**4.1. Cultural targeting**

and the culture of medicine as a discipline. The success of this interaction influences adherence to medical regimens, patient satisfaction, healthcare utilization, and ultimately health

The World Health Organization (WHO) global strategy on people-centered and integrated health services is a call for a fundamental paradigm shift in the way health services are funded, managed, and delivered [6]. Behind this new approach is a vision of a time when the needs, personal preferences, and safety of target populations are taken into consideration in health program planning. It is also based on the conviction that this is possible while still maintaining the timeliness, quality, effectiveness, and comprehensive content of these services.

It is sad to note that in many instances, culture is not properly evaluated. There seems to be instead a lot of assumptions made about what the culture of a group of interest is. A typical example is the mistake of assuming that all Asians have a single uniform culture or that all members of the Zulu tribe have identical belief systems. Instead that racial entity comprises several cultural subgroups and any one individual may belong to one, none, or several.

If indeed one could categorize all members of a given population into groups that had practically all aspects of their culture in common, one would have gained the advantage of carving out groups with very high levels of homogeneity. However, the process would produce so many groups, some with scanty numbers, that it would no longer be feasible to address the

At the opposite extreme, culture would be assumed and overgeneralized based on more eas-

Although it is true that certain cultural characteristics may cluster within a given racial or ethnic group, it is at least equally true that substantial differences exist between individuals and subgroups within these populations [7–10]. Somewhere between these two extremes, we might settle for a slightly deeper, albeit imperfect, understanding of culture that is practical enough to be easily applied yet still potent enough to enhance healthcare delivery efforts.

Many authors have previously described strategies to make health promotion programs and materials more culturally appropriate for target populations and these have been divided into five main categories: peripheral, evidential, linguistic, constituent-involving, and sociocultural [4]. It should be emphasized that these categories are for organizational clarity only and are not necessarily mutually exclusive. Besides, it is presently common, and advisable, for practitioners to use strategies from multiple categories when a health program is to be

**Peripheral strategies** ensure that health programs are culturally appropriate by presenting them based on what the perceived interests of the target group are. This is achieved by matching materials to "surface" characteristics of a target population—as is done using peripheral approaches—the group's receptivity to and acceptance of information and services can be enhanced [11]. For example, materials used for health education can carry national colors or be made from traditionally familiar materials such as "Kente" in Ghana or "Ankara" in

population any more. Which of the myriad of groups should then become the focus?

ily identifiable variables such as race [4]. Neither of these approaches is ideal.

planned and implemented. These approaches are explained below.

outcomes [5].

32 Current Issues in Global Health

Nigeria.

Cultural targeting is a term that has been given multiple definitions by various authorities. It has been defined as "the use of a **single intervention approach** for a defined population subgroup that takes into account **characteristics shared by the subgroup's members** [17]." Others have defined it as part of a larger process of audience segmentation in which **appropriate channels for reaching a given group** are identified [18], while another school of thought defines it as "a **single intervention approach** for a defined population subgroup that takes into account characteristics shared by the subgroup's members" [19]. The concept is based on the assumption that the group has enough characteristics in common to make a single approach effective. In reality, this is not always the case.

these diseases. Many indices of poor health situations such as socioeconomic strata, level of education, job-related hazards, and environmental pollution have been found to be more prevalent among minority groups [21, 22]. These poorly represented groups have also been found in greater numbers among the uninsured than among people with insurance. They have higher rates of emergency department use and avoidable hospitalizations, later-stage

Cultural Sensitivities and Health

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http://dx.doi.org/10.5772/intechopen.79455

"Unequal treatment: confronting racial/ethnic disparities in health care," a report by the Institute of Medicine in 2002 identified more than 175 studies which demonstrated the link between minority groups and several disease conditions. These associations were observed even after the effect of possible confounders such as age, disease stage, socioeconomic status,

Furthermore, this groundbreaking research exposed factors which had been initially overlooked as playing important roles in the observed disparities between minority groups and the rest of the population. These included health beliefs, values, personal preferences, ability to identify clinical features of disease, ability to communicate effectively with health workers, level of adherence to preventive measures, and health outcome expectations among others. It is believed that all these factors influence health outcomes via their effect on the way the patient interacts with the health system, whether it be the way services are designed or the

As the abovementioned evidence accumulated over the years, solutions in the form of "cultural competence" in health care have been prescribed. This refers to a situation where the importance of culture and cultural disparities is taken into consideration and where the design of health programs and services addresses the peculiar cultural needs of a target population. As a result, understanding and addressing the "social context" has emerged as a

A culturally competent healthcare agency, program, or individual provider can function effectively and appropriately in healthcare delivery to culturally diverse individuals. It also involves understanding, appreciation, and respect for cultural differences and similarities within, among, and between culturally diverse populations. To be culturally competent in healthcare delivery, the health professional needs to be sensitive to the differences between groups, to the differences in outward behavior, and also to the attitudes and meanings

The extent to which a society perceives health information or medication as being relevant to them has a profound effect on their reception to and willingness to use them. Even at individual levels, culture-specific values greatly influence perception of sickness and disease, patient roles, expectations, how much information the patient desires, what treatment modalities are acceptable, gender and family roles, and processes of taking decisions con-

attached to emotionally related health issues like depression, pain, and disability [29].

diagnosis of cancer, and the inability to obtain prescription medications [23, 24].

and treatment facility was eliminated [25].

people who deliver them [26–28].

critical component of cultural competence [26].

**6. Cultural competence**

cerning health care [26].

## **4.2. Cultural tailoring**

Cultural tailoring, on the other hand, is any combination of information or change strategies intended to reach **specific individuals** based on characteristics that are unique to them related to the outcome of interest, and have been **derived from an individual assessment.**

Historically, only a few health promotion programs made serious attempts to develop culturally appropriate strategies to meet the needs of target populations. But with increasing evidence that health promotion programs and materials will be more effective when cultural factors are taken into consideration health service managers seem to be gradually changing their approach. Recently, most interventions have been based on assumptions of culture. While this may be an improvement of the past, much more precision in culture interpretation and description is required for better outcomes [20].
