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Health Education Theoretical Models and Multicultural Populations 115

The results of this investigation showed that in general, health educators were
operating at a level of cultural awareness. Moreover, thirty - four percent of the partici-
pants were operating at a level of cultural competence. Overall, the health educators in
this study could be described as individuals who are sensitive to the values, beliefs,
and practices of different ethnic and cultural groups and who would be able to respond
appropriately to the needs of these groups. Study results also showed that variables
such as race of the individual, encounters with diverse populations, and participation

in cultural diversity educational programs influenced the level of cultural competence
among health educators (Luquis & P é rez, 2005). Findings from this study demonstrate
the role cultural competence education plays in developing culturally competent health
educators, and they support the need for more research in this area for a better under-
standing of the complexity of cultural competence.

MODELS FOR DEVELOPING HEALTH EDUCATION PROGRAMS

The Cultural Assessment Framework
The cultural assessment framework (CAF), developed by Huff and Kline (1999),

contains five levels of assessment that should be included when planning health pro-
motion programs for multicultural groups. The CAF categories and subcategories sug-
gest areas of inquiry that are race, ethnicity, and culture specific. Huff and Kline (1999)

also recommend employing these areas in assessment tools such as surveys, focus

groups, and other formative evaluation processes. The five major categories of assess-
ment are (1) cultural or ethnic group – specific demographic characteristics, (2) cultural

or ethnic group – specific epidemiological and environmental influences, (3) general

and specific cultural or ethnic group characteristics, (4) general and specifi c health
care beliefs and practices, and (5) Western health care organization and service deliv-
ery variables.
The cultural or ethnic group – specific demographic characteristics include age,

gender, social class, education and literacy, religion, language, and acculturation,
among others (Huff & Kline, 1999). The more health educators and promoters know
about these factors, the better they will be at targeting health education programs

toward specific ethnic and racial groups and at incorporating these characteristics into
the development, implementation, and evaluation processes. For example, when
developing a program for a Hispanic population it is important to note that although
Hispanics as a group have some common demographic characteristics, relating to
such factors as socioeconomic status, educational level, and language, there are some
differences among each subgroup. When the three main Hispanic subgroups in the
United States are compared, for example, Mexicans are younger, have larger families,
and have less income and educational attainment than Puerto Ricans and Central
Americans (Ramirez & de la Cruz, 2002). Such demographic differences need to be
taken into consideration when developing programs targeting specifi c Hispanic
subgroups.

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