Page 111 - Cultural Competence in Health Education

A Spiritually Grounded and Culturally Responsive Approach 89

The chapter begins with a brief overview of society ’ s perception of religion and health
and then reviews spirituality and culture in the health education literature. Because we
often teach by example, this chapter then provides a spiritually grounded and cultur-
ally responsive example of our approach, showing how we taught in a workshop at an
immigrant women ’ s health conference. Then it outlines the components of a spiritu-
ally grounded, culturally responsive approach to education for health (Tisdell, 2003).
A basic assumption we make is that such an approach requires an understanding of
health that is beyond the medical model and that educates the whole person and hence
makes the person visible. At times in our teaching we speak in the first person about

ourselves to make ourselves as educators visible, in the same way that we want to
make our students or our patients visible. At other times we speak in the third person,
when we are talking about theory and the professional literature, for example. This use
of multiple voices is intentional and is meant partially to embody and make visible a
holistic understanding of education for health. Even with a group, our work is individ-
ual and personal. This is part of what makes it spiritual. We have carried that practice
and principle into this chapter.

DEFINING SPIRITUALITY
Spirituality is individually determined, often fi nding expression and meaning in life ’ s

most ordinary aspects. An individualistic approach to its definition allows the word to
remain mysterious, making room for the analogy and symbolism used throughout his-

tory to reflect and inspire connection with divinity (McSherry, 2006).
WHO ’ s definition of spirituality can only be inferred, but that organization does

believe it is something that can be measured and has designed an instrument for that
purpose. WHO conceives of spirituality as a subset of quality of life, related to reli-
giousness and personal belief (Saxena, 2007). This defi nition influences the public

health emphasis on religion and faith - based health programs when programs are seek-
ing to operationalize spirituality. Faith - based programs in the United States do achieve
positive effects by increasing knowledge of disease, improving screening and chang-
ing behavior, and reducing risk associated with disease symptoms. This is especially
true among African Americans (DeHaven, Hunter, Wilder, Walton, & Berry, 2004).
However, there is a possible downside to attempting to induce behavioral change
through religion, as WHO is learning. WHO has been criticized because its regional
offi ces have supported religion - based tobacco control activities, family planning, and
HIV/AIDS/STD responses in some Islamic and Buddhist countries. These programs
are considered potentially volatile by some because religion is such a divisive issue
(Jabbour & Fouad, 2004). However, these religion - based public health campaigns are
often less costly than others would be, and they avoid complications at the level of
authority because religious leaders are key social players in the countries where they
are operating. According to WHO, all religions are in a position to prohibit tobacco
use, and WHO ’ s part in religion - based interventions is traced to its inclusion of a spiri-
tual dimension in its health strategies (El Awa, 2004).

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