Page 141 - Cultural Competence in Health Education

Health Education Theoretical Models and Multicultural Populations 119

information, access to care, and medications prevents Latinas from seeking health care
services. Nurturers are family, friends, and community members who positively or
negatively influence health beliefs, attitudes, and actions. Abernethy and colleagues

(2005) identify pastors, church leaders, and community leaders as individuals who can
promote prostate cancer screening among African American males. Similarly, the cul-
tural practice of caring for a sick relative at home has become an important aspect of
HIV/AIDS care in Africa (Airhihenbuwa & DeWitt Webster, 2004).

The cultural empowerment domain is an affirmation of the possibilities of cultural
influences, which are positive, existential, and negative (Airhihenbuwa & DeWitt

Webster, 2004). This dimension is crucial in the development of culturally appropriate
health education and promotion interventions (Airhihenbuwa, 1995). As part of the
development of such interventions, health educators must promote the good aspects
and also recognize the unique aspects of a culture and not focus merely on its bad
aspects (Airhihenbuwa & DeWitt Webster, 2004). Cultural empowerment is positive
when it promotes the health behaviors of interest: for instance, the traditional healing
modality for dealing with health problems such as sexually transmitted infections
(Airhihenbuwa & DeWitt Webster, 2004). Similarly, eating a balanced diet, exercis-
ing, praying, and going to church are positive cultural aspects and behaviors that can
be encouraged among Latinas (Garc é s et al., 2006) as these behaviors will support
other behaviors that help women to stay physically healthy and spiritually healthy.
Existential aspects of a culture are those cultural beliefs, practices, and behaviors that
are natural to a group and also have no harmful effect on health. These beliefs, prac-
tices, and behaviors should not be targeted for change and should not be blamed for
the failure of the health education program. Garc é s et al. (2006) describe the use of
alternative and complementary healing practices, such as home remedies, as an exis-
tential behavior among Latinas. Health educators must be aware of these practices and
embrace them, as they can help to produce a holistic view that can inform the develop-
ment of a health education program. Finally, negative aspects are those based on val-
ues, beliefs, and relationships known to be harmful to health behaviors. Among such
negative aspects are social actions that lay a foundation for inequality such as racism
and differential housing and education (Airhihenbuwa & DeWitt Webster, 2004). To
be successful health educators should develop programs that increase or support the
naturally occurring positive behaviors while decreasing the negative behaviors and
respecting the existential ones.
Finally, the cultural identity domain in the PEN - 3 model seeks assessment of per-
son, extended family, and neighborhood. It is important to understand that cultural
identity, which represents an important intervention point of entry, is not defi ned on
race and culture alone but refers to the multiple identities experienced by men and
women in different cultures (Airhihenbuwa & DeWitt Webster, 2004). For example,
“ an African South African (such as Zulu) might out of necessity embrace the lived
experiences of being Zulu (ethnicity), English (language), Afrikaans (oppressed expe-
rience) and poor person ” (p. 8). Once the intervention point of entry (components of

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