A report from the National Institutes of Health in March offers researchers guidance on how to incorporate cultural variables in their health and mental health-care research.
The report is important because research often highlights culture as a powerful force in determining health outcomes, but rarely defines or correctly measures it, says lead author Marjorie Kagawa Singer, PhD, a professor of public health and Asian-American studies at the University of California, Los Angeles.
"The report provides a tool to help researchers and funders identify which aspects of culture may help to drive good or poor health outcomes," she says.
"Right now, many researchers erroneouslyuse ethnicity or race to describe a group or groups of study participants, assuming that these race or ethnic identifiers can substitute for cultural factors or differences," she adds. "This practice tends to miss or negate the complex and dynamic nature of culture," and hence contribute to the likelihood of disparities in health care.
The 319-page report, called The Cultural Framework for Healthopens in new window, is the result of 18 months of work by 30 experts from seven disciplines — psychology, anthropology, medicine, nursing, psychiatry, public health and sociology — who worked together to develop a consensus definition of culture and recommendations on how to more accurately apply it in health research.
A resulting practical tool is a "flow map" of questions that researchers can use when considering the role of culture in areas like health behavior research, research with diverse racial or ethnic groups, and implementation science.
The map avoids prescribing universal instructions or definitions, instead encouraging researchers to be explicit and precise in the ways they consider cultural variables in their individual studies. The aim is to capture an accurately nuanced view of cultural factors that also produces findings that can be generalized to populations in similar circumstances — an important consideration for funders, says William N. Elwood, PhD, project officer for the report and one of its four main authors. A hypothetical example he gives is a study that tests interventions to improve people's attitudes, beliefs and behaviors toward organ and tissue transplantation, designing the interventions in ways that take into account cultural nuances as well as general effectiveness.
Psychologist and report contributor Joseph E. Trimble, PhD, a professor at Western Washington University, says a deeper and more sophisticated understanding of culture is long overdue in research.
"In general, researchers have avoided addressing the deep cultures of different ethnic groups, or even the cultures within ethnic groups," he says. To properly address a community's needs, "researchers need close collaboration with the culture of the community, regardless of what ethnicity is involved."
By fostering a more comprehensive view of culture, the report will help researchers develop a fuller understanding of the underlying mechanisms that maintain health disparities, adds Tiffany G. Townsend, PhD, senior director of APA's Office of Ethnic Minority Affairs. Factors such as gender, nationality, immigrant status and sexual orientation are just a few additional contextual elements that can help paint a more accurate picture of what influences the lives and health of study participants, she says.
One of the most important of these additional ingredients is social class, adds Keyona King-Tsikata, director of APA's Office on Social Economic Status.
"Economic and class status have tremendous impact on health outcomes," she says. "So any comprehensive definition of culture must carefully and critically address individual and contextual economic environments and social class."
The report is available at onlineopens in new window. For additional information on this topic, see the APA publication Guidelines for Research in Ethnic Minority Communitiesopens in new window.
— Tori DeAngelis