Cross-Cultural Perspective in Health Care:
When Culture Matters!
Elizabeth Trejos-Castillo, Ph.D.
TTU Human Development & Family Studies
--“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)
The Greatest Sin of Specialists:
Knowledge Bias
“Emic” (insider) vs. “Etic” (outsider) views in Health Care
“Disease”, “Illness”,
or
“Sickness”?
“Social Constructionism”
or
“Biological Reductionism”
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)
“Understanding Pain”
“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)
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).
Trejos-Castillo, E., & Vazsonyi, A.T. (In-press)
Diversity = True Multiculturalism?...
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:
a. Response Consistency: similar use of response categories
b. Item Equivalence: respondents can related to items
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?

Table 2. Mean Level Comparisons of T1 Parenting Processes and T2 Risky
Sexual Behaviors by Immigration Status
1st Generation
Immigrant
Hispanic Youth
Parenting Processes (T1)
Items
(range)
Autonomy Granting
M
2nd Generation
Immigrant
Hispanic Youth
SD
M
SD
p
7 (0-7) 2.49
1.75
2.19
1.57
.614
Support
5 (5)
4.43
.585
4.39
.680
.915
Communication
4 (0-4) 1.80
1.30
1.94
1.28
.872
Risky Sexual Behaviors (T2) 6 (0-6) .663
.883
.717
.950
.499
Trejos-Castillo, E., & Vazsonyi, A.T. (In-press)
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!...
“Translation process should be focused
not merely on language transfer but also
—and most importantly—
on cultural transposition.”
(Karamanian, 2002)
Becoming Culturally Competent
Cross-Cultural Research
Cavusgil S.T., & Das, A. (1997).
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
"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)
References
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Cavusgil S.T., & Das, A. (1997). Methodology issues in cross-cultural sourcing research - A primer. Marketing Intelligence &
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meeting of the American Sociological Association, New York, NY.
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WHO (2003). Preamble to the Constitution of the World Health Organization as adopted by the International Health
Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the
World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.