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