CrossCultural Perspective in Health Care:

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Cross-Cultural Perspective in Health Care When
Culture Matters!
Elizabeth Trejos-Castillo, Ph.D. TTU Human
Development Family Studies
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--Previously, men could be divided the learned
and the ignorant, those more or less the one, and
those more or less the other. But your SPECIALIST
cannot be brought in under either of these two
categories. He is not learned, for he is formally
ignorant of all that does not enter into his
specialty but neither is he ignorant, because he
is a scientist, and knows very well his own
tiny portion of the universe. We shall have to
say that he is a Learned Ignoramus... a person
who is ignorant, not in the fashion of the
ignorant man, but with all the petulance of one
who is learned in his own special line. José
Ortega Gasset The Revolt of the Masses
(1930)
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The Greatest Sin of Specialists Knowledge Bias

• Emic (insider) vs. Etic (outsider) views in
  Health Care
• Disease, Illness, Social
  Constructionism
• or or
• Sickness? Biological
  Reductionism

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Disease-Illness-Sickness

• Disease bio-medical definition of a pathology
  (physical)
• Illness subjective feelings of not feeling
  well (psychological)
• Sickness social interpretation of a personal
  condition (social well-being)
• Health is a state of complete Physical,
• Psychological, Social well-being (WHO, 1948)
• How we communicate about our health problems,
  the manner in which we present our symptoms, when
  and to whom we go for care, how long we remain in
  care, and how we evaluate that care are all
  affected by cultural beliefs
• (Kleinman, Eisenberg, Good, 2006, p.251)

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Understanding Pain
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Understanding Pain

• Thus, while the stimulation of pain fibers to
  tell the brain that something is wrong is the
  same among all human beings, the perceptions and
  control of pain vary from society to society.
  (Moore-Free, 2002, p. 143)
• While individual scholars conduct studies and
  issue reports on the phenomena of pain and its
  control, it is simply impossible for clinicians
  to understand all of these differences and
  societal belief systems. What is possible for
  clinicians and is important and comforting to
  patients is to ask them about their belief
  systems. (Moore-Free, 2002, p. 144)

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Similarities vs. Differences in Human
Developmental Processes

• Universal View Developmental processes (patterns
  of association between predictors and outcomes)
  are highly similar across ethnic/racial,
  cultural, immigrant, and national groups (Barber
  Harmon, 2002 Dmitrieva et al., 2004).
• Differential View Developmental processes vary
  due to specific characteristics of a group of
  individuals and how cultural patterns in such
  groups and social networks impact individual
  development and behaviors (Kagitçibasi, 2003
  Kwak, 2003).

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Trejos-Castillo, E., Vazsonyi, A.T. (In-press)
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Diversity True Multiculturalism?...
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• Common Design Flaws in
• Multi-Cultural Research

• Unequal percentages of participants across groups
• Mostly Between-group comparisons
• Assuming within-group homogeneity (generational
  differences?)
• Mostly quantitative methods
• Measurement assumptions
• Response Consistency similar use of response
  categories
• Item Equivalence respondents can related to
  items

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Statistical vs. Practical Significance

• The Sizeless Stare of Statistical Significance
  
• (Ziliak McCloskey, 2007)
• How BIG is big in practical/clinical terms?
• (sample size and true effects)
• Better Practice
• Clinically Meaningful Statistical
  Significance
• Is it possible?
• What are the Costs? To Whom?

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Trejos-Castillo, E., Vazsonyi, A.T. (In-press)
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Where is the Culture in Cross-Cultural
Translation?

• Translation Back-Translation
• Culturally Sensitive Instruments
• A Zebra is a ZEBRA
• not a Black White Striped Horse!...

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• Translation process should be focused not merely
  on language transfer but also
• and most importantly
• on cultural transposition.
• (Karamanian, 2002)

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Becoming Culturally Competent
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Cross-Cultural Research
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Becoming Culturally Competent

• Generating Comparative Knowledge
• Medicine in many cultural groups is not
  clearly differentiated
• from that of religion, politics, and the rest
  of social life
• Beliefs and health practices go together
• Raising awareness, tolerance, and respect

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"The art of teaching is TOLERANCE. HUMBLENESS is
the art of learning"
BKS Iyengar (1918-
Indian Yoga Master)
If we are to achieve a richer culture, rich in
contrasting values, we must recognize the whole
gamut of human potentialities, and so weave a
less arbitrary social fabric, one in which each
diverse human gift will find a fitting place.

Margaret Mead (1901-1978 American
Anthropologist)
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References

• Barber, B. K., Harmon, E. L. (2002). Violating
  the self Parental psychological control of
  children and adolescents. In B. K. Barber (ed.),
  Intrusive Parenting How Psychological Control
  Affects Children and Adolescents (pp. 15-52).
  Washington, DC APA.
• Cajan, S. (2001). Statistical significance is not
  a "Kosher Certificate" for observed effects A
  critical analysis of the two-step approach to the
  evaluation of empirical results. Educational
  Researcher, 29, 31-34.
• Cavusgil S.T., Das, A. (1997). Methodology
  issues in cross-cultural sourcing research - A
  primer. Marketing Intelligence Planning, 5,
  213-220.
• Dmitrieva, J., Chen, C., E., Greenberger, E.,
  Gil-Rivas, V. (2004). Family relationships and
  adolescent psychosocial outcomes Converging
  findings from Eastern and Western cultures.
  Journal of Research on Adolescence, 14(4),
  425-447.
• Kagitçibasi, C. (2005). Autonomy and relatedness
  in cultural context Implications for self and
  family. Journal of Cross-Cultural Psychology 36
  (4), 403-422.
• Karamanian, A.P. (2002). Translation and culture.
  Journal of Translation, 6(1), 1-3.
• Kleinman, A. Eisenberg, L. Good, B. (2006).
  Culture, Illness, and Care Clinical Lessons from
  Anthropologic and Cross-Cultural Research.
  American Psychiatric Association, Focus
  4140-149.
• Kwak, K. (2003). Adolescents and their parents A
  review of intergenerational family relations for
  immigrant and non-immigrant families. Human
  Development, 46, 115-136.
• Maturo, A. (2007). "Integrating the Triad
  Disease-Illness-Sickness The Concept of
  Sickscape.  Paper presented at the annual
  meeting of the American Sociological Association,
  New York, NY.
• Moore Free, M. (2002). Cross-cultural conceptions
  of pain and pain control. Baylor University
  Medical Center Proceedings, 15143145.