Culture
is an ambiguous term. It can be, and is, operationalized differently depending
on the agenda of the researcher, the topic of research, or the outcome that one
is looking for. It can be observed in different levels, whether it be the
culture of a country (macro), a state/territory/province (mid-range), or of a
village (micro), and often times is evaluated based on the different cultural
values that the researcher, knowingly or unknowingly, bring from his/her own
point of view. When I say culture, I am referring to the meaning-making
processes, point-of-views, and framework of a group that guides the actions and
problem-solving processes of the individuals within that group (Kao et al.,
2004; Swindler; 1986). Common characteristics that are threaded throughout
culture are:
1) learned from birth
through the processes of language acquisition and socialization, 2) shared by
all members of the same cultural group, 3) an adaptation to specific
environmental and technical conditions, and therefore 4) a dynamic,
ever-changing process (Kagawa-Singer 2012:357; Leininger, 1995).
The
above characteristics illustrate the reciprocal nature of culture. #3 in particular, “an adaptation to
specific environmental and technical conditions”, brings to the forefront that
culture is, in part, a result of the conditions that a community experiences as
a way to not only make sense of life, but to survive. #4 goes further to explain that culture
is dynamic, not static, and will continue to change as life changes.
When I
look at this definition, it makes me realize a more careful consideration of
culture in developing and implementing health interventions should be a
priority. It is important to ask ourselves, as researchers, not just what
problem we are trying to address, but also what is creating the problem, and
how culture interacts with the problem. We must take into account the size of
the group we are trying to generalize about. If we are trying to create and
implement a national scale intervention, we must recognize that there will be
within level differences of culture that makes the applicability of that
intervention vary depending on the cultural clashes within a country. Further, recognize that culture clashes
that seem to be between what we deem the “civilized” majority and the “uncivilized”
minority may speak about the inequalities embedded within the social structure
of that country. There are different levels of culture that need to be taken
into consideration:
-Macro:
national culture (values, behavior, environment)
-Middle-Range:
States/territories/Provinces
-Micro:
Villages (taking into special consideration the marginalized and poorer
populations that are usually silenced, and victims of social inequality)
Without
knowing who you are trying to target with your intervention, and what possible
cultural differences lies between and within these different levels of
organization, the effectiveness of the intervention can be entirely
compromised. For example, in Dutta-Bergman’s article on the Santali (2004), trying
to promote national family planning to a village whose culture revolves around
large families not because they are primitive, but because the culture of their
village promotes many children to bring in money and labor into their family’s
income due to their marginalized status, the intervention is not going to be
successful. This also points to structural violence’s role in causing harm to
certain populations. Culture has become a scapegoat of failed public health
interventions, but there needs to be a deeper look at how culture has arisen in
populations.
References:
Dutta-Bergman,
Mohan J. 2004. “Poverty, Structural Barriers, and Health: A Santali narrative
of Health Communication.” Qualitative
Health Research 14(8): 1107-1122.
Kagawa-Singer, M. 2012.”Applying the concept of
culture to reduce health disparities through health behavior research.” Preventative Medicine 555(5):356-361.
Kao, H.F., M.T. Hsu, & L. Clark. 2004. “Conceptualizing
and critiquing culture in health research.” Journal
of transcultural nursing 15:269-277.
Leininger, M. 1995. Trancultural
Nursing: Concepts, Theories, Research, and Practice. McGraw Hill: New York.
Swidler,
A. 1986. “Culture in Action: Symbols and Strategies.” American Sociological Review 51:273-286.
