Cultural Influences and Acceptance of New Ideas and Interventions Peggye Dilworth-Anderson, Ph.D. Professor, Health Policy and Administration Director, Center for Aging & Diversity/Institute on Aging University of North Carolina at Chapel Hill

Overview The Importance of culture Overview of culture Components of culture to consider Implications Linking culture and a guiding model for implementing new ideas and interventions Conclusion

The Importance of Water and Culture “The importance of water in our everyday lives cannot be

overestimated. Although it is ever-present, it is also ever-changing. Indeed, the ways in which water is perceived and managed are determined by cultural traditions, which are themselves determined by factors as diverse as geographical location, access to water and economic history.” “Water is not perceived the same way in Africa as it is in Asia or in Australia as it is in the Amazon. The role that water plays in shaping the lives of people can be seen in the huge variety of water-related religious practices, spiritual beliefs, myths, legends and management practices throughout the world.” World Water Day 2006: Water and Culture United Nations Conference on Environment and Development

What Is Culture? Set of shared symbols, beliefs, and customs that shape individual and group behavior (Goodenough, 1999) Provides guidelines for speaking, doing, interpreting, and evaluating one’s actions and reactions in life (Goodenough, 1999)

Culture Is… Shared among an identifiable segment of a population (Rohner, 1984) Influenced by individual characteristics such as gender and age (Goodenough, 1981) Socially constructed and learned, not genetically transmitted (Institute on Medicine, 2002)

The Influence of Culture Shapes how people perceive and interpret their environment Influences how people structure their community and social life Determines what is perceived as a priority in the community Serves as both an enabler and barrier to acceptance of new ideas and interventions

Introducing New Ideas and Implementing Interventions Within a Culture It is important to recognize, respect, and work within the major components of culture when introducing new ideas and implementing new interventions

Select Components of Culture What are some components of culture that influence the acceptance of a new idea or intervention? Community values Construction of health Stigma & taboo Patterns of authority Trusted sources of information

Religion & spirituality Gender norms & roles Social structures Daily activities Language & communication

Community Values May be moral, ideological, or social Influences what the community deems a priority To be successful, intervention must reflect the values of the community

Constructions of Health Cultures understand and define the concepts of “health” and “illness” differently Possible constructions: l

l

Biomedical vs. folk conceptions of health, illness, and disease Health as absence of disease/symptoms vs. state of well-being

Stigma and Taboo Certain topics may carry stigma or may be considered taboo May affect willingness to discuss topic or participate in intervention Can also be used to promote desire for intervention

Patterns of Authority Defines appropriate channels through which can initiate intervention Can help to determine who are the community gatekeepers Community members may be more likely to accept intervention when promoted by people in authoritative roles

Trusted Sources of Information Who is considered a credible source of information varies across cultures l

Medical providers, traditional healers, family members, friends, religious leaders, political leaders

Value of folk wisdom and experience vs. formal education Potential distrust of outsiders

Religion and Spirituality Influences health beliefs and practices Water plays a key role in many religions l l l

Symbolic in most religions Considered a cleanser and purifier Used in spiritual rituals

Gender Norms & Roles Dictate social roles and relationships between women and men Often result in gender-based inequalities Intervention may need to be tailored to meet the different needs of women and men

Social Structures Considerations related to social structures: l l l

Kin structures Social support systems Emphasis on individuals vs. communities

Will dictate how the intervention should be tailored (e.g., aimed at individual behavior or group action)

Daily Activities A full daily routine may limit time or energy necessary to participate in a new intervention Intervention must promote behavior that can be easily incorporated into the daily routine

Language & Communication Various types of communication: l l l l

Written and oral language Body language/gestures Pictures Objects

Language considerations l l l l

Communication styles Meanings of gestures/body language Guidelines on appropriate discussion content Literacy levels

Language & Communication Preferred methods of teaching and learning l l l l l

Oral story-telling Pictures Lecture Songs Written materials

Poor communication leads to: l l l

Frustration, discomfort, fear Misunderstanding Decreased compliance

Implications Let community structures dictate whether the intervention is based on individual education/ behavior changes or community mobilization Ensure interventions are communicated appropriately l l l l

Language used Method of communication Culturally acceptable content Appropriate literacy level

Implications Understand the cultural milieu before designing an intervention l l

Partner with community gatekeepers Gather input from community members

Ensure there is congruence between community values and the intervention

Implications Learn how the community views health and tailor the intervention accordingly Beware of stigmas and taboos, but also use them to promote the message of the intervention Respect patterns of authority within the community and garner support from these individuals or groups

Implications Utilize sources considered to be credible to convey the intervention message Understand and respect religious and spiritual traditions and beliefs Tailor the intervention to benefit both men and women

Linking Culture and a Guiding Model for Implementing a New Intervention: Community-Based Participatory Research Model Definition: Collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings 1 Topic: Research is of importance to the community Goals: Combine knowledge with action to achieve social change 1 WK

Kellogg Foundation Community Health Scholars Program/ University of Washington Community Campus Partnership for Health

Community-Based 1 Participatory Research Model Recognizes the community has its own identity Builds on the strengths and resources of the community Facilitates collaborative partnerships Integrates knowledge and action for mutual benefits of all partners 1. Israel, Schulz, Parker, & Becker, 1998

Community-Based 1 Participatory Research Model Promotes co-learning Involves a cyclical and iterative process Addresses health from positive and ecological perspectives Disseminates findings to all partners Involves a long-term commitment by all partners 1. Israel, Schulz, Parker, & Becker, 1998

Determining the Appropriate Time to Intervene Assess community’s readiness Assess the need for building an infrastructure Determine if information is of mutual benefit to researchers/scientists and the community Help provide information needed to develop culturally appropriate programs

Conclusion Culture produces local knowledge, interprets and translates outside information, and determines the acceptance of new practices, technologies and laws Culture shapes how people perceive an intervention and therefore should shape how the intervention is designed and implemented It is important to recognize that culture can serve as both an enabler and barrier to acceptance of a new intervention

Ultimately: Culture empowers Culture organizes Culture harmonizes Culture integrates Culture sustains

Select References Bohlman-Nielsen, L., Panzer, A. M., Kindig, D. A. (2004) Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. University of Washington Community Campus Partnership for Health. (2007a). “Community-Based Participatory Research.” Retrieved from http://depts.washington.edu/ccph/commbas.html on August 31, 2007. Goodenough, W. H. .(1981). Culture, Language, and Society. Menlo Park, CA: Benjamin-Cummings. Goodenough, W. H. (1999). Outline of a framework for a theory of cultural evolution. Cross-Cultural Research, 33, 85-107. Institute on Medicine. (2002). Speaking of Health: Assessing Health Communication Strategies for Diverse Populations. Washington, DC: The National Academies Press. Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173-202. Rohner, R. P. (1984). Toward a conception of culture for cross-cultural psychology. Journal of Cross-Cultural Psychology, 15, 111-138.