Page 152 - Cultural Competence in Health Education

130 Cultural Competence in Health Education and Health Promotion

Religious Practices
Religion is one of the key cultural practices that influence the health status of individu-

als. Due to their religious beliefs, individuals may refuse health treatments that could
extend their life span. The Hmong, for example, believe in reincarnation and therefore
wish to preserve their bodies without scars for their future lives. Hmong patients who
still follow their own traditions will not agree to have a surgery or amputation that will
leave a scar even if that refusal puts their health in jeopardy (Bryan, 2003). Similar
cases have been reported among Jehovah ’ s Witnesses, who among other things may
refuse blood transfusions. Health educators must understand a population ’ s religious
beliefs and practices in order to develop appropriate health promotion programs.
It is very important to have a good understanding of the health practices of the tar-
get population, especially when this population is composed of immigrants. Thus
health educators must learn more about the socioeconomic background of this popula-
tion and its health literacy level. What were these individuals ’ living conditions in
their hometowns? Did they have access to medical care? Did they practice preventive
care? How is the health care system in their home country different from the U.S.
health care system? Understanding such population aspects will improve health edu-
cators ’ ability to plan programs that acknowledge key parts of the target population ’ s
cultural background.

CONDUCTING NEEDS ASSESSMENTS IN
CULTURALLY DIVERSE GROUPS

The needs assessment is the fi rst phase in the planning process for a health education
and promotion program; this phase is also known as community analysis, community
diagnosis, or community assessment (McKenzie et al., 2005). Many authors have pro-

posed definitions of needs assessment. Gilmore and Campbell (1996) define it as a
“ planned process that identifies the reported needs of an individual or group ” (p. 5).

McKenzie, Neiger, and Smeltzer (2005) refer to it as “ the process by which those who
are planning programs can determine what health problems might exist in any given

group of people ” (p. 73). Regardless of which definition one prefers to use, the practi-
cal reality is that needs assessment is the process through which health educators can
identify, analyze, and prioritize the needs or problems of the group or community that
they have selected to work with.
On the surface the identification of needs might seem to be a straightforward pro-

cess, but there are many issues health professionals should be aware of when using such
assessments. One important fact is that they can encounter two different types of needs:
actual needs and perceived needs. Actual needs are the problems that have been scientif-
ically documented and expressed through incidence and prevalence rates. Perceived
needs are the problems that the community considers to be prevalent and that do not nec-
essarily coincide with the factual data (Green & Kreuter, 2005; Doyle & Ward, 2001). As
Doyle and Ward (2001) suggest, it is important for health education professionals to fi nd

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