Svara Shah WP2

Svara Shah

Writ 340

Professor David Tomkins

4 October, 2023

WP 2

Part 1

Aronowitz, Robert, et al. “Cultural Reflexivity in Health Research and Practice.” American Journal of Public Health (1971), vol. 105, no. S3, 2015, pp. S403–S408, ProQuest, https://doi.org/10.2105/AJPH.2015.302551.

Beller, J., & Wagner, A. “Loneliness and Health: The Moderating Effect of Cross-Cultural Individualism/Collectivism.” Journal of Aging and Health, vol. 32, no. 10, 2020, pp. 1516-1527. Sage Journals. https://doi.org/10.1177/0898264320943336

This article found that individualistic culture had a negative effect on loneliness. The methods were taking samples from the Survey of Health, Ageing, and Retirement in Europe (SHARE) and included people ages 50+. The research discussed the effects of loneliness on health, describing it as a risk factor as detrimental as obesity, physical inactivity, and smoking. A limitation is that the data is primarily from individualistic countries like the United States and European countries. Including diverse countries would result in a more accurate representation of global health patterns.

Buettner, Dan, and Sam Skemp. “Blue Zones: Lessons From the World’s Longest Lived.” American Journal of Lifestyle Medicine, vol. 10, no. 5, 2016, pp. 318–21, https://doi.org/10.1177/1559827616637066.

This text discusses behaviors and habits within the seven blue zones, where people typically live past 100 years old. Small changes that were supported by the nine characteristics of blue zones were applied to Albert Lea, Minnesota that resulted in an average 3.5 years life expectancy increase. A limitation of the article was that the specific changes that resulted in the increase in life expectancy were unclear.  

Causadias, José M. “What Is Culture? Systems of People, Places, and Practices.” Applied Developmental Science, vol. 24, no. 4, 2020, pp. 310–22. Taylor & Francis Online, https://doi.org/10.1080/10888691.2020.1789360. Accessed 3 October 2023.

The author’s purpose is to define the term culture and establish a p-model that defines the three main components of culture as people, places, and practices, grounded in research in the US and studies in relation to power and racism. The limitations are a vague description of processes and dimensions that bring the p-model together backed by very little evidence and examples. A few strengths include making the info approachable and discussing their own limitations at the end.

Canady, Brittany E., and Mikayla Larzo. "Overconfidence in managing health concerns: The Dunning–Kruger effect and health literacy." Journal of Clinical Psychology in Medical Settings, vol. 30, no. 2, 2023, pp. 460-468. Springer Link, https://doi.org/10.1007/s10880-022-09895-4

This article explored the relationship between health literacy and risk behaviors. Participants were recruited through an outsourcing company and only those who were interested would fill out the survey, which indicated response bias as participants were willing to discuss their health status. The study found that those with measured low health literacy showed equal or greater confidence in their knowledge about health factors than those with higher health literacy levels, and health behaviors and outcomes were lower within individuals with lower health literacy. The Dunning-Kruger effect, which states that individuals may overestimate their knowledge about a subject, was supported in the context of health literacy and behaviors.

Choi, Sung In, et al. “Effects of Individuals’ Cultural Orientations and Trust in Government Health Communication Sources on Behavioral Intentions During a Pandemic: A Cross-Country Study.” Health Communication, vol. ahead-of-print, no. ahead-of-print, 2022, pp. 1–15. Taylor & Francis Online, https://doi.org/10.1080/10410236.2022.2159975.

The study seeks to understand the relationship between cultural orientations, trust in government sources, and health behaviors during the pandemic. The study considered how factors that determine trust in the government affect health outcomes and vaccination intentions. An online survey was conducted in six countries: Australia, Finland, Italy, South Korea, Sweden, and the US. National health authority was found to have the highest positive impact on vaccination intentions. The only other country is South Korea and the data collection method is completely dependent on the participants' responses which can result in biases.

Crowe, Ruth, et al. “Culture and Healthy Lifestyles: a Qualitative Exploration of the Role of Food and Physical Activity in Three Urban Australian Indigenous Communities.” Australian and New Zealand Journal of Public Health, vol. 41, no. 4, 2017, pp. 411–16, ScienceDirect, https://doi.org/10.1111/1753-6405.12623.

Cooper Brathwaite, Angela, and Manon Lemonde. “Health Beliefs and Practices of African Immigrants in Canada.” Clinical Nursing Research, vol. 25, no. 6, 2016, pp. 626–45, https://doi.org/10.1177/1054773815587486.

This study evaluated 14 people from Nigeria and Ghana regarding diverse beliefs about diabetes, cultural food preferences and preparation, cultural practices to stay healthy, fruit and vegetable consumption, and physical activity in the context of diabetes. Limitations are that cultural differences between Nigeria and Ghana are not discussed and the sample size is only 14 participants, meaning that the finding is likely not applicable to the population. 

Goto, Keiko, et al. “Globalization, Localization and Food Culture: Perceived Roles of Social and Cultural Capitals in Healthy Child Feeding Practices in Japan.” Global Health Promotion, vol. 21, no. 1, 2014, pp. 50–58, Sage Journals, https://doi.org/10.1177/1757975913511133.

Islam, Asadul, et al. “The Long-Term Health Effects of Mass Political Violence: Evidence from China’s Cultural Revolution.” Social Indicators Research, vol. 132, no. 1, 2017, pp. 257–72, https://doi.org/10.1007/s11205-015-1030-6.

Jongen, Crystal, et al. Cultural Competence in Health: A Review of the Evidence. Springer Singapore Pte. 2017.

This article discusses facets of cultural competence in healthcare. Although the article only utilizes evidence from Canada, Australia, New Zealand, and the USA which makes the finding applicable to only populations residing in western countries, it clearly defines key areas that require attention to better incorporate cultural competency to the healthcare field.

Lines, Laurie-Ann, and Cynthia G. Jardine. “Connection to the Land as a Youth-Identified Social Determinant of Indigenous Peoples’ Health.” BMC Public Health, vol. 19, no. 1, 2019, pp. 176–176, Gale in Context, https://doi.org/10.1186/s12889-018-6383-8.

Marcelin, Jasmine R., et al. "The impact of unconscious bias in healthcare: how to recognize and mitigate it." The Journal of infectious diseases, vol. 220, no. 2, 2019, pp. S62-S73. Oxford Academic, https://doi.org/10.1093/infdis/jiz214

This study reviewed the biases that exist within medical education and how medical providers often do not represent the population within the US. Diversity within the healthcare field results in better delivery of care. The purpose is to describe tools to evaluate cultural incompetence and unconscious bias in healthcare. The article only utilizes data from Canada, Australia, New Zealand, and the USA, making the data very specific to western countries. 

Schwartz, S. J., et al. “Trajectories of Cultural Stressors and Effects on Mental Health and Substance Use Among Hispanic Immigrant Adolescents.” Journal of Adolescent Health, vol. 56, no. 4, 2015, pp. 433–439. ScienceDirect, https://doi.org/10.1016/j.jadohealth.2014.12.011

This study explored how cultural stressors can predict well-being and health risk behaviors among a sample of 302 Hispanic adolescents who recently immigrated to the US. Factors measured included bicultural stress, perceived discrimination, perceived context of reception, positive youth development, depressive symptoms, conduct problems, and substance use. Researchers found that cultural stressors have immediate and long-term effects on adjustment and health outcomes.

Shahin, Wejdan, et al. "The impact of personal and cultural beliefs on medication adherence of patients with chronic illnesses: a systematic review." Patient preference and adherence, vol. 13, 2019, pp. 1019-1035. Taylor & Francis Online, doi: 10.2147/PPA.S212046 

This study investigates the effect of cultural and personal beliefs on medication adherence for individuals with chronic illnesses. This was a systematic review of 25 articles. The review found a significant relationship between personal, cultural beliefs and medication adherence. The most significant likely predictor of medication adherence was the participant’s belief in their control over their illness. Additionally, factors like illness perception, nature and progression of disease, religious spiritual and cultural beliefs, and social health-care factors had an effect on medication adherence. One limitation is not discussing how important is a risk factor of medication adherence. 

Theroux, Rosemary, et al. “Working Hard: Women’s Self-Care Practices in Ghana.” Health Care for Women International, vol. 34, no. 8, 2013, pp. 651–73, Taylor & Francis Online, https://doi.org/10.1080/07399332.2012.736574.

Vaughn, Lisa M., et al. "Cultural health attributions, beliefs, and practices: Effects on healthcare and medical education." The Open Medical Education Journal, vol. 2, no. 1, 2009, Bentham Open, doi: 10.2174/1876519X00902010064

This article discusses the responsibility that medical educators have in ensuring that medical providers can address cultural factors that affect healthcare. A few factors important to building cultural competence are establishing trust between physicians and patients, understanding cultural differences, gaining cultural knowledge, health attributions that depend on cultural differences, diverse health and healing approaches, and having knowledge about illnesses that are tied to specific cultures. The article clearly outlines health-related factors in the immigrant community including the “healthy migrant”, acculturation, poverty, medical adherence, and different approaches to administering medical care, however it fails to discuss how these concepts can be applied to clinical systems.

Volkwein-Caplan, Karin A. E., editor. Ageing, Physical Activity and Health : International Perspectives. Routledge, 2018.

Wu, Wen-Hsiung, et al. "The Impact of Integrating Tribal Culture and Science Education Through Information and Communication Technology." Science & Education vol. 1, no. 18, 2022, Springer Link, https://doi-org.libproxy2.usc.edu/10.1007/s11191-022-00391-7

This study described the need for indigenous culture to be integrated into science education in the context of Taiwan’s Rukai tribe through information and communication technologies. This would help students understand scientific implications of their culture, and would acknowledge the cultural beliefs that have been passed down through generations. A few strengths of this study is that the researchers are from Taiwan, so they have a better understanding of indigenous communities in Taiwan. 

Part 2:

The frontiers of my knowledge were the understanding of how culture plays a role in health. I have always been interested in this topic because I am a child of immigrants, and I employ many of the cultural medicinal remedies, physical practices, and cultural practices that have direct health outcomes. For example, my family greatly believes in natural remedies to health issues, therefore we often refuse to take medication when we're sick unless it's absolutely necessary. Until this project, I didn’t know that many cultural factors affect medical adherence. According to Vaughn, Lisa M., et al, medical adherence is greatly dependent on whether the patients trust the physician (2009). This is related to my family, because my parents also show distrust in the medical system, claiming that providers always resort to medication rather than trying any natural solutions. I learned that there is literature in place to provide medical educators frameworks to teach cultural competence so that providers can create solutions that align with patients' belief systems. 

Many of the articles I chose solidified what I already knew. Many of the trends discussed in the articles include the lack of cultural competence in the health care setting, biases that limit the quality of healthcare, the experience of immigrants, previous health beliefs and more. These sources helped me gain a better understanding of the vocabulary used to address various issues within providing healthcare and healthcare outcomes. 

A perspective I didn’t consider before was how diversity within the healthcare field results in better cultural understanding.  Another surprising measure of health outcomes was patients’ confidence in their knowledge. Both of these made sense as I read it, but I always considered cultural and healthcare discrepancies as mostly due to lack of education. 

Another surprising thing was the analysis of cultural stressors by Schwartz, S. J., et al. In this study they discussed that targeting bicultural stress, perceived discrimination, perceived context of reception resulted in health outcomes can result in lower risk of substance abuse, higher self esteem, decreased symptoms of depression, and decreased aggressive and harmful behaviors  (2014). This made me think about the negative immigrant experiences that lead to worse health outcomes. 

In general, I found a large amount and significant sources about experiences and beliefs that affect different cultural communities, especially in the US. This surprised me because I realized that the relationship between culture and health outcomes have been studied for years, however there is still little to no institutional change that accounts for this diversity in the US. Additionally, the research from these articles solidified my understanding that cultural competence directly results in positive health outcomes. As someone who has volunteered at a clinic, I have seen how the understanding of different cultures isn’t embedded in the system and doctors rarely ever consider anything beyond family history when diagnosing a patient or providing interventions. Therefore, more research and work needs to be done to provide a framework to apply these results to medical education and the clinical systems in place to take care of patients. 

At first when researching, I found that there were significantly more studies about the western countries including the US and European countries than other countries. Although studies about global trends often cater to trends that exist in western countries and especially the US, I thought that there would be more comparisons that discuss cultures other than the US and Europe. My location in the US also results in more access to papers published in and about the US, but I noticed a trend of focusing on health trends within western countries when characterizing global health trends. There were many studies about specific populations, however I didn’t find any articles that compared multiple non-western countries to each other to discuss trends in health outcomes due to lifestyle and cultural influences. 

In future projects, I would be interested in writing an op-ed about how research is conducted and conclusions about cultural concepts like individualistic vs collectivist societies are drawn. Additionally, a topic I would find interesting to explore via an informative essay is creating a framework and methodology to be applied to the clinical setting that is a systematic way to address various cultural issues. I believe that these would allow me to further understand why cultural incompetence is still such a large issue in the US and globally. I believe that traditional writing genres like informational writing would be most appropriate for this topic since it is related to health and science, however I would be interested to explore how the information would exist in a multimedia analytical essay.