Reaching a Culturally Diverse Community

1. Reaching a Culturally Diverse Community Barri Burrus, Ph.D., Phillip Graham, DrPH, Maria Girlando; BA Linda Bailey Stone, MS; Mary Council, BA - RTI International Presented at the North Carolina’s Health & Wellness Trust Fund’s Annual Meeting October 23, 2009 Greensboro, NC

2. Overview • Introduction to RTI team • Session approach • Defining the terms • Highlights on cultural tailoring • Working within the community setting

3. What Do We Mean By “Culture” Examples from Merriam Webster: • the customary beliefs, social forms, and material traits of a racial, religious, or social group; the set of shared attitudes, values, goals, and practices that characterizes an institution or organization • the integrated pattern of human knowledge, belief, and behavior that depends upon the capacity for learning and transmitting knowledge to succeeding generations • the set of values, conventions, or social practices associated with a particular field, activity, or societal characteristic

4. Breaking Down the Definition • The customary beliefs, social forms, and material traits of a racial, religious, or social group; the set of shared attitudes, values, goals, and practices that characterizes an institution or organization • Culture is not just determined by race and ethnicity…also has religious culture, regional culture, youth culture, etc. • Although culture is viewed from a group perspective, the blending of all of the different components in an individual contributes to that person’s individuality

5. Breaking Down the Definition (cont.) • The integrated pattern of human knowledge, belief, and behavior that depends on the capacity for learning and transmitting knowledge to succeeding generations • Culture is a learned phenomenon rather than a biological or fixed characteristic • Cultures evolve over time • Examples: ethnic groups, youth cultures

6. Breaking Down the Definition (cont.) • The set of values, conventions, or social practices associated with a particular field, activity, or societal characteristic • Cultural lenses include many different aspects that influence a person’s “world” view • Cultural lenses can’t be determined by looking at the person

7. Examples of Possible Cultural Components at the Individual Level Geographic Region Age Group Peer Group Religious Belief System SES Status Ethnic Affiliation

8. Diversity • Diversity―composed of distinct or unlike elements or qualities (Merriam Webster) • Example: Diverse cultures

9. Cultural Diversity

10. Cultural Relativism • Ethnicity refers to selected cultural and sometimes physical characteristics used to classify people into groups or categories considered to be significantly different from others.  Commonly recognized American ethnic groups include American Indians, Latinos, Chinese, African Americans, European Americans, etc.    • Cultural relativism: judging and interpreting the behavior and beliefs of others in terms of their own cultural traditions and experiences.  This suspension of one’s own ethnocentric views is necessary in order to begin to truly understand another culture or ethnic group.  Source: http://anthro.palomar.edu/ethnicity/ethnic_1.htm

11. Implications for Interventions: Some Do’s and Don’ts • Don’t generalize by “race,” “culture,” or “ethnic” characteristics • Do seek to understand the cultural context in your communities • Do focus on commonalities for your community • Do continue to focus on priority population groups • DO focus on the “culture” of youth at risk • DO focus on the “culture” of youth at risk within priority groups

12. Culturally Tailored Interventions • The extent to which ethnic/cultural characteristics, experiences, norms, values, behavioral patterns, and beliefs of a target population as well as relevant historical, environmental, and social forces are incorporated in the design, delivery, and evaluation of targeted health promotion materials and programs. • Resnicow, K., Baranowski, T., Ahluwahlia, J. S. and Braithwaite, R. L. (1999) Cultural sensitivity in public health: defined and demystified. Ethnicity and Disease, 9, 10–21

13. Keys for Reaching Cultural Diverse Groups

14. Culturally tailored programs • The extent to which ethnic/cultural characteristics, experiences, norms, values, behavioral patterns, and beliefs of a target population as well as relevant historical, environmental, and social forces are incorporated in the design, delivery, and evaluation of targeted health promotion materials and programs. • Resnicow, K., Baranowski, T., Ahluwahlia, J. S. and Braithwaite, R. L. (1999) Cultural sensitivity in public health: defined and demystified. Ethnicity and Disease, 9, 10–21

15. Cultural tailoring

16. What Does It Mean to Have Culturally Competent Staff? • Considerations • Geography • Urbanicity • Race/Ethnicity • Gender

17. Operationalization at Different Levels • State-level Considerations • Regional-level Considerations • Community-level Considerations • Programmatic-level Considerations

18. Overarching Examples & Principles • CSAP’s State Incentive Grant program • Vermont • Louisiana • Maine • Nebraska • North Carolina • Georgia • District of Columbia

19. Application to Teen TUPC Grantees • Identify needed skill set • Understand the community context • Understand the specific needs of program participants (i.e., what are the underlying contributing factors to tobacco use among the groups you are working with) • Where attributes are needed to have credibility among program participants?

20. Key Take Home Message • Having culturally competent staff is only second to selecting and implementing culturally competent evidence-based strategies. • Being culturally competent means more than just looking like program participants • Understanding the community context that allows target risk behaviors to operate must be fully assessed to appropriately engage program participants • Staff must demonstrate a working knowledge or understanding challenges and barriers encountered by program participants • Bicultural competence