Page 133 - Cultural Competence in Health Education

Health Education Theoretical Models and Multicultural Populations 111

food, common foods and rituals, food limitation and nutritional deficiencies, and the use

of food for health promotion and disease prevention (Purnell & Paulanka, 2003). Cul-
tural values and beliefs influence food choices, dietary behaviors, and the use of food for

health promotion among racial and ethnic groups. For example, many racial and ethnic
groups have theories that a balance of proper foods is needed for health maintenance
and that selecting appropriate “ hot ” and “ cold ” foods can prevent and treat illnesses
(Purnell & Paulanka, 2003; Spector, 2004). In addition, dietary patterns and food selec-
tion are closely tied to health issues such as obesity, cardiovascular disease, and diabe-
tes. Health educators need to understand the different nutritional patterns among racial
and ethnic groups to provide successful health promotion programs.
Pregnancy and childbearing practices among multicultural groups are also deter-

mined by cultural influences. This domain considers culturally sanctioned and unsanc-
tioned fertility practices; views about pregnancy; and prescriptive, restrictive, and
taboo practices used during pregnancy, birth, and after pregnancy (Purnell & Paulanka,
2003). Cultural beliefs and views regarding conception, pregnancy, and childbearing
practices are passed down from generation to generation and are assimilated into each
group ’ s custom without being validated or completely understood. For example,
Muslim and orthodox Jewish groups expect limited involvement of the husband dur-

ing the delivery of the baby and prescribe specific steps to protect the baby from evil
spirits (Cassar, 2006). Other ethnic and racial groups avoid certain foods or practices
during pregnancy to prevent illness or harm to the baby (Purnell & Paulanka, 2003).
Health care providers must respect cultural beliefs surrounding conception, pregnancy,
and childbearing when making decisions related to the health of pregnant women.
The next two domains are interconnected with beliefs regarding life, religion, and
death. Death rituals are the practices and views surrounding death and bereavement.
These views are less likely than others to change over time within any cultural group
and may cause concerns among health professionals (Purnell & Paulanka, 2003). For
many racial and ethnic groups, rites surrounding death are connected to their beliefs
about protecting the dead person and the family from evil spirits or ghosts and about
preparing the dying person for his or her journey after death. For example, many
groups use candles in rituals surrounding death to illuminate the way for the spirit
of the deceased (Spector, 2004). Moreover, although the dominant American culture
has a practice of burying the dead within few days, other cultural groups, such as the
Mexicans, hold elaborate ceremonies in commemoration of the dead that may last for

days. Among many groups these rituals are influenced by religious beliefs and spiritu-
ality. In the Purnell model the domain of spirituality is made up of religious practices,
use of prayer, the meaning of life, and the relationship between spirituality and health
care practices. For some people religious beliefs, more than cultural beliefs, direct
their other beliefs, values, and practices (Purnell & Paulanka, 2003). Health educators
must consider these religious and spiritual beliefs when developing health promo-
tion programs. For example, the concept of spirituality has been used in health promotion
to prevent early sexual behavior among African American adolescent girls (Doswell,
Kopuyate, & Taylor, 2003) and has been associated with the development of resilience

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