- 1 NCCC: Curricula Enhancement Module Series
- 2 How Culture Influences Health
- 3 What is culture?
- 4 Case examples
- 5 Culture: The hidden and the obvious
- 6 The cultural continuum
- 7 Impact of culture on health
- 8 What health professionals can do
- 9 Providing health care to different cultural groups
- 10 Resources
- 11 References
- 12 Culture and the Self: A New Global Perspective
NCCC: Curricula Enhancement Module Series
|Key Content Areas I.What Is Culture? First, whatisculture, anyway, and how do we humans acquire our cultures? A good working definition is the following:Culture is the learned and shared knowledge that specific groups use to generate their behavior and interpret their experience of the world.It comprises beliefs about reality, how people should interact with each other, what they “know” about the world, and how they should respond to the social and material environments in which they find themselves. It is reflected in their religions, morals, customs, technologies, and survival strategies. It affects how they work, parent, love, marry, and understand health, mental health, wellness, illness, disability, and death. Much of culture resides only in people’s heads; thus, it is invisible and sometimes hard to detect. One way to understand culture is to think of it as the “software” of the mind. Essentially, individuals are “programmed” by their cultural group to interpret and evaluate behaviors, ideas, relationships, and other people in specific ways that are unique to their group. Another excellent analogy for understanding the cultural process is to see culture as the “lens” through which people in a specific group view the world.Notice that these analogies imply that culture exercises a kind of invisible control over members of a cultural group. Psychologists call this “internalizing” our cultural norms and concepts. We all do this very naturally. However, this process often has the effect of rendering our own culture invisible to us, though we can readily identify cultures that differ from ours.Despite the invisibility of “software” or a “lens,” a culture is clearlyreflectedoutwardly in such things as how people behave, what they eat, how they dress, the tools they use, and the values and ideas they express. Nevertheless, it takes considerable introspection and self-analysis for individuals to discover how deeply and strongly their culture influences their own thoughts and behaviors. Doing this reflective work is a crucial part of becoming culturally aware.|
How Culture Influences Health
- A culture is a set of beliefs, practices, and behaviors that are shared by a group of people or a civilization as a whole. It is continually changing
- The rate at which cultural evolution takes place varies. It rises when a group migrates to a new culture and adopts elements of that culture into their own culture of origin, as in Children frequently experience difficulties when they are ‘between cultures,’ trying to strike a balance between the ‘old’ and the ‘new.’ They are fundamentally a part of both cultures, but their parents are frequently associated with the ‘old’ culture. One method of thinking about cultures is to consider whether they are predominantly ‘collectivist’ or ‘individualist’ in orientation. The ability to distinguish between the two can assist health professionals in making diagnoses and designing treatment plans that cover a bigger or smaller number of patients. Cultural factors have a significant impact on health. Patients’ perspectives of health, sickness, and mortality are influenced by their beliefs about disease origins, methods to health promotion, the way in which illness and suffering are experienced and communicated, where they seek care, and the forms of therapy they choose. Health professionals and patients both have cultural influences that impact their decisions and actions. It is possible that cultural bias will result in vastly divergent health-related choices and perceptions in Canada’s health system since popular ideas of historically dominant cultures have formed the system. Understanding and negotiating cultural differences are abilities that are referred to as ‘cultural competency.’ From this perspective, it is possible for caregivers to expressly inquire about particular beliefs or sources of care, and to include in new awareness into diagnostic and treatment plans
- The demonstration of understanding of a patient’s culture can help to build trust, provide better health care, increase acceptance of diagnoses, and enhance treatment adherence, among other things.
What is culture?
Culture refers to the patterns of beliefs, practices, and behaviors that are shared by a group of individuals or a community as a whole. These patterns let individuals identify themselves as members of a group and distinguish themselves from members of other groups. Culture may encompass all or a subset of the following qualities, which may be present in any combination: 1Given the large number of elements that may influence any culture, there is certain to be a tremendous deal of variation within any one cultural group.
- Ethnicity, language, religion, and spiritual beliefs, gender, socioeconomic status, age, sexual orientation, geographic origin, group history, education, upbringing, and life experience are all important factors to consider while making decisions.
Culture consists of the following elements:
- Dynamic and developing
- Taught and handed down through generations
- Shared among individuals who agree on the way they define and comprehend reality
- Frequently identified’symbolically,’ via language, dress, music, and behaviors
- And interwoven into all elements of an individual’s existence. 2
Take a look at the following two tales and think about how each child may react differently to a similar scenario such as a problem at school or a criticism, or even their mother falling unwell.
A great escape?
A 10-year-old Sudanese girl was raised by her aunt, who also had four other children, for three years as the less-cared-for child. Following the publication of politically sensitive stories in a major daily, her mother, a journalist in Sudan, was hounded and imprisoned for her actions. During the night, her mother appeared out of nowhere to whisk the youngster away under the cover of darkness. They walked all night and snuck across the border in the middle of the night. After crossing the border, they spent the next two years in a refugee camp, where they encountered a variety of hardships due to the fact that they had no male family members to guard them.
In the aftermath of the incident, the mother was diagnosed with post-traumatic stress disorder (PTSD), and although she is receiving treatment, she continues to have problems functioning in her daily life and adapting to life in Canada.
She looked to be well-adjusted; she performed well in school; she was eager to assist her mother; she smiled and chatted readily; and she appeared to be really interested in learning English.
Turning the page
As part of a diplomatic mission to maintain stability in Sudan, the 10-year-old daughter of a Sudanese schoolteacher in a posh district of Khartoum fled the country with her mother under the cover of a diplomat. This diplomat had arranged for visas to Germany and had given them with a car with diplomatic license plates as well as a skilled driver who took them to the most secure airport possible. They then boarded a tiny plane that took them to a connecting trip to Frankfurt, Germany, which had been pre-arranged.
They stayed in a room rented from a friend. After much deliberation, they opted to immigrate to Canada in order to join extended relatives in Toronto, who had sponsored their immigration. Following her arrival in Canada, the mother remarried.
- Within any single culture, there is a great deal of variation. In addition to culture, a child’s ability to adapt can be impacted by a variety of other elements (personal, familial, migration-related, social, environmental)
- Even if such variables have harmful impacts on the kid, these effects may be successfully concealed by the youngster. A kid may be able to make up for a parent’s incapacity
- Migration paths differ significantly from one another.
As seen in Figure 1, culture has been compared as an iceberg, with its most potent qualities submerged under the surface of the water. Explicit cultural factors are frequently visible, but they may be less significant than the unacknowledged or subconscious elements that act as ballast below the surface.
|Figure 1: Elements of culture|
|Source: Slide 6, Introduction to clinical cultural competence. Clinical Cultural Competency Series. Courtesy of the Centre for InnovationExcellence in ChildFamily Centred Care at SickKids Hospital.|
The cultural continuum
Collectivism and individualism are two main aspects of culture that are often seen to be at opposing ends of a continuum: collectiveistic and individualistic. Most civilizations fall somewhere in the middle between the two poles, exhibiting features of both at the same time. Furthermore, within any one culture, individual variances can be found at all points on the spectrum. To be sure, understanding the features of collectivistic and individualistic cultures is beneficial (see Table 1) because it allows practitioners to “find” where a family fits within their cultural continuum and to tailor patient care.
According on where a patient “fits” on the cultural continuum, incorporating extended family members in discussions regarding disease etiology, diagnosis, and therapy may be beneficial.
|Focus on “we”||Focus on “I”|
|Promote relatedness and interdependence||Value autonomy|
|Connection to the family||View ability to make personal individual choices as a right|
|Value respect and obedience||Emphasize individual initiative and achievement|
|Emphasize group goals, cooperation and harmony||Lesser influence of group views and values, and in fewer aspects of life|
|Greater, broader influence of group views and values|
|Source: Adapted from slide 11, Cross-cultural communication.Clinical Cultural Competency Series. Courtesy of the Centre for InnovationExcellence in ChildFamily Centred Care at SickKids Hospital, Toronto.|
Indecision or decision-making?
Normally, you’d expect a 26-year-old mother to make the decision about her child’s medical treatment on her own. You have just completed an examination of her 6-year-old and are presenting her with two alternatives for further study. The mother is reluctant to make a clear choice and responds to you in ambiguous words. Even after hearing all of the facts necessary to make a decision on which care course to take, she appears to be talking in circles, almost as if she is dancing around the issue.
She will be back the following week.
You are taken aback by how decisive she is.
She is now able to proceed with confidence in the examination of her child’s condition.
- The individualistic culture of the health care professional contrasts with the collectivistic culture of the mother. She wanted to confer with someone before she could deliver a response because everyone’s communication methods varied. The mother was concerned about putting the provider on the defensive by questioning his advise, but she also didn’t want to accept that she would have to bring the options home to make a decision. The fact that someone has a high school diploma is irrelevant: it is a red herring.
Impact of culture on health
Because culture defines and molds our perceptions of the world and our experiences, health is a cultural term to understand. Culture, in conjunction with other variables of health and disease, contributes to the definition of:
- The perspectives of patients and health-care professionals on health and sickness
- Insights into what people and health-care professionals think about the origins of disease Examples include patients who are uninformed of germ theory and who instead believe in fate, adjinn (an evil spirit believed to be responsible for tetanus-like sickness in rural Afghanistan), the “evil eye,” or a demonic entity. They may refuse to accept a diagnosis and even assume that they are unable to alter the path of events. Instead, people can only accept events as they develop
- Which diseases or conditions are stigmatized and why
- And which diseases or conditions are stigmatized and why. Depression is a prevalent social stigma in many cultures, and consulting a psychiatrist is considered “crazy.” What sorts of health promotion activities are done, encouraged, or insured varies from culture to culture. It is common in certain cultures to be “strong” or overweight (what Canadians would call “obese”) as a method of storing energy in case of famine, and “strong” women are considered desirable and healthy. The way in which disease and pain are perceived and conveyed. To be stoic is the norm in certain societies, even in the face of excruciating discomfort. In other cultures, individuals are not afraid to express mildly painful emotions out loud. Depending on where individuals seek assistance, how they request assistance, and, perhaps most importantly, when they first approach a health care provider, the extent to which pain should be explored or treated may vary significantly. When a situation gets serious, certain cultures choose to seek allied health care practitioners first, rather than going to the doctor
- Patient engagement with health care providers. For example, in many cultures, avoiding making direct eye contact is considered a show of respect
- Nonetheless, a care provider may worry if the same behavior indicates that her patient is sad. When it comes to treatment alternatives given by health care specialists who do not share their cultural views, the degree of knowledge and compliance is measured. Occasionally, patients assume that a physician who does not administer an injection is not paying enough attention to their problems. The perceptions of chronic illness and treatment choices held by patients and healthcare practitioners
Other aspects of culture have an impact on health, such as:
- Acceptance of a diagnosis, including who should be informed of it, when, and in what manner Affirmation of preventative or health-promoting interventions (e.g. immunizations, prenatal care, birth control, screening tests, and so on)
- A perception of the degree of control that individuals believe they have over the prevention and control of disease Death, dying, and who should be engaged in the process are all discussed. The use of direct communication as opposed to indirect communication. If you avoid eye contact or make it, it might be considered impolite or courteous in different cultural contexts. willingness to discuss symptoms with a health-care provider or with an interpreter in the presence of the provider Affective effects of family dynamics, such as established gender roles, filial obligations, and patterns of support among family members
- Young people’s perceptions of themselves and their aging
- The accessibility of the health-care system, as well as the efficiency with which it operates
What health professionals can do
Health care professionals are more likely to have favorable contacts with patients and to deliver better treatment if they are aware of the differences between their patients’ cultural values, beliefs, and practices and those held by the providers themselves.
Following are some tips to assist you in providing care to and communicating with patients who are new to Canada: 3,4
- Consider how your own cultural views, attitudes, and behaviors may influence your relationships with patients. Consider the following: If you believe that a patient-provider relationship has been negatively impacted by cultural prejudice – whether your own or your patient’s – consider getting assistance. Respect, comprehend, and collaborate with people who have different cultural perspectives on what constitutes successful or suitable therapy. Make inquiries about and keep track of how your patients prefer to get health-care and treatment information. Make arrangements for a suitable interpreter if one is required. Pay close attention to what your patients are saying and make sure you understand what they are saying
- Inquire about and learn about the patient’s perceptions of their own health or sickness. It is important to acknowledge that families may benefit from complementary and alternative therapy. When suitable and particular conditions are present, inform them that the use of complementary and alternative medicine can cause a delay in biological testing or treatment, as well as the possibility of injury. Determine where the patient is in the process of adjusting to Canadian culture by “locating” him or her. Examine their network of support. What is the level of their linguistic proficiency? Negotiate a treatment plan that is founded on a common understanding and acceptance
- In Canada, the majority of health information is provided in print form. Examine the possibility that a patient or family might benefit from spoken or visual communications due to cultural differences or inadequate literacy.
Learn more about cultural competency, including specific ways for providing culturally competent care, by reading this article. Other sources provide useful tools and information that may be used to assist you. An e-learning program developed by SickKids Hospital in Toronto has been made available online. Two modules in particular may be of interest to you. They are: Cross-Cultural Communication and Parenting in a Multicultural Environment.
Providing health care to different cultural groups
Creating a handbook to assist health professionals in better understanding cultural preferences and features throughout the world would be a monumental endeavor of monumental proportions. Furthermore, any work of this nature would be skewed by the authors’ own cultural viewpoints. Health professionals in Canada are becoming increasingly varied in terms of their cultural backgrounds, and they perceive the world and the people they encounter through a variety of lenses. Health care practitioners, on the other hand, should gain skills in the areas of cultural competency and patient-centered care.
Above all, keep in mind the following:
- Cultures change with time
- Within any culture, there is a great deal of variation. Even if you believe you understand a culture, it will have changed or you will have uncovered exceptions by the time you are through.
- Additionally, there are other tools and resources for cultural competence. Culture matters workbook: Thirteen cultural categories
- American and host nation perspectives are examined in Coverdell, Paul D. World wise schools:Culture matters workbook: Thirteen cultural categories Gregory Juckett, Peace Corps Volunteer. Medicine that is cross-cultural in nature. Am Fam Physician. 2005
- Am Fam Physician. 2005
- A child and family-centered care center at SickKids Hospital (in Toronto, Ontario), the Centre for Innovation and Excellence in Child and Family-Centered Care. E-Learning Modules for Clinical Cultural Competence
- Clinical Cultural Competence
Webinar: Pay Attention to the Gap! Develop skills to navigate cultural issues with newcomer children, youth, and families on September 24, 2014 at the University of California, Los Angeles.
The most recent update was made in March of 2018.
Culture and the Self: A New Global Perspective
Our self-perception defines our life, and our cultural milieu influences how we perceive ourselves. Self-perceptions impact, among other things, how we think about the world, our social interactions, health and lifestyle choices, community involvement, political activities, and, ultimately, our own and other people’s well-being, as well as the well-being of those around us The fact that individuals in various regions of the globe perceive themselves differently has long been recognized by social scientists; nonetheless, research has frequently been guided by a relatively binary, some would say conventional, perspective of what the differences are.
- The authors of a recent study in the Journal of Experimental Psychology: General (PDF, 209KB) provide a novel perspective on cultural variations in self-construal in their article (PDF, 209KB).
- For several decades, psychology experts have thought that Western cultures promote the perception of oneself as separate from others, whilst civilizations across the rest of the globe promote the perception of oneself as interconnected with others.
- The new research provides a considerably more detailed picture of the diversity of cultural theories of selfhood than previous studies.
- While Western cultures are not “unique” when seen in a global perspective, they do constitute part of the wide range of cultural variance that exists across the world.
- There were differences in how people saw themselves as both autonomous and interdependent in different regions of the world, which was partially explained by the socioeconomic development and religious history of the cultural groups under investigation.
- They open up new study avenues that will aid academics in better understanding how psychological processes differ across cultures and time zones.
Researchers believe that a more comprehensive understanding of cultural variance, grounded in scientific study rather than prejudices, might assist practitioners in intervening more successfully with members of varied cultural communities.
- The following authors contributed to this work: Vignoles (VL), Owe (E), Becker (M), Smith (PB), Easterbrook (MJ), Brown (R),.Bond (MH) (2016). Beyond the ‘east–west’ dichotomy: Cultural theories of selfhood differ across the world. Journal of Experimental Psychology: General, 145 (8), 966–1000
- Journal of Experimental Psychology: General, 145 (8), 966–1000
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