PORTAL TRANSACCIONAL

The idea behind cultural competence (also referred to as cultural appropriateness and cultural relevance) is designing messages that “meet the people where they are” (Resnicow et al., 1999). In other words, messages must communicate in ways that make sense to the receiver of the message. One prerequisite to “meeting people where they are,” would require not just knowledge of their specific culture, but understanding the norms, values, experiences, and conceptualizations related to their health issues (Kreuter et al., 2003).

Given the increasing diversity within the U.S. population and the variations in health indicators among population sub-groups, it is vital that cultural differences are acknowledged and incorporated in message design (Resnicow et al., 1999). Some researchers treat

race/ethnicity as being equivalent to culture, but there are different cultures within racial/ethnic groups (Kreuter et al., 2003). For example, cultural differences may arise based upon where African-Americans live (e.g., South versus Midwest versus New England area; city versus rural community) or where they are originally from. Although both groups may share African

heritage/ethnicity, Afro-Caribbean immigrant women and African-American women living in Metro Atlanta may have cultural differences that could impact obesity risk and prevention behaviors. Acknowledging these differences when designing health messaging will likely improve the effectiveness of such messages.

Culturally appropriate messages can be designed by utilizing peripheral, linguistic, and sociocultural approaches (Kreuter & McClure, 2004). Peripheral approaches, referred to as surface structure, include using colors and images that are salient to the audience. Linguistic approaches ensure that messages are designed in the common language of a group, and are the most basic of cultural sensitivity strategies aimed at reaching particular audiences. Sociocultural approaches use deep-structure strategies to incorporate culture and social context into messages (Resnicow et al., 1999). Deep-structure involves understanding the role of, among other things, environment, psychological makeup, and culture in how individuals perceive, and act on, health issues (Resnicow et al., 1999). This understanding then informs the development of meaningful health-related messages that are sensitive to the values, beliefs and behaviors of the group (Kreuter et al., 2003; Kreuter & McClure, 2004). These socio-cultural approaches to designing culturally appropriate messages have been insufficiently utilized in health communications

targeted toward minority groups (Kreuter & McClure, 2004). This study utilized a socio-cultural approach to understand and compare obesity-related attitudes and behaviors of African-

American and Afro-Caribbean women.

There is no “one size fits all” set of factors that should be considered in the development of culturally sensitive material (Di Noia et al., 2009). In their review of literature focusing on cultural approaches to nutrition-related issues in African-Americans, Di Noia et al. (2009) contend that some factors are more relevant to particular cultures than to others. For example, there are key factors to consider when developing culturally sensitive diet-related interventions for African-Americans. These factors include spirituality (connection with a higher power), collectivism (placing emphasis on the overall goals of family and friends, rather than one’s own personal goals), the role of women as influencers on the foods consumed by the family, and preference of larger body size (Di Noia et al., 2009). Furthermore, there may be some aspects of a culture that may be “more compelling to some than others” (Kreuter et al., 2003, p. 137). The set of cultural-factors that are most relevant to individuals within each cultural group may differ (Di Noia et al., 2009).

History is an important factor that helps define different cultures and can affect food- related choices (Horowitz, Tuzzio, Rojas, Monteith, & Sisk, 2004). For example, research has shown that African-Americans believe that slavery and economic discrimination impacted their eating patterns. What is considered “Soul food” was attributed to slavery, when Whites left food that they found unfit for their own consumption for the slaves to eat, and was associated with food habits of African-Americans in southeastern U.S. states (Airhihenbuwa & Kumanyika, 1996). Foods categorized as “Soul food” are usually high fat and high-calorie (Parker & Grinter, 2014). Regardless of the nutritional problems associated with these foods—pork, macaroni,

cheese, biscuits, fried chicken, fatback, and grits—they are an important part of history, the knowledge about which African-Americans want to pass down to their children (Airhihenbuwa & Kamanvika, 1996; Parker & Grinter, 2014). Because of the meanings associated with cultural food choices, interventions that aim to persuade people to give up cultural food preparation practices may be met with resistance (Parker & Grinter, 2014).

A cultural value of individualism versus collectivism—i.e., belief that the fundamental unit of society is individual or the group, and that health and wellbeing is an individual versus group effort—is also important to designing health promotion programs (Parker & Grinter, 2014). Collectivism has been found to be an important cultural factor in designing health-related programs for African-Americans; therefore a focus is on adhering to and meeting the

expectations of the family and larger community, as opposed to one’s own individual desires or goals. Designing collectivist health messages focuses on group responsibility for meeting the goals of friends and family (Parker & Grinter, 2014).

Health-related programs often fall short because of a lack of understanding of the populations for whom the programs are intended (Horowitz et al., 2004). Cultural tailoring provides a means of addressing uniqueness within cultures (Kreuter et al., 2003). The process involves understanding individuals’ perceptions of their culture, the degree to which they identify with the culture and the values within that culture that they consider important to them, and then designing messages that appeal to their most salient cultural values. Very few studies have tailored health messages to Afro-Caribbean Americans. One study, however, found that this group depended on the church and spiritual leaders to help them reach health-related goals. In addition, the Afro-Caribbean group was found to hold strong values and the desire to be healthy (Archibald, 2011). Being aware of characteristics such as these is important for successful

tailoring of health-related message (Archibald, 2011). The following discussion explores what is currently known about communication, social influence and health behaviors, and cultural variation in food choices, physical activity, and body image.