Cultural Sensitivity
• Ethnic or cultural characteristics, experiences, norms, values, behavior patterns, beliefs of a target population
• Relevant historical, environmental, & social factors
• Design, delivery, & evaluation of targeted health interventionsResnicow et al., 2002
Cultural Competence
• Capacity of individuals to exercise interpersonal cultural sensitivity
Resnicow et al., 2002
Cultural Humility
• Lifelong commitment to self evaluation & self critique to redress power imbalances
Minkler, 2005, p. 10
Surface Structure
• Observable social & behavioral characteristics of a target population
Resnicow et al., 2002
Deep Structure
• How cultural, social, psychological, environmental, & historical factors influence health behaviors differently across racial & ethnic populations
Resnicow et al., 2002
Examples in the African American Community
• Surface structure:• Dialect• Female head of household• Church
• Deep structure:• Slavery• Tuskegee (Syphilis) Experiment• HIV/AIDS and the US government
Why Cultural Sensitivity?
• Ethical/moral argument
• Economic argument
• Pragmatic argument (health communication perspective)
Why Target & Tailor Interventions?
• Disease prevalence
• Risk factor prevalence
• Socio-economic distribution
• Physiological differences
• Environmental differences
• Behavioral differences
• Socio-cultural differences
INEQUALITY EXISTS
Definitions of “Health Disparities”• Whitehead/WHO (1992) Differences in health that are “not only unnecessary and
avoidable but, in addition, are considered unfair and unjust.”
• NIH (2005) “…differences in the incidence, prevalence, mortality and
burden of disease and other adverse conditions that exist among specific populations groups in the US.”
• NCI (2005) “…occur when members of certain population groups do
not enjoy the same health status as other groups. Disparities are often identified along racial and ethnic lines-show, [but] also extend beyond race and ethnicity.”
Health Disparities/Inequalities
• Population-specific differences in the presence of disease, health outcomes, or access to health care
• Gaps in the quality of health & health care across populations
Ethnic Variation in Heart Disease MortalityAg
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National Center for Health Statistics, 2004
Ethnic Variation in Cancer MortalityAg
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SEER Cancer Statistics Review, 1975-2002
Prevalence of Overweight* in Texas Children by Race/Ethnicity, School Physical Activity & Nutrition (SPAN) Study
*Overweight is > 95th Percentile for BMI by Age/SexHoelscher et al., 2004
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HP 2010Goal
WHAT CAN WE DO?
Community-Based Participatory Research (CBPR)
• “… a partnership approach to research that equitably involves, for example, community members, organizational representatives, and researchers in all aspects of the research process”
Israel et al., 2003
Translation
• All vested parties work jointly to achieve a common goal by contributing different• Instruments
• Talents
• Knowledge
• Expertise
Key Principles• Builds on strengths & resources within
the community
• Addresses health from an ecological perspective
• Collaborative partnerships in all phases of researchIsrael et al., 1998
Key Principles• Integrates knowledge & action for mutual benefit
of all partners
• Promotes co-learning & empowering process that attends to social inequalities
• Findings & knowledge disseminated to all partners
• Cyclical & iterative process
Israel et al., 1998
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