Page 140 - Cultural Competence in Health Education

118 Cultural Competence in Health Education and Health Promotion

Cultural Empowerment Relationships and Expectations

Positive Perceptions
Existential Enablers
Negative Nurturers

Person
Extended Family
Neighborhood

Cultural Identity

FIGURE 6.2. The PEN - 3 Model.

Source: Airhihenbuwa, 2007, p. 38. Reprinted with permission of the author.

According to Airhihenbuwa (2007), “ the PEN - 3 model offers an opportunity to
promote the notion of multiple truths by examining cultures and behaviors and by
beginning with and identifying the positive — allowing us to examine and acknowl-
edge the existential, which represents values that makes a culture unique — before
identifying the negative ” (p. 37).
The relationships and expectations domain assesses perceptions, enablers, and
nurturers of behaviors from the cultural point of view. This dimension of the PEN - 3
model has evolved from other theories and models, such as the health belief model
(Rosenstock, 1974) and the PRECEDE - PROCEED framework (Green & Kreuter,
1999). However, this model places culture in the core of health promotion and disease
prevention programs (Airhihenbuwa, 1995, 2007). Among the three components of
this domain, perceptions consist of the knowledge, attitudes, values, and beliefs that
exist within a cultural context and that motivate or inhibit individual or group behav-
ioral change. For example, knowledge and cultural beliefs about breast and cervical
cancer can influence cancer screening and health and health care – seeking behaviors

among Hispanic women (Garc é s, Scarinci, & Harrison, 2006; Luquis & Villanueva,
2006; Allison, Duran, & Pe ñ a - Purcell, 2005). Enablers are resources, institutional sup-
port, and societal or structural factors that may enhance or hinder preventive health
decision and actions. For instance, the role of government policy has been noted in the
low incidence or decline of new HIV cases in some African countries (Airhihenbuwa &
DeWitt Webster, 2004). However, distrust of research and medical care has negatively

influenced the recruitment of African American males for prostate cancer screening
(Abernethy et al., 2005). Similarly, Garc é s et al. (2006) have suggested that lack of

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