The cultural Framework for health

An integrative approach for research and program design and evaluation (EXECUTIVE SUMMARY)

By: Multiple Authors (see the references) 

Culture informs all human behavior; it allows us to exist as social animals. Yet no other variable used in health research is as poorly defined or tested as is culture (Dressler, Oths, & Gravlee, 2005; Hruschka, 2009). There has been surprisingly little attention to identify how culture works or to develop standards to guide the integration or application of culture in health research.

This report provides the first multidisciplinary, consensus effort to define culture and identify the necessary scientific elements and methods required to identify what culture is and how it functions to influence health differentially among diverse population groups along the entire disease continuum from prevention and incidence to morbidity and mortality from most diseases.

The Cultural Framework for Health (CFH) presented in this report:

1.    Provides a tool for researchers and program evaluators to use in project design.

2.    Identifies why culture is fundamental for understanding human behavior and the impact of cultural ways of life on mental and physical health and well-being.

3.    Identifies the major scientific challenges with the current use of the concept of culture for health behavior research (see below),

4.    Presents the methods and tools to discover the salient cultural processes involved with health behaviors, and how the processes and behaviors influence health and well-being. The framework also suggests techniques to develop measures for these processes. We augment these guidelines with case studies that demonstrate the integration of this framework into health programs and services for specific sub-populations,

·         across the disease spectrum, including genetic, infectious, and chronic diseases, and

·         from prevention to end-of-life care; and,

5.    Provides a processual framework that guides researchers through six steps that more effectively distinguish cultural processes relevant in any given study context, and how they likely influence health outcomes. The cultural influences identified can be tested to differentiate universally-human from culturally-specific practices that ultimately can be used to improve health outcomes for all populations. These techniques are applicable across the health, wellness, and disease spectra.

Application of this framework across the research continuum and across multiple disciplines likely will increase the explanatory power of research and the positive impact of interventions by ensuring that research plans are reliable and valid scientifically and to target populations. The ultimate goal is to develop interventions that improve the well-being of all populations we work with locally and globally. Application of the CFH will increase the likelihood for future research findings that provide more comprehensive reasons why health outcomes differ across population groups.

Scientific Challenges Posed by the Current Use of Culture in Research

Conceptualization

1. The concept of culture is inadequately conceptualized and inconsistently applied.
2. Few studies demonstrate how culture affects health outcomes with clear definitions, measurable constructs, and conceptual models that indicate the interactions of the cultural processes.
3. Problems of diverse cultural groups are identified, but devoid of their historical, geographic, social, and political contexts, and the influence of such contextual factors on their positions in the societal power hierarchy.
4. The dynamic nature of culture is not reflected in most studies.
5. The role of culture in shaping the nature and conduct of health research in the U.S. is lacking.
6. The assumed universality of the dominant culture’s constructions of reality and salient domains, such as self-hood, family, fairness, and well-being, is problematic.

Operationalization

       7.The current practice of using nominal, dichotomous variables of race and/or ethnicity and/or ancestry to represent culture, is overly simplistic and inadequate.

   8.The heterogeneity within the group of focus should be explicit and demonstrated in the description of the study sample. 

    9.The biomedical and behavioral sciences have focused primarily on the individual without accounting for the influence of the social, historical, political and environmental context of the group(s) to which s/he belongs.

Health Disparities

         10. The challenges listed in #1-9 contribute to the inability to effectively reduce health disparities.

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.

Read Also:

 What we know about culture and health?
Defining Mental Illness
Taijin Kyoufu and Avoidant Personality Disorder
Culture and Personality  
Stereotyping
Substance Abuse And Youth
Stress/Stressors And Acculturation
Positive Psychology
Somatization Disorder
Completing the Diagnostic Assessment
Diversity and the Interviewing Process
Creating Cultural Competence in Practitioners
Culture, Ethnicity, and Race