Page 112 - Cultural Competence in Health Education

90 Cultural Competence in Health Education and Health Promotion

Considering the WHO perspective, it is not surprising that an extensive review of
spirituality in the health education literature reveals that in most cases, spirituality is
conflated with religion, religiosity, or complementary and alternative medicine. This

spiritual dimension of health remains elusive, with no standardized language of descrip-
tion, and is omitted from much professional literature (Perrin & McDermott, 1997).
Two exceptions are research that attempts to equate spirituality with meaning making by
measuring coherence in life attitude (Dennis, Muller, Miller, & Banerjee, 2004) and
emerging “ indigenist ” models that consider how spirituality is being expressed in a par-
ticular culture (Coreil & Maynard, 2006; Walters & Simoni, 2002).
Health care professionals attempting a more academic understanding of spiritual-

ity need a clear definition in order to communicate effectively. We choose an empiri-

cally derived definition, which, like other research definitions, distinctly distinguishes
spirituality from religion.
Religion is an organized community of faith that has written doctrine and codes of
regulatory behavior. Spirituality, however, is more about personal belief and experi-
ence of a divine spirit or higher purpose, about how individuals construct meaning,
and what they individually and communally experience and attend to and honor as the
sacred in their lives. For those who were socialized in a religious tradition, spirituality
and religion often are related (Tisdell, 2003, p. 29).

SPIRITUALITY AND CULTURE IN HEALTH EDUCATION
There has been much discussion in recent years about the importance of attending to
cultural issues in health care and in health education (Luquis, P é rez, & Young, 2006;
Shaya & Gbarayor, 2006). Given the changing demographics in society and the fact
that people of color and those who are poor are more likely than other groups to lack
insurance, and to lack adequate health care in general, clearly it is important for educa-
tors and health care professionals to better understand some cultural issues in health
care. Further, as those concerned with cultural competence and health education sug-
gest, it is important to have a sense of how to deal with communication issues across
cultural differences as well as to understand differences in attitudes toward health and
wellness across cultures.
Discussion on the role of spirituality in health care and health education has also
been growing recently (Hawks, 2004; Hill, 2006). Much of the discussion specifi cally
related to health care centers on the role of spirituality in palliative care (Puchalski,
2004); numerous studies are related to the role of religion in dealing with a particular
disease (Koenig, McCullough, & Larson, 2001); to spirituality ’ s connection to com-
plementary and alternative medicine (Baer, 2001; Dossey, 1993, 1998; Hill, 2006);
and finally, to ways in which various health practitioners such as physicians, nurses, and

other health care providers can be responsive to patients ’ spiritual needs (McEwen,

2005). Writing more specifically from a health education perspective, Hawks (2004)
notes that the field of health education has philosophically espoused the importance of

attending to the multiple dimensions of health, including the physical, emotional,

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