Page 128 - Cultural Competence in Health Education

106 Cultural Competence in Health Education and Health Promotion

INTRODUCTION
In the last decade the population of the United States reached its most racially and
ethnically diverse composition yet. U.S. Census Bureau (2004) projections of popu-
lation growth indicate that the number of Hispanics, African Americans, Asians
and Pacific Islanders, Native Americans and Alaska Natives, and members of other

racial and ethnic groups will continue to grow in the next few decades. In fact, it is
estimated that by 2020, the nonwhite population will have increased to 39 percent
of the U.S. total (U.S. Census Bureau, 2004). (See Chapter One in this volume for
a more complete description of the demographic changes taking place in the United
States.)
The increasing diversification of the population confirms the health education

field ’ s need to incorporate the concepts of multicultural groups and cultural compe-

tence into every aspect of the planning, implementation, and evaluation processes of
health education and promotion programs (Luquis & P é rez, 2003). It is essential that
these processes incorporate theoretical models so that cultural competence and related
concepts can be considered in needs assessments and in the development and imple-
mentation of culturally and linguistically appropriate health education and promotion
programs. (This need is discussed in greater detail in Chapter Seven.)

Culture has been defined as the “ sum of beliefs, practices, habits, likes, dislikes,
norms, customs, rituals, and so forth that we learn from our families, during the years
of socialization ” (Spector, 2004, p. 9). To some extent, a person ’ s cultural back-
ground defi nes his or her perceptions in the context of a larger group and infl uences
how he or she behaves throughout a lifetime. Culture infl uences people ’ s percep-
tions of their health; it also affects their health beliefs, attitudes, and actions such as
diets and nutritional habits, self - care practices, communication, and health care–
seeking behaviors (Nakamura, 1999). Thus it is imperative that health educators rec-
ognize the importance of and apply the concept of culture in health education and
prevention interventions.
In the past health educators have relied on theories and models such as the health
belief model, social cognitive theory, and the transtheoretical model, among others, to
explain behavioral determinants of health. In addition, health educators have used
planning models such as PRECEDE-PROCEED or MATCH to develop and imple-
ment health education and promotion programs. Although these commonly used
theories and models emphasize logical and critical thinking in relation to health behav-
iors, they do not attend to the sociocultural determinants of health behaviors (Simon,
2006). Thus the purpose of this chapter is to describe four models that assess the role
of culture in the prevention of disease and promotion of health. The first two models,

Purnell and Campinha - Bacote, specifically describe the role of culture and the concept

of cultural competence among health care professionals. The last two models describe
two frameworks to be used when developing health promotion and disease prevention
programs.

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