies central to health communication: cultural features of the intervention messages (77.3%) and the cultural beliefs and values that the intervention focused on (43.2%). Few used cultural tailoring (4.5%) and none aimed to address acculturation or cultural identity. The theoretical framework most frequently used was the health belief model (27.3%) which does not explain the role of culture. More studies focused on cultural barriers (20.5%) than cultural strengths (9.1%). Our revised framework comprises six cultural appropriateness strategies of cultural identity, linguistic, perceptual features, content, constituent-involving, and socioeconomic context-adaptive. It prioritizes cultural identity to recognize the dynamics within racial ethnic groups and to inform adaptive efforts for cultural appropriateness. It emphasizes examining cultural strengths that can facilitate change, as well as reducing cultural barriers. Future research and action should address the disparities in extant health disparities research in which theory and methods are underdeveloped and underutilized for Asian Americans.     

贯穿以人为本管理思想 建设新时期医院文化

医院文化建设是医院管理的重要组成部分 ,是精神文明建设的主要内容 ,也是医院可持续发展的关键要素。贯穿以人为本的管理思想 ,把医院文化建设作为重点 ,与医院发展同步进行 ,与精神文明建设紧密结合 ,打造医院品牌 ,树立医院形象 ,提高综合效率。     

Social and cultural dimensions of hypertension in Brazil: a review

Elevated arterial blood pressure varies substantially in relation to social and cultural variables. Early work on acculturation, socioeconomic status, and blood pressure documented this variation, which could not be explained entirely by conventional factors such as diet, physical activity, or access to medical care. These findings stimulated the development of a model of stress and disease. The stress model emphasizes social and psychological factors that are perceived by individuals to be stressful, as well as factors that help individuals to respond to those stressors. Conventional stress models are, however, problematic because the primary emphasis is on individual perception, with little consideration of the social and cultural context in which stress occurs. This paper describes a complementary model of social and cultural influences on disease risk, placing greater emphasis on how individuals are able to approximate, in their own behaviors, shared cultural models of life, referred to as "cultural consonance". Findings from research in Brazil indicate that the higher an individual's cultural consonance, the lower his or her blood pressure. These results indicate the importance of linking different levels of analysis - the cultural, the individual, and the biological - to understand disease risk.     

Navigating different cultural beliefs and practices to support immigrant preschoolers and their families: a Bakhtinian textual analysis on preschool teacher and administrator perspectives

ABSTRACT

Understanding different cultural beliefs and practices has become increasingly important for early childhood educators in the contemporary United States. This paper investigates how preschool teachers and administrators navigate different cultural discourses in classrooms that frequently go unidentified or ignored, and how they support children and parents from immigrant families. Preschool teachers and administrators play a vital role as moderators in contemporary early childhood education and care settings due to the increasingly diverse demographic and cultural landscape. Using a version of Bakhtinian textual analysis, we illustrate the complexities of navigating multiple sets of cultural beliefs and practices in early childhood classrooms, as well as the possible challenges of supporting children and parents from immigrant families. The paper makes visible tacit cultural values and attitudes that manifest in early childhood classrooms to explore the circulating discourses about cultural diversity in the midst of rising anxieties, ambivalence, and tensions around immigration.     

Culturally responsive health promotion in puerto rican communities: a structuralist approach

This literature review discusses the value of the structuralist approach as an integrated theoretical and methodological framework for participatory cultural assessments designed to capture the cultural dynamics of those affected by health disparities. Drawing from principles of the Lévi-Straussian strand of structural anthropology found in contemporary cultural studies, and using the Puerto Rican cultural experience as an example, the authors present the distinction between deep and surface structures of cultural knowledge and meaning and highlight information-processing and behavioral systems influenced by the complexity of cognitive and social representations of cultural structures. To understand and address the deeply rooted web of ideology, norms, and practices that influence health decision making and behavioral responses, the authors show the need for ethnographic narrative inquiry beyond surface manifestations of culture. Finally, the authors discuss the implications of the structuralist approach for culturally responsive health education and other health promotion interventions.     

A prospective study of cultural consonance and depressive symptoms in urban Brazil

Cultural consonance refers to the degree to which individuals, in their own beliefs and behaviors, approximate the prototypes for belief and behavior encoded in shared cultural models. In previous cross-sectional studies, lower cultural consonance in several cultural domains was associated with worse health outcomes, including greater psychological distress. The current paper extends these findings in three ways. First, the effect of cultural consonance on depressive symptoms is tested in a prospective study. Second, it is hypothesized that the effect of cultural consonance in a specific cultural domain will depend on the degree of cultural consensus within that domain: the higher the cultural consensus, the greater the effect of change in cultural consonance in that domain on depressive symptoms. Third, it is hypothesized that cultural consonance will have an inverse effect on depressive symptoms independent of the occurrence of stressful life events (a well-known risk factor for depression). We tested these hypotheses in a study conducted in urban Brazil, and found that change in cultural consonance (assessed as a general construct) was associated with depressive symptoms at a 2-year follow-up. Furthermore, cultural consonance in the domains in which there was highest cultural consensus—the domains of family life and lifestyle—was more strongly associated with depressive symptoms at follow-up than cultural consonance in domains with lower cultural consensus. Finally, all of these effects were independent of stressful life events. These results lend further support to the importance of cultural consonance in relation to human health.     

Medicine in a multi-cultural society: the effect of cultural background on beliefs about medications

This exploratory, cross-sectional study examined the effect of self-reported cultural background on beliefs about medicines (modern pharmaceuticals) and perceptions of personal sensitivity to the adverse effects of taking medication. Using a validated questionnaire, beliefs about pharmaceutical medication were compared between 500 UK undergraduate students who identified themselves as having an Asian or European cultural background. There was a significant association between cultural background and beliefs about the benefits and dangers of medicines. Students who self-reported to have an Asian cultural background expressed more negative views about medication than those who reported a European cultural background. Students with an Asian cultural background were significantly more likely to perceive medicines as being intrinsically harmful, addictive substances that should be avoided. They were significantly less likely to endorse the benefits of modern medication. There was no significant relationship between cultural background and perceptions of personal sensitivity to medication effects or belief about how doctors use medication. In the total sample, past and present experience of taking medication was associated with a more positive orientation to medicines in general. Students who considered themselves to have a European cultural background had significantly more experience with prescribed medication than those who selected an Asian cultural background. The relationship between cultural background and beliefs about medicines in general was maintained after controlling for potential confounding variables, including chosen degree course, experience of taking prescribed medication, age, and gender. The identification of differences in beliefs about medication, between two specific cultural groups, suggests the need for a greater understanding of the effects of cultural background on medicine-usage with potential implications for the conduct of prescribing-related consultations and for the provision of patient information on medication.     

Critical elements of culturally competent communication in the medical encounter: A review and model

Increasing the cultural competence of physicians is one means of responding to demographic changes in the USA, as well as reducing health disparities. However, in spite of the development and implementation of cultural competence training programs, little is known about the ways cultural competence manifests itself in medical encounters. This paper will present a model of culturally competent communication that offers a framework of studying cultural competence ‘in action.’ First, we describe four critical elements of culturally competent communication in the medical encounter – communication repertoire, situational awareness, adaptability, and knowledge about core cultural issues. We present a model of culturally competent physician communication that integrates existing frameworks for cultural competence in patient care with models of effective patient-centered communication. The culturally competent communication model includes five communication skills that are depicted as elements of a set in which acquisition of more skills corresponds to increasing complexity and culturally competent communication. The culturally competent communication model utilizes each of the four critical elements to fully develop each skill and apply increasingly sophisticated, contextually appropriate communication behaviors to engage with culturally different patients in complex interactions. It is designed to foster maximum physician sensitivity to cultural variation in patients as the foundation of physician-communication competence in interacting with patients.     

Cultural competence: a proposal for physicians reaching out to Native Hawaiian patients

Many physicians of Native Hawaiian ancestry, as well as others, have noted a cultural gap between themselves and their Native Hawaiian patients. This cultural gap could potentially lead to discordance in the physician-patient relationship, and in turn, result in less than adequate therapeutic outcomes. Native Hawaiian physicians and those who treat Native Hawaiian patients are seeking ways to improve therapeutic relationships. Developing cultural competency in Native Hawaiian physicians and those who treat Native Hawaiian patients may be expected to improve therapeutic relationships. Principles of cultural competency, including increasing awareness of self and others, enhancing one's cultural knowledge base, and developing skills to communicate effectively, could be applied to physician-patient encounters with Native Hawaiian patients. The principles and skills of cultural competency could be learned during the formal and continuing medical education process. Developing an educational system that promotes cultural competency in physicians is necessary to address the health needs of Native Hawaiians and other diverse populations in Hawai'i.     

Cultural competence dimensions and outcomes: a systematic review of the literature

It has been widely suggested that cultural competence is an individual's core requirement for working effectively with culturally diverse people. However, there is no consensus regarding the definition or the components of this concept and there is a dearth of empirical proof indicating the benefits of cultural competence. Therefore, a systematic review was conducted to identify the most common cultural competence dimensions proposed in recent publications and to identify whether sufficient evidence exists regarding the efficacy of cultural competence in the healthcare context. A total of 1204 citations were identified through an electronic search of databases, of which 18 publications included cultural competence frameworks, and 13 studies contained empirical data on cultural competence outcomes. The overarching themes of the review were centred around the challenges faced by the healthcare sector in many countries due to growing cultural diversity, but lack of cultural competence, leading to predicaments that arise during intercultural interactions between patients and clinicians. This review will benefit researchers exploring cultural competence as one of the research variables impacting research outcomes.     

Cultural diversity in Australian medical education

The present study sought to explore the relevance of cultural dimensions and cultural diversity among overseas and local medical students. The main comparison among the fourth year medical students studied was between Asian origin and Anglophone background students. The measures used included cultural variation, reasons for studying medicine, learning approaches and strategies, patient interaction confidence, and medical practices anxieties. Results indicated cultural differences between the two groups, and relationships between cultural variables and, in particular, reasons for studying medicine, learning approaches and strategies, and patient interaction confidence. Results were interpreted according to Hofstede's(1980, 1986) theory of cultural dimensions as they may apply in the educational setting.     

Cross cultural communication to help physician assistants provide unbiased health care.

Teaching cross cultural communication typically involves instruction in differences between groups. As part of this course in cross cultural communication, six specific underserved population groups are introduced to students as a cultural experience. Additionally, instruction is provided to sensitize students to their personal biases and prejudices through videotaped mock interviews. The combination of instruction and experience forms a paradigm for teaching cross cultural communication in a way that has personal and immediate impact on faculty members and students. The model, "Differences + Discomforts = Discoveries," inhibits factionalizing and promotes depth of knowledge about underserved groups as well as personal awareness of prejudicial feelings. As a result, students learn techniques to provide unbiased health care to these, and other, populations.     

Reducing disparities through culturally competent health care: an analysis of the business case

Finding ways to deliver high-quality health care to an increasingly diverse population is a major challenge for the American health care system. The persistence of racial and ethnic disparities in health care access, quality, and outcomes has prompted considerable interest in increasing the cultural competence of health care, both as an end in its own right and as a potential means to reduce disparities. This article reviews the potential role of cultural competence in reducing racial and ethnic health disparities, the strength of health care organizations' current incentives to adopt cultural competence techniques, and the limitations inherent in these incentives that will need to be overcome if cultural competence techniques are to become widely adopted.     

Cultural health capital and the interactional dynamics of patient-centered care

As intuitive and inviting as it may appear, the concept of patient-centered care has been difficult to conceptualize, institutionalize and operationalize. Informed by Bourdieu's concepts of cultural capital and habitus, we employ the framework of cultural health capital to uncover the ways in which both patients' and providers' cultural resources, assets, and interactional styles influence their abilities to mutually achieve patient-centered care. Cultural health capital is defined as a specialized collection of cultural skills, attitudes, behaviors and interactional styles that are valued, leveraged, and exchanged by both patients and providers during clinical interactions. In this paper, we report the findings of a qualitative study conducted from 2010 to 2011 in the Western United States. We investigated the various elements of cultural health capital, how patients and providers used cultural health capital to engage with each other, and how this process shaped the patient-centeredness of interactions. We find that the accomplishment of patient-centered care is highly dependent upon habitus and the cultural health capital that both patients and providers bring to health care interactions. Not only are some cultural resources more highly valued than others, their differential mobilization can facilitate or impede engagement and communication between patients and their providers. The focus of cultural health capital on the ways fundamental social inequalities are manifest in clinical interactions enables providers, patients, and health care organizations to consider how such inequalities can confound patient-centered care.     

Cultural tailoring and feasibility assessment of a sexual health middle school curriculum: a pilot test in Puerto Rico

BACKGROUND: To assess the need for cultural tailoring of an effective sexual health middle school curriculum, “It's Your Game: Keep It Real” (IYG), prior to implementation in Puerto Rican (PR) middle schools. METHODS: Seventy‐three seventh‐grade bilingual students participated in IYG curriculum activities (both group‐based and computer‐based) in two 2‐hour testing sessions in spring 2008. Rating scales of acceptability, understandability, credibility, ease of use, and motivational appeal and qualitative feedback via open‐ended responses and group process provided insight into needed surface and deep structure cultural tailoring. RESULTS: Students rated IYG highly on cultural tailoring and motivational parameters and were highly engaged by the lesson content. School personnel rated IYG as a feasible strategy for use in PR middle schools. While surface cultural elements (eg, characters, attire, body language) were identified as important foci for adaptation, content related to deeper cultural elements such as core behaviors, risky situations, attitudes, and specific skills were considered as relevant to PR youth as to their US counterparts. CONCLUSION: Effective human immunodeficiency virus, sexually transmitted disease, and pregnancy skills training prevention programs such as IYG that are developed for minority US youth may offer a feasible option for international implementation when extensive cultural adaptation is not a viable option.     

The interpretation of "culture": diverging perspectives on medical provision in rural Montana

Seeking to address evident disparities in health care delivery to minority populations, researchers have developed a framework generally referred to as "cultural competency." This framework suggests that increasing providers' knowledge about culturally specific beliefs and behaviors will both assist providers in caring for particular, traditionally underserved groups and enhance the quality of health care delivery for all patients. Meanwhile, a number of critics have challenged the presuppositions of the "culture" concept underlying cultural competency, arguing that such well-intended efforts may merely exacerbate received stereotypes. Despite such criticism, the influence of cultural competency, along with the related categories of cultural sensitivity, cultural humility, cultural proficiency, and cultural awareness, continues to grow in medical schools, governmental agencies, and health care organizations, particularly in the United States. To better assess the varying theoretical and policy claims of proponents and opponents of the cultural competency framework, we undertook a modest qualitative, interview-based investigation. We explored how "culture" is being presented and enacted by Mexican agricultural workers and US health care providers in one rural Montana clinic. While the Mexican agricultural workers in the study emphasized structural dimensions of labor migration as the most relevant factors in shaping patient-provider interactions, the US health care providers tended to focus on the "cultural characteristics" peculiar to their patients. The discrepancy in these assessments serves to extend and complement existing criticism of cultural competency. While our study was limited to one locale with a limited number of participants, its findings highlight the paucity of empirical research in this area and suggest the need to examine the efficacy of cultural competency in settings outside conventional "needs assessment" or "outcome studies" models.     

Southeast Asian Refugees And School Health Personnel

This paper describes methodological and demographic limitations of attempts to generalize how traditional Southeast Asian cultural beliefs may affect attitudes of refugee children to the health services and style of education in American schools. It presents brief overviews of the diverse cultural influences upon Vietnam, Cambodia and Laos and then discusses some of the psychological consequents of cultural change observed with uprooted children. Finally, it describes the role of school health personnel as a cultural bridge carrying out three functions: (1) Direct Services; (2) Indirect Services; and (3) Research.     

Beyond geography: Cultural zones and global patterns of modern-method contraceptive use

Abstract

To increase understanding of global variation in contraceptive use, we classify countries into “cultural zones” based on religious traditions and geographical regions. Using data for 156 countries, we model modern contraceptive use rates as a function of cultural zones, geographic regions, economic development, women’s education, and time. We find that cultural zones explain modern-method contraceptive use better than geographic regions alone, even when adjusting for economic development, women’s education, and time. We argue that practitioners and researchers should make use of cultural zones as a tool for understanding cross-national variation in sexual and reproductive health outcomes.     

Cultural competence in healthcare in the community: A concept analysis

This study aims to conduct a concept analysis on cultural competence in community healthcare. Clarification of the concept of cultural competence is needed to enable clarity in the definition and operation, research and theory development to assist healthcare providers to better understand this evolving concept. Rodgers’ evolutionary concept analysis method was used to clarify the concept's context, surrogate terms, antecedents, attributes and consequences and to determine implications for further research. Articles from 2004 to 2015 were sought from Medline, PubMed, CINAHL and Scopus using the terms “cultural competency” AND “health,” “cultural competence” OR “cultural safety” OR “cultural knowledge” OR “cultural awareness” OR cultural sensitivity OR “cultural skill” AND “Health.” Articles with antecedents, attributes and consequences of cultural competence in community health were included. The 26 articles selected included nursing (n = 8), health (n = 8), psychology (n = 2), social work (n = 1), mental health (n = 3), medicine (n = 3) and occupational therapy (n = 1). Findings identify cultural openness, awareness, desire, knowledge and sensitivity and encounter as antecedents of cultural competence. Defining attributes are respecting and tailoring care aligned with clients’ values, needs, practices and expectations, providing equitable and ethical care, and understanding. Consequences of cultural competence are satisfaction with care, the perception of quality healthcare, better adherence to treatments, effective interaction and improved health outcomes. An interesting finding is that the antecedents and attributes of cultural competence appear to represent a superficial level of understanding, sometimes only manifested through the need for social desirability. What is reported as critical in sustaining competence is the carers’ capacity for a higher level of moral reasoning attainable through formal education in cultural and ethics knowledge. Our conceptual analysis incorporates moral reasoning in the definition of cultural competence. Further research to underpin moral reasoning with antecedents, attributes and consequences could enhance its clarity and promote a sustainable enactment of cultural competence.