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Cultural Sensitivity. Resnicow et al., 2002. Ethnic or cultural characteristics, experiences, norms, values, behavior patterns, beliefs of a target population Relevant historical, environmental, & social factors Design, delivery, & evaluation of targeted health interventions.
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Cultural Sensitivity Resnicow et al., 2002 Ethnic or cultural characteristics, experiences, norms, values, behavior patterns, beliefs of a target population Relevant historical, environmental, & social factors Design, delivery, & evaluation of targeted health interventions
Cultural Competence Resnicow et al., 2002 Capacity of individuals to exercise interpersonal cultural sensitivity
Cultural Humility Minkler, 2005, p. 10 Lifelong commitment to self evaluation & self critique to redress power imbalances
Surface Structure Resnicow et al., 2002 Observable social & behavioral characteristics of a target population
Deep Structure Resnicow et al., 2002 How cultural, social, psychological, environmental, & historical factors influence health behaviors differently across racial & ethnic populations
Examples in the African American Community • Surface structure: • Dialect • Female head of household • Church • Deep structure: • Slavery • Tuskegee (Syphilis) Experiment • HIV/AIDS and the US government
Why Cultural Sensitivity? • Ethical/moral argument • Economic argument • Pragmatic argument (health communication perspective)
Why Target & Tailor Interventions? • Disease prevalence • Risk factor prevalence • Socio-economic distribution • Physiological differences • Environmental differences • Behavioral differences • Socio-cultural differences
Definitions of “Health Disparities” • Whitehead/WHO (1992) Differences in health that are “not only unnecessary and avoidable but, in addition, are considered unfair and unjust.” • NIH (2005) “…differences in the incidence, prevalence, mortality and burden of disease and other adverse conditions that exist among specific populations groups in the US.” • NCI (2005) “…occur when members of certain population groups do not enjoy the same health status as other groups. Disparities are often identified along racial and ethnic lines-show, [but] also extend beyond race and ethnicity.”
Health Disparities/Inequalities • Population-specific differences in the presence of disease, health outcomes, or access to health care • Gaps in the quality of health & health care across populations
Ethnic Variation in Heart Disease Mortality Age-adjusted per 100,000 National Center for Health Statistics, 2004
Ethnic Variation in Cancer Mortality Age-adjusted per 100,000 SEER Cancer Statistics Review, 1975-2002
Prevalence of Overweight* in Texas Children by Race/Ethnicity, School Physical Activity & Nutrition (SPAN) Study % of population HP 2010 Goal *Overweight is > 95th Percentile for BMI by Age/Sex Hoelscher et al., 2004
Community-Based Participatory Research (CBPR) • “… a partnership approach to research that equitably involves, for example, community members, organizational representatives, and researchers in all aspects of the research process” Israel et al., 2003
Translation • All vested parties work jointly to achieve a common goal by contributing different • Instruments • Talents • Knowledge • Expertise
Key Principles • Builds on strengths & resources within the community • Addresses health from an ecological perspective • Collaborative partnerships in all phases of research Israel et al., 1998
Key Principles • Integrates knowledge & action for mutual benefit of all partners • Promotes co-learning & empowering process that attends to social inequalities • Findings & knowledge disseminated to all partners • Cyclical & iterative process Israel et al., 1998