Health Promotion in Multicultural Populations

A Handbook for Practitioners and Students

Robert M. Huff, Michael V. Kline, Darleen V. Peterson

• Publisher: SAGE Publications, Inc
• Year: 2014
• ISBN:
  9781483322018
• Edition: 3
• Topic: Médecine
• Subtopic: Santé publique, administration et soins

Edited by Robert M. Huff, Michael V. Kline, and Darleen V. Peterson, the Third Edition of Health Promotion in Multicultural Populations offers both students and practitioners an indispensable resource on assessment and implementation guidelines for promoting health and enhancing behaviors that optimize health in any cultural community. Leading experts explore a wide range of topics, including the context of culture, cross-cultural perceptions of health, conceptual approaches to multicultural health promotion, health disparities, and the contributions of multicultural populations. Using the Cultural Assessment Framework (CAF), this proven handbook includes a focus on six specific populations (Hispanic/Latino, African American, American Indian and Alaska Native, Asian American, Pacific Islanders, and Arab Americans).The text concludes with a set of tips for working cross-culturally and a discussion about where the field is heading with respect to research and practice in the 21st century.

Part I Foundations

1 Culture, Health Promotion, and Cultural Competence 3

2 Cross-Cultural Concepts of Health and Disease 24

3 The Ethics of Health Promotion Intervention in Culturally Diverse Populations 43

4 Models, Theories, and Principles of Health Promotion and Their Use With Multicultural Populations 64

5 Health Disparities in Multicultural Populations: An Overview 101

6 The Cultural Assessment Framework 127

7 Planning Health Promotion and Disease Prevention Programs in Multicultural Populations 150

8 Cross-Cultural Communication and Health Literacy in Multicultural Populations 181

1 Culture, Health Promotion, and Cultural Competence

Robert M. Huff

Michael V. Kline

Darleen V. Peterson

Chapter Objectives

On completion of this chapter, the health promotion student and practitioner will be able to

• Define and discuss the concepts of health education, health promotion, and disease prevention as these relate to working with multicultural population groups
• Define and discuss at least five common terms associated with working with diverse population groups, including the terms culture, ethnicity, acculturation and assimilation, ethnocentrism, and cultural competence
• Identify and discuss at least five potential barriers to multicultural health promotion and disease prevention activities designed for diverse cultural groups

Activities for promoting health and preventing disease in any population, whether directed at individuals, groups, or communities, are a formidable task. Such endeavors require an organized effort characterized by an understanding that culture and cultural forces, among other social forces, are powerful determinants of health-related behaviors. Culture, in any group or subpopulation, can exist as a total or partial system of interrelationships of human behavior guided and influenced by the organization and the products of that behavior. Indeed, the beliefs, ideologies, knowledge, institutions, religion, and governance, as well as nearly all activities (including efforts to achieve health-related behavior change), are affected by the forces of culture.

Culture is a dynamic, fluid, ever-changing, and complex force in the lives of individuals, groups, and communities. And it is this complexity that has made it difficult to formulate a universally accepted definition of culture. Kreuter, Lukwago, Bucholtz, Clark, and Sanders-Thompson (2003) note that no single definition of culture is universally accepted. But there is “general agreement that culture is learned, shared, and transmitted from one generation to the next, and it can be seen in a group's values, norms, practices, systems of meaning, ways of life, and other social regularities” (p. 133). The definition of culture will be dealt with in greater depth later in the chapter. It is also important, where possible, to be aware that ethnic and cultural factors may be connected with a target group's vulnerability to certain communicable and chronic diseases and other health-related problems. Such knowledge can provide the planner with many clues during the assessment process. Students and practitioners should be aware that many of a target group's health risk factors are amenable to behavior change, thus reducing risk. Efforts to promote health and prevent disease within culturally different ethnic subgroups, as in any target group, will entail influencing the health behavior of individuals, families, groups, or communities. This will require identifying and changing those factors that are associated with accomplishing the desired health-related behavior. Also, these efforts probably will require some type of sustained collaboration between the public, private, and voluntary sectors and the people most directly affected by a defined health concern or problem. Cultural considerations ultimately may determine whether a particular population or target group will choose to participate in health promotion and disease prevention (HPDP) programs. There will be the need for a continuing communication between these stakeholders that establishes and maintains working relationships characterized by mutual understanding, trust, and respect (see Hodge, Hodge, & Palacios, Chapter 16, this volume, for a discussion reflecting this process).

There are many settings in the community where activities are conducted for promoting health and preventing disease in a population. These include a myriad of work sites, schools, health care program sites, and the community itself. Comprehensive health promotion activities at a work site consisting of a large, culturally diverse employee population may, for example, carry out employee-risk assessments (including screenings and appraisals) as well as establish and maintain an appropriate variety of educational programs, services, and activities to reduce or eliminate identified areas of health risk. In this setting, a work site must carry out culturally sensitive and effective interventions that meet the needs of their employees. This sensitivity must be carried over in the group as well as in one-to-one counseling or educational encounters. Awareness and sensitivity to cultural diversity, then, must be reflected in the planning, design, implementation, and evaluation phases of such a complex undertaking.

This chapter will distinguish between the concepts of health promotion and health education and briefly examine the implications and impact of culture at these two overlapping levels. We will also provide an overview of culture, particularly as cultural differences affect HPDP efforts, and discuss current paradigms that have been proposed to improve practitioner skills in working in multicultural health care settings. Finally, we will describe potential barriers to effective multicultural HPDP efforts.

Health Promotion and Disease Prevention

The terms health promotion and disease prevention, when used in this text, encompass a similar range of interests and concerns as expressed long ago in the Joint Committee on Health Education Terminology (1991) report. The committee defined HPDP as “the aggregate of all purposeful activities designed to improve personal and public health through a combination of strategies, including the competent implementation of behavior change strategies, health education, health protection measures, risk factor detection, health enhancement, and health maintenance” (p. 102). Central to this conceptualization, it should be noted, is the need to achieve different levels of outcomes (e.g., individual, family, group, organization, community) through a combination of health promotion and health education strategies and intervention activities.

Another ageless definition of health promotion is “any planned combination of educational, political, regulatory, and organizational supports for actions and conditions of living conducive to the health of individuals, groups, or communities” (Green & Kreuter, 1991, p. 432). Explicit in this definition is the need for interventions that respond to a broad level of community concern relating to stimulating, establishing, and sustaining an appropriate combination of educational, organizational, and political support needed to facilitate actions aimed at achieving desired community health outcomes. These definitions of health promotion provided above serve the purpose of this text well because they are valid in today's context; they are succinct, readily understandable, multidimensional; and they focus on the reality and need for several different levels of specific and needed program activities and outcomes (e.g., individual, family, group, organization, community) in HPDP program planning.

Health education has been defined as “any planned combination of learning experiences designed to predispose, enable, and reinforce voluntary...