Communicating Health

A Culture-centered Approach

Mohan J. Dutta

• Publisher: Polity
• Year: 2015
• ISBN:
  9781509506057
• Edition: 1
• Topic: Medizin
• Subtopic: Gesundheitswesen, Verwaltung & Pflege

The culture-centred approach offered in this book argues that communication theorizing ought to locate culture at the centre of the communication process such that the theories are contextually embedded and co-constructed through dialogue with the cultural participants. The discussions in the book situate health communication within local contexts by looking at identities, meanings and experiences of health among community members, and locating them in the realm of the structures that constitute health. The culturecentred approach foregrounds the voices of cultural members in the co-constructions of health risks and in the articulation of health problems facing communities. Ultimately, the book provides theoretical and practical suggestions for developing a culture-centred understanding of health communication processes.

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Culture in Health Communication

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Chapter objectives

In this chapter, we will:

• examine the history of culture in health communication
• study the different models of health communication
• compare the different strands of culture-based health communication work

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How did culture emerge as a concept in health communication, and how does culture get used in health communication theories and applications? In our discussions in this chapter, after reviewing the major health communication theories, we will connect our discussion of these theories to the dominant and culture-centered approaches to health communication. As articulated in the introduction, closely aligned with the biomedical model, the dominant approach focuses on utilizing cultural variables to develop more effective health communication solutions (more on this in chapter 2); and the culture-centered approach is a critique of the dominant approach that focuses on the erasure of cultural voices in dominant discourses and seeks to engage with these voices as entry points for dialogue. Locating the current scholarship on culture-based health communication in the realm of its historical roots will offer the foundation for discussing the culture-centered approach to health communication in chapters 2 and 3. Throughout the present chapter, the discussion of the different approaches to health communication will draw upon the critical and cultural underpinnings of the culture-centered approach outlined in the Introduction.

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Box 1.1 The story of Suzanne

Suzanne has recently graduated with a PhD in Health Communication from a prestigious US university, and has received a tenure-track position as an assistant professor at a research university. Although she has never really traveled much to other parts of the world, she is very interested in issues of global health. The topic of global health has a great deal of funding potential and Suzanne thinks this would be a great opportunity for her to set up a program of research. She expresses this interest to her Department head and is assigned to teach a course on “Gender, Development, and Health." She has quite a few women who she thinks come from somewhere in the Middle East (she does not know where from exactly . . . both of these students are actually from Pakistan) and feels uncomfortable having them in class because they wear burquas. Being a feminist, she feels that women should not have to cover their heads, and especially not in the US. She is further aggravated by the Middle Eastern women after her Head of Department calls her to his office letting her know that there has been a complaint lodged against her for being culturally insensitive in her classroom by talking about the “primitive cultures” of the Muslim world when she addressed the topic of honor killings in her lecture day on “Gender and Health.” She is quite confident that those women are the ones who probably complained. This infuriates her as she feels that the climate of political correctness in the academy has gone too far - one can’t even address “primitive cultures” and call them for what they are. She further feels that one can’t even discuss the real health problems in the Third World. After all, she only wants to help these women and others like them, who are oppressed by their men. Based on your reading of culture in health communication, how would you interpret Suzanne’s attitude toward her Pakistani students? What do we learn about Suzanne from this encounter? What do we learn about the values of Suzanne and what are the similarities and differences between these values and the values of dominant health communication projects that use the concept of culture?

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Historical Overview

The role of culture in health communication started to receive increasing attention in the 1980s, with the acknowledgement of the shifting demographic patterns within the US, and with the emerging understanding that health communication efforts needed to respond systematically to the shifting cultural landscape in order to be effective; this created the climate for multicultural health communication efforts (Brislin and Yoshida 1994; Resnicow et al. 2002). The emphasis on multicultural populations within the US was set in the backdrop of the criticism of health promotion efforts in the global South that questioned the universalist assumptions of the health communication programs targeted at the global South and emphasized the necessity to incorporate an understanding of culture in international health communication efforts (Airhihenbuwa 1994, 1995; Airhihenbuwa and Obregon 2000). This criticism was keenly aware of the negative ramifications of the top-down approaches which did not take local cultures into account. Advocating an urgency to situate culture and context at the core of public health communication practices, Airhihenbuwa noted (1995: x):

It has become common practice in the field of public health and in the social and behavioral sciences to pay lip service to the importance of culture in the study and understanding of health behaviors, but culture has yet to be inscribed at the root of health promotion and disease prevention programs, at least in the manner that legitimates its centrality in public health praxis.

In the decade following this observation, health communication theorizing and practice has taken a turn towards incorporating culture in health communication (see Dutta-Bergman 2004a, 2004b, 2005a, 2005b; Dutta 2007; Dutta and Basu 2007; Ford and Yep 2003; Harris et al. 2001). Scholars have increasingly vouched for a need to develop communication frameworks grounded in the culture and context of those who are at the heart of health promotion efforts (Airhihenbuwa and Obregon 2000; Airhihenbuwa, Makinwa and Obregon 2000; Dutta-Berg man 2004a; Dutta and Basu 2007). Airhihenbuwa (1995) writes that health is a cultural construct and health theory and practice must be rooted in cultural codes and meanings, inherently tied to values. These values make up the transient framework of a person’s everyday living. Embedded in and influenced by these values are notions of community rules, traditions, health beliefs, socio-economic ability, societal power structures, education, religion, spirituality, gender roles and exposure. Helman (1986: 71) adds that in every human society beliefs and practices related to health are a central feature of culture: “both the presentation of illness, and others’ response to it, are largely determined by socio-cultural factors.”

This growing awareness of the cultural differences globally is based on the understanding that there are many different ways of perceiving and interpreting health across different cultural groups, and, in order to become effective, health communicators needed to become aware of these cultural differences (Hammerschlag 1988). Cultural differences were conceptualized as barriers to effective health communication efforts, and the goal of the health communicator was to develop communication programs that would address these barriers and overcome them. Health communicators now faced the challenge of identifying the barriers to effective communication and of incorporating them into successful messages that would target these barriers.

In responding to the concept of culture, the literature in health communication suggests some important constructs that have been developed for the purposes of assisting the health communicator (Huff and Kline 1999a; Resnicow et al. 2002). These constructs include acculturation and assimilation; ethnocentrism; and cultural competence. Each of these concepts was brought into health communication for the purposes of guiding the health communication scholar and his/her work, and suggested methods for modifying the existing concepts of health communication so as to take culture into account. Furthermore, responding to the call issues by Airhihenbuwa (1995), the PEN-3 model and the culture-centered approach emerged as two key approaches that attempt to place culture at the center of theorizing and application development rather than as an afterthought.

Acculturation and assimilation

The literature on acculturation explores the ways in which multicultural populations adjust to the cultural values and mores of a dominant culture (Resnicow et al. 2002). Acculturation reflects the degree to which an individual migrating into another culture gives up the traits of the home culture and adopts the traits of the dominant culture (Locke 1992). According to Locke, immigrants typically may be categorized into one out of four groups, on the basis of their levels of acculturation into the dominant culture. The “bicultural” individual functions equally well both in his/her home culture and in the dominant culture; the “traditional” individual is defined as someone who holds on to most of the traits of his culture of origin; the “marginal” individual seems to have lost contact with traits from either culture; and the “acculturated” individual seems to have given up most of the traits of his culture of origin and has adopted the traits of the dominant culture. Locke points out the importance of addressing the level of acculturation of the target audience in order to develop meaningful health promotion messages.

Like acculturation, assimilation relates to the degree to which the members of a multicultural population merge and mingle with the dominant culture. The idea of assimilation taps into the notion that cultural assimilation is critical to important health outcomes. The dominant culture is taken for granted as the normative ideal, and immigrant communities are evaluated on the basis of their adherence to the broader cultural standards; the more assimilated the community is, the better equipped it is to succeed in the dominant culture. Much of the health-promotion work that emerges out of this line of thought seeks to teach skills to multicultural communities with the goal of assimilating them into the broader community.

Ethnocentrism

Ethnocentrism reflects the social, cultural and individual trait of remaining closed to other cultures, which are considered outside cultures (Ferguson 1991). In other words, ethnocentrism refers to cultural insularity. In this sense, the goal of health communication programs is to counter the ethnocentrism of healthcare professionals, so that they can provide better and more effective healthcare services to their multicultural clients and stakeholders.

Cultural competence

The idea of cultural competence captures the degree of adeptness displayed by healthcare professionals in handling the cultural mores and rituals of other cultures they interact with daily (Campinha-Bacote 1994). A highly culturally competent healthcare professional is well equipped to pick up the nuances of other cultures and to respond to them. The goal of health communication efforts dealing with the notion of cultural competence is to train healthcare professionals and to evaluate them in terms of their competence.

What we see in the emerging efforts toward incorporating culture into health communication scholarship is an increasing awareness of the

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Box 1.2 The story of Ibasa

Ibasa migrated with his mother Jameela in 1998 to Minneapolis, after his family was left homeless during the civil war in Somalia. Since moving to the US, Ibasa and his mother have enrolled in vocational training classes and joined a local church directed at acculturating Somalis. Ibasa has also received invitations to multiple health trainings and health workshops at the local community health center. However, Ibasa has been skeptical about joining these training programs, because he has heard from his Somali friends how these workshops talk about the importance of family planning and keep pushing the idea of contraceptive choice.

He feels uncomfortable with this, as contraception does not fit well with his values and beliefs. One of his friends at work, Sam, told him the other day that he should forget about his old values; “the quicker he is able to forget them, the better he will be.” Sam had said, “Ibasa, become an American. Forget the old dreams. . .they are standing in your way. This is a new land of opportunities.” However, Ibasa still struggles.

What does Ibasa’s story teach us about the experiences of acculturation? What are the possible advantages of acculturation? What are the possible drawbacks of acculturation?

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cultural differences that constitute health experiences. An awareness of these cultural differences improves the existing approaches to health communication by incorporating the concept of culture; the goal is to adjust the health messages to the cultural beliefs, mores, and rituals. Knowledge of the cultural differences allows the health communicator to develop further messages and communication strategies that are sensitized to these differences. Furthermore, notions such as acculturation, assimilation, and cultural competence conceptualize culture as a static entity, which may be extracted to articulate differences. By contrast, the concept of culture driving the PEN-3 and culture-centered approaches is dynamic and context-based (to be discussed later).

Discussion point 1.1

• What is health communication to you?
• How would you define culture?
• Now examine your own values and beliefs about culture. Where did you learn your concept of culture? What does your concept of culture tell you about yourself and the world you live in?

Models of Health Communication

The models discussed in this section have been instrumental in guiding health communication interventions. Whereas some of these models have explicitly debated, and engaged with, the concept of culture, other models have implicitly assumed the role of culture in health communication.

Theory of reasoned action (TRA)

Having been applied in the realm of multiple health campaigns, TRA explains volitional human behavior, proposing that one’s intention to perform or not to perform a behavior is a result of that person’s attitude toward the specific behavior and of her perception of the evaluation of the behavior by important others (Ajzen and Fishbein 1980; Fishbein and Ajzen 1975). The attitude of the individual results, in turn, from her salient beliefs about the outcomes of the behavior in question. Two critical components define the participant’s state of belief toward the behavior: her belief strengths and her belief evaluations. Similarly, the individual’s motivation to comply with salient others in her social network, accompanied by the normative beliefs regarding the target behavior ascribed to these salient others, produce her subjective norms. Central to the conceptualization of ...