Responses to illness are determined and regulated by cultural norms, which determine how people characterize health and illness, determine the origin of illness, and plan ways to protect and maintain health (Spector, 1996). To date, researchers' attempts to address culture and cultural appropriateness of health communications have not included the complexity required for substantial progress (Mullings and Schulz, 2006). Often the efforts have failed to address the dynamic structures of communities, the intersecting nature of the characteristics associated with culture, and how these interact with theories used in health promotion. This presentation will review current research, what is known, and suggest areas for future research. This analysis uses illustrations and data that explore the selection and categorization of cultural variables; how decisions to use tailored or targeted approaches affects the way cultural issues are addressed, how culture may inform the presentation of evidence, behavioral recommendations and appeals, as well as the selection of source, channels, and distribution venues.
There are three major tasks to be considered in the production of culturally appropriate health communication: selection of communication and intervention theories appropriate to the population, selection of cultural constructs to guide the intervention, selection of cultural appropriateness strategies, integration of cultural elements into the communication program (channel, source, message content). Stewart, Rakowski, and Pasick (2009) report on an initial effort to begin the important process of providing statistical evidence that demonstrates the need for theories that better integrate and reflect the role of culture and context to explain health behavior. Airhihenbuwa (1995) has developed the PEN3‐ model, which describes a process that addresses culture primarily through an educational diagnosis of health behaviors, via survey, interviews and community input. The data analysis allows categorization of beliefs and behaviors according to their utility in health promotion programs. However, neither the distribution of these beliefs and attitudes in the population, nor the relevance of the theories guiding the programs is typically examined. The integration of cultural elements into health promotion and communication programs has been addressed using five basic strategies: constituent involving, peripheral, linguistic, socio‐cultural, and evidential (Kreuter, Lukwago, Bucholtz, Clark, and Thompson Sanders, 2003). Peripheral approaches address colors, images, photographs and titles expected to appeal to a given group. Constituent involving strategies involve members of the community in intervention activities as advisory board members or intervention staff. Linguistic strategies make services, interventions and materials accessible by providing them in the native or dominant language of a group. Socio‐cultural approaches discuss and/or seek to change health behaviors and treat disease in the context of specific social and/or cultural characteristics of the group. Evidential approaches seek to understand what constitutes evidence to a specific group. Despite their practical value, these approaches do not address the relative merits of any particular strategy for intervention. Despite the limitations in theory and research noted, the work to date suggests strategies and changes that might assist cancer communication scholars in their efforts to communicate more effectively in culturally distinct communities. For example, ethnic minority media are trusted and valued by members of their communities (Pickle, Quinn and Brown, 2002) because their coverage is especially attentive to issues that affect ethnic communities, and provides perspectives missing from general media (Vercellotti, T. & Brewer, P, 2006). African American newspapers (Cohen, Caburnay, Luke, Cameron, and Kreuter, in press) have been tested and shown to be effective in broadening the reach of cancer messages. Hispanic radio, in conjunction with print media and a Cancer Preventorium, has been used to promote cancer prevention messages (Huerta, 2003) in Hispanic communities. Despite these successes, cancer communication specialists have some ways to go to fully understand the power of media for cancer prevention and screening. Health communications frequently compare the health status of one group to another. A study of racially comparative cancer information (Nicholson, 2008) indicated that participants exposed to disparity articles reported less intention to be screened for colorectal cancer than those in other groups. In contrast, progress articles elicited greater intention to be screened. Thus, the data suggest that we must be more systematic in our approach to presenting health and cancer evidence to African American and perhaps other ethnic minority communities.
Citation Information: Cancer Prev Res 2010;3(1 Suppl):CN08-03.