Culture, Health, & Social Change

We have talked a lot about culture and health. In this sense, I was rethinking some critical questions. How is culture related with health? Why is culture so important in health care and health communication? How do researchers and health care practitioners locate culture in their research and work? What do they need to do to improve health outcomes, as well as achieve individual behavior change and social change? We have discussed most of them, however, as to the social change issue, it probably is hard to develop a certain answer. The role of culture in social change is always being re-evaluated, and dynamics over time and across regions. Culture is such a shared belief system, I think, that acts as a mirror upon which we might gaze in order to better understand our history, our present, and predict the potential future. It is because the way in which we think, believe, and behave, is strongly supported by different cultural values. This is not only about understanding why individuals perform the actions in terms of the contexts in which they act, as well as exploring the links of cause and influence on social, economic and political practices, but also concerns the expectations and hopes that individuals embrace.

When it comes to the health of a population, social problems largely depend on individual solutions through application of series of knowledge to inform people. I was impressed by the diffusion-of-innovation theory mentioned in Collins & Zoch’ paper (2001). One of the properties of innovation is compatibility. It assumes that if an innovation is perceived to be more consistent with individual’s values, and needs, the individual would be more likely to adopt the innovation. To approach target audiences in different cultures, thus, the diffusion of innovation is required to consider different decision making processes. For example, in Chinese culture, and other Eastern cultures, young adults or adolescents largely reply on information and suggestions from family members or older parents, whereas in western cultures, young people are more independent. In this case, it is not only the decision makers should be viewed as a target in the health campaign, but also how strong their opinions works should be identified in different issues.

The articles of Bollen et al., (2001), and Millen et al., (2000), who are talking about SES, class and political impact of transnational corporations, lead me to think about the strong link between inequalities caused by social, economic, and political forces and health. We strive to make change on the society and policy because the inequalities exist. So who are suffering? The poor who are vulnerable in economy, the women who have less power in the society, the young children who are ignored in the communities, the minority groups who are in silence in the dominant culture. The interaction between the indicators of health and how they are processed are influenced by the health care system and context where the interactions happen. Individuals (are forced to) make “rational” choices based on the social relations of which they are a small part.

Thus, what to do with the inequalities? How to make a social change in health care? Understanding, I think, is always the first step. Understand the problems, how the issues have taken place; understand the social, economic, and political context where the problems emerge; understand who are struggling in the pain, how people perceive their experience, what do they believe. And then, enlightened by the cultural sensitivity approach and culture-centered approach (Dutta, 2007), both approaches put culture on a vital position in health applications, I think is to effectively respond to the norms of the culture, infusing the culturally sensitive voices into dominant health system, and designing appropriate interventions towards target group. Otherwise, the strategies which are blind to cultural values are just like air, no sense to people. There is never an end. The society is changing, health status is changing, as well as culture. The road we are walking on is infinite, although numerous directions are ahead. That’s why the colorful future is so fantastic.

Culture and Prevention II

Entertainment-education programs are widely utilized to deliver educational knowledge about peer group norms, protective health behaviors, and ways of disease prevention in entertaining form. I was thinking what is the advantage of entertainment-education compared with pure education? Entertainment is an approach to engage the attention, interest, and curiosity of target audience. More importantly, the ultimate goal is to seek change of knowledge, attitudes, and behaviors to an issue. The social and cultural norms also might be influenced (Nariman, 1993). In the case of health, entertainment-education strategy is aimed to promote lifestyle change or prevent disease. For example, to address sensitive youth issues, combination of education and entertainment has been found to effectively influence young people about HIV/AIDS.

In this sense, I was wondering whether the format of entertainment would overweigh the purpose of education. Is knowledge of causes, consequences, and intervention of prevention of HIV infection sufficient to motivate behavior change such as promoting condom use? The concept of culture plays a vital role in understanding human behavior, which should be incorporated in disease prevention intervention. It makes meanings to the population in communities to their health status. Thus, it seems that knowledge transmitting may not enough to stimulate behavior change. It also needs to be cultivated through audience involvement, peer rapport, supportive social norms, and cultural beliefs. Individuals therefore are likely to talk about media knowledge within the social network. That might be the ways in which entertainment-education intervention build positive relationship between self-efficacy about control of self sexual behavior, mass and interpersonal communication about condom use, utilizing various media (Sood, 2002).

Besides entertainment-education strategy, cultural values, especially cultural gender norms regarding sexual behavior contribute to effectiveness of HIV prevention intervention. Condom use or request, the effective way to prevent HIV infection, is associated with many cultural and behavioral factors. Women are more likely to face difficulty in negotiating safer sex behavior with men due to the perceived power imbalance in sexual decision making. I was impressed by the assumption of McQuiston (2000), which argued that “the timing for condom use was never right”. For the men, communication is based on trust, while trust is built on communication for the women. Not only power imbalance exists between genders, but also male and female always behave differently because of distinct perceptions towards sexual behaviors. Requesting a partner to use a condom require the woman to obtain a dominant role in sexual practice – very hard in many cultures. For men in most cultures, condom use might mean distrust and bring sense of distaste. It can be extremely difficult to negotiate safer sex within complex situations. For steady partners, how can a woman gain power and improve condom use? Can the timing for condom use be right and match between men and women? One more question, what if the man has a spiritual belief that “God tells me do not use condom/control birth”? How do we, as researchers, persuade them to change the way to do it?

Culture and Prevention I

     Cultural perceptions and health beliefs would greatly affect health promotion and disease prevention. Every ethnic group faces particular health challenges due to genetics, cultural practices, and epidemiologic difference. Thus it is important to understand the role and influences of culture and tradition on health. For example, Chinese culture emphasizes harmony, self-control, interdependency, and yin-yang balance. The cultural norms are achieved by social relationship, balancing the state of mind and body, and health-seeking behaviors. Therefore, coherence between the cultural values and the disease prevention strategies can accomplish acceptance of health information.

     As Donohew (1998) argued that adolescents who are high sensation seekers – the ones who seek for novel, exited, and complex experiences and sensations – would be difficult to reach through conventional and rational approaches, I was thinking about some questions: why some people pursue novelty? How to reach high sensation seeker? People are attracted by novelty sensation may be due to the needs for detecting risk and design strategies for survival. But the sensation seeking behavior also potentially puts people in the risk. Reaching high sensation seeker and avoid risky behavior, such as drug use among adolescents, is very difficult. At least, I was thinking, is to reduce the number of individuals who use drug for the first time, and to intervene with those who are using. The two target groups should be quite different in designing prevention. For example, training peer group resistance may be effective in nonusers groups, but it may not in users. Various factors should be identified, such as family environment, physical abuse, and poor performance in school. We need to find ways to attract attention of target audiences and persuade them to engage in positive behaviors. For example, high sensation seekers may be more likely attracted to messages that are creative, complex, fast-paced, and emotionally powerful.

     The term of self construal reminded me of the difference of Western and Eastern conceptualization of the self. In Western culture, specifically, people seem to construe the self independently as separate from social context, emphasizing autonomy, whereas Eastern culture construes the self as an interdependent part of social context. I recall the example of Confucianism. Confucianism might be the most influential philosophy in traditional Chinese culture due to its systemic and detailed norms in social, interpersonal, and familiar relationships. Confucianists focus on collectivism, in contrast to individualism in the West. Collectivist values affect Chinese people’s health beliefs and behaviors. So how does self-construal affect the strength of attitudinal and normative component of the TRA (Park, & Levine, 1999)? Self-construal seems to vary across individuals and contexts. It also influences cognitive performance, social interaction, and other facets of behavior. When people observe social icons, and family norms, they might change preferences, which alternatives are adequate on the attributes. For example, Chinese people believe in the group identity, interdependency, thus their health behavior is largely affected by social context and family members. It is correspondent with what Parrott (1998) assumed in the behavior adaptation model, that an individual tends to behave in a certain way when significant others expect one to adapt his/her behavior to reduce risk resulted from a particular action. In decision-making process, elderly parents usually leave important family decision to adults children, especially son.  

     In addition, behavior adaptation emphasizes building habitual practices with the adoption of particular prevention to reduce the harm in relation to the risky behavior. I was reminded of the situation of Chinese American. Acculturation levels of Chinese American into the Western lifestyle were linked to access to and utilization of health services. However, the processes Chinese Americans underlying adaptation to residency in the US are complicate. For example, Chinese immigrants may follow some recommended health treatments, but may not comprehend why many Western diagnostic tests are necessary. Many Chinese immigrants integrate traditional Chinese medicine and conventional Western medicine as “alternative medicine” to heal illness. But as to disease prevention, they usually believe diseases are preventable or controllable through maintaining balanced state and proper eating habits.