Evolving effort to include a more comprehensive use of culture

The cultural framework for health (Project design)

By: Multiple Authors (see the references) 

The ultimate goal of health behavior science is to translate this knowledge into effective interventions that will improve the well-being of all populations, locally and globally.

In this century, the Institute of Medicine (2002) established guidelines to promote the development and use of health-related communication practices that are tailored for treating different patient groups.

The Journal of the American Medical Association’s editor operationalized parameters for authors on the use of race in submitted manuscripts (Winker, 2004) and the Uniform Guidelines for Science Journals recommended the development of guidelines for the use of race for health research (International Committee, 2010).

Henrich, Heine and Nazaryan (2010) posited that many concepts of human behavior assumed to be universal are quite ethno-centricly Western, are quite false among other cultures. Salway and colleagues (2011 a&b) published guidelines for the use of ethnicity in health research and for cross-cultural collaborations on migration that require, in particular, that researchers recognize the lack of universality of the validity of many concepts and measures.

More recently the Leeds Consensus Panel on Ethnicity in Health issued 10 recommendations for the use of ethnicity in health studies (Mir et al., 2012), and Lewis-Fernandez and colleagues (2013) published a checklist to assess the comprehensiveness and applicability of race, ethnicity, and cultural factor reporting in psychiatric research publications.

In the context of these multiple efforts, the lack of attention to culture takes on heightened significance for the science of health behavior. We posit that clearer articulations of definitions and valid and relevant measures of culture can,

·   Increase the ability for health behavior research to provide more precise explanations for disparate health outcomes among different target populations,

·    Expand current theories and programs to account for culture in more valid and reliable ways that not only increase relevance to target populations, but also inform and refine extant theory and produce more efficacious results,

·    Promote the development of constructs that more accurately delineate culture as a concept and construct that informs the health and wellbeing of all groups, and,

·    Translate this knowledge into effective and sustainable health outcomes.

Project design

To build on these previous efforts, 30 researchers, each of whom have substantial experience studying culture and health, and long histories of NIH funding, were invited to join the Expert Panel (EP) for this 18-month, NIH/OBSSR1-funded project. The panelists represented seven main disciplines: anthropology (11), medicine (6), nursing (2), psychology (3), psychiatry (1), public health (4), and sociology (6).

Most panelists had appointments in departments other than the disciplines in which they

trained, thus providing even broader perspectives than their disciplinary backgrounds alone.
In Phase 2, we conducted two sets of webinars. The first set focused on a review and critique of this report’s Introduction and Defining Culture sections. The second set reviewed the Implementation and Application section drafts. Numerous drafts and feedback were circulated in a Delphi fashion. Between Phase 1 and 2, notes and preliminary drafts were circulated to obtain EP input.

EP members collectively had extensive expertise in qualitative, quantitative, and mixed methods and in conducting health research in a wide range of cross-cultural, linguistic and national contexts. The EP members also conduct health research at different stages of the research continuum, from formative, basic intervention, clinical trials, and evaluation, to translational studies.

Members were balanced in terms of gender; approximately one-third belonged to communities of color, and conduct research with diverse populations. Seven external reviewers2 with expertise in cross-cultural health research and practice provided their evaluation of the final draft prior to the finalization of the report.

We used a modified Delphi Process throughout the project. In Phase 1, we convened a 1½-day workshop with breakout groups and plenary sessions. Prior to the workshop, the EP members were asked to submit published articles they believed to be exemplary of the project’s goals and objectives.

In addition, we asked each member to write a two-page “reflection paper” on the most essential information needed to meet the report objectives. All the articles and papers were shared among the EP and formed the basis of the literature review that was conducted.

The workshop consisted of three workgroups that focused on:

·     the importance to delineate culture for health research;

·     to identify appropriate methodological approaches to operationalize culture; and,

·    mechanisms to translate the concept of culture into research and practice, as well as plenary discussions of workgroup reports.

Phase 3 consisted of additional webinars to evaluate the first draft of the full integrated report. All meetings and webinars were audiotaped and transcribed for subsequent analysis and feedback integration.

The final report included sign-off of each panel member, indicating their concurrence with the finalized document. The NIH project director then revisited the document twice: First as a standard manuscript editor, second to add additional resources and content to ensure that this report relates not simply to anthropology but also just as easily to other socio-behavioral disciplines through additional content and implementation of Federal clear communication guidelines.

1 OBSSR: National Institutes of Health Office of Behavioral and Social Science Research

2 Arleen Brown, MD, UCLA, Carole Browner, PhD, MPH, UCLA, Chandak Ghosh, MD, MPH,

U.S. DHHS, Joseph P. Gone, PhD, UNM, Carla Herman, MD. MPH, UNM, JaWanna Henry, MPH, UMB, Carol R. Horowitz, MD, MPH, Mount Sinai School of Medicine

References:

Marjorie Kagawa-Singer, William W. Dressler, Sheba M. George, William N. Elwood, with the assistance of a specially appointed expert panel, 2014, national institute of health NIH.

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Culture, Ethnicity, and Race