Page 208 - Cultural Competence in Health Education

186 Cultural Competence in Health Education and Health Promotion

(Mar í n & Mar í n, 1991), their gender (Wyn & Solis, 2001), and their religion (Brooks,
2004; Holt & McClure, 2006). Understanding the specific needs of individuals, groups,

or communities based on their demographic characteristics is key in assisting these
individuals and groups to attain a positive health outcome and in avoiding coercing
them to engage in activities that may run contrary to their beliefs and values.
Despite overwhelming evidence that behavior modifi cation cannot occur without
taking into account people ’ s environment and social support networks, health educa-
tors tend to focus almost exclusively on individuals and their needs and behaviors.
This approach is based on the cultural tenet that we are responsible for our own well -
being but unfortunately fails to take into account differences by gender, age, and eth-
nic group. In this regard our approach as health educators resembles that of health care
professionals who tend to focus on the pathophysiology of illness and give little regard
to the individual as a whole. This shortsighted approach fails to take into account
the impact of culture on the health status of individuals and may in fact diminish the

impact of our scientifically sound programs (Dimou, 1995; Hall, 1990; Marmot,
Siegrist, Theorell, & Feeney, 1999).
The professional literature suggests that a culturally appropriate approach to
health education requires an emphasis not only on individual behavior but also on the
family and the environment of the person (Airhihenbuwa, 1995a, 1995b; Anand, 2003;
Casken, 1999), as each of these factors contributes to the explanatory model of health
and disease as experienced by individuals and has an impact on perceptions, knowl-
edge, attitudes, and health - related behaviors (Kleinman, 1980) and also affects the
symbolism attached to an illness behavior. Recent professional literature also calls for
health educators to have a good understanding of their target individuals ’ culture if
they are to effectively work in diverse settings. For example, the following list from
AAHE (1994) summarizes some differences in cultural values found among non -
Western and Western cultural groups in the United States:

Cultural Values
Non-Western Western

Fate Personal control
Tradition Change
Human interaction dominates Schedules dominate
Group welfare Individualism and privacy
Cooperation Competition
Formality Informality
Indirectness Directness
Modesty Self-confi dence
Extended family Nuclear family

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