Page 132 - Cultural Competence in Health Education

110 Cultural Competence in Health Education and Health Promotion

Similarly, issues in the family roles and organization domain affect other domains ’
issues and define what relationships will look like between insiders and outsiders. The

family roles and organization domain addresses the views related to the head of the
household and to gender roles; family roles including those for children, adolescents,
and the elderly; and opinions about alternative lifestyles, such as single parenthood or
same - sex sexual orientation (Purnell & Paulanka, 2003). For example, for many mem-
bers of the Hispanic community the family is the most important institution in life and
in one ’ s cultural and social existence, as it provides a strong feeling of loyalty, reci-
procity, and solidarity among its members. Health educators targeting the Hispanic
community must understand the importance of family among this group as it can affect
group members ’ decisions about health care and preventive behaviors.
The workforce issues comprise language barriers, degree of assimilation and
acculturation, and matters of autonomy. Moreover, concepts from the other domains,
such as gender role, cultural communication, and health care practices, affect the
workforce issues in a multicultural work environment (Purnell & Paulanka, 2003). For
example, Americans are expected to be punctual on the job and to use formal meetings
and appointments in interacting with other workers. For individuals from cultures
where time is less important, however, such timeliness and punctuality are culturally
based attitudes that can cause serious worksite problems. For example, a number of
researchers have suggested that Hispanics can be considered present - oriented individ-
uals; therefore they do not demand punctuality and place more value on the quality of
an interpersonal relationship than on the time during which this relationship takes
place (Mar í n & Mar í n, 1991). Public health educators in administrative positions need
to support cultural and diversity initiatives to diminish these possible problems.
The domain of biocultural ecology is concerned with physical, biological, and
physiological variations among racial and ethnic groups. For instance, some racial
and ethnic groups are more susceptible to and affected by certain illnesses and diseases
than other groups are. Moreover, health care professionals treating dark - skinned people
for rashes, anemia, or jaundice need to employ assessments different from those used
with light - skinned people. In addition, differences among racial and ethnic groups in
the way drugs are metabolized affect the prescription of medication for different groups
(Purnell & Paulanka, 2003). Health educators must be educated about these variations
as they will affect the health care and health promotion interventions developed for spe-
cifi c groups.
Understandings of high - risk behaviors such as tobacco, alcohol, and drug use; sex-
ual practices; high - fat diets; and lack of physical activity differ among racial and ethnic

groups. For example, culture, rites, and customs may influence the use of alcoholic bev-
erages among ethnic groups. For instance, the Roman Catholic Church uses wine during
the celebration of the mass, and the French ingest larger amounts of alcohol than
Americans do, a fact some have related to a lower mortality rate due to cardiovascular
disease in the latter population (Purnell & Paulanka, 2003). When assessing alcohol use,
health professionals must place this high - risk behavior within the context of the cultural
group. Likewise, the domain of nutrition looks at having adequate food, the meaning of

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