RTI International is a trade name of Research Triangle Institute Reaching a Culturally Diverse Community Barri Burrus, Ph.D., Phillip Graham, DrPH, Maria Girlando; BA Linda Bailey Stone, MS; Mary Council, BA - RTI International Presented at the North Carolina’s Health & Wellness Trust Fund’s Annual Meeting October 23, 2009 Greensboro, NC

Overview Introduction to RTI team Session approach Defining the terms Highlights on cultural tailoring Working within the community setting

What Do We Mean By “Culture” Examples from Merriam Webster: the customary beliefs, social forms, and material traits of a racial, religious, or social group; the set of shared attitudes, values, goals, and practices that characterizes an institution or organization the integrated pattern of human knowledge, belief, and behavior that depends upon the capacity for learning and transmitting knowledge to succeeding generations the set of values, conventions, or social practices associated with a particular field, activity, or societal characteristic

Breaking Down the Definition The customary beliefs, social forms, and material traits of a racial, religious, or social group; the set of shared attitudes, values, goals, and practices that characterizes an institution or organization –Culture is not just determined by race and ethnicity…also has religious culture, regional culture, youth culture, etc. –Although culture is viewed from a group perspective, the blending of all of the different components in an individual contributes to that person’s individuality

Breaking Down the Definition (cont.) The integrated pattern of human knowledge, belief, and behavior that depends on the capacity for learning and transmitting knowledge to succeeding generations –Culture is a learned phenomenon rather than a biological or fixed characteristic –Cultures evolve over time Examples: ethnic groups, youth cultures

Breaking Down the Definition (cont.) The set of values, conventions, or social practices associated with a particular field, activity, or societal characteristic –Cultural lenses include many different aspects that influence a person’s “world” view –Cultural lenses can’t be determined by looking at the person

Examples of Possible Cultural Components at the Individual Level Religious Belief System Ethnic Affiliation SES Status Age Group Geographic Region Peer Group

Diversity Diversity―composed of distinct or unlike elements or qualities (Merriam Webster) Example: Diverse cultures

Cultural Diversity

Cultural Relativism Ethnicity refers to selected cultural and sometimes physical characteristics used to classify people into groups or categories considered to be significantly different from others. Commonly recognized American ethnic groups include American Indians, Latinos, Chinese, African Americans, European Americans, etc. Cultural relativism: judging and interpreting the behavior and beliefs of others in terms of their own cultural traditions and experiences. This suspension of one’s own ethnocentric views is necessary in order to begin to truly understand another culture or ethnic group. Source:

Implications for Interventions: Some Do’s and Don’ts Don’t generalize by “race,” “culture,” or “ethnic” characteristics Do seek to understand the cultural context in your communities Do focus on commonalities for your community Do continue to focus on priority population groups DO focus on the “culture” of youth at risk DO focus on the “culture” of youth at risk within priority groups

Culturally Tailored Interventions  The extent to which ethnic/cultural characteristics, experiences, norms, values, behavioral patterns, and beliefs of a target population as well as relevant historical, environmental, and social forces are incorporated in the design, delivery, and evaluation of targeted health promotion materials and programs.  Resnicow, K., Baranowski, T., Ahluwahlia, J. S. and Braithwaite, R. L. (1999) Cultural sensitivity in public health: defined and demystified. Ethnicity and Disease, 9, 10–21 12

Keys for Reaching Cultural Diverse Groups We are committed to ensuring culturally competent approaches by developing culturally diverse teams that are reflective of the priority populations with whom we are working. Cultural competence of team members Members of the priority population group to be served should be included in the planning and implementation process to help guide what is to be done and how it is to be accomplished. Inclusivity The intervention is occurring within a community setting and in a unique cultural context. The intervention activities should be respectful of, and sensitive to that context. Cultural appropriateness of the intervention

Culturally tailored programs  The extent to which ethnic/cultural characteristics, experiences, norms, values, behavioral patterns, and beliefs of a target population as well as relevant historical, environmental, and social forces are incorporated in the design, delivery, and evaluation of targeted health promotion materials and programs.  Resnicow, K., Baranowski, T., Ahluwahlia, J. S. and Braithwaite, R. L. (1999) Cultural sensitivity in public health: defined and demystified. Ethnicity and Disease, 9, 10–21 August

Cultural tailoring Hire knowledgeable and culturally competent staff Conduct formative research Identify the community’s priorities Engage stakeholders in project planning Design services /materials specifically for targeted population Field test materials Document effective recruitment and retention strategies August

What Does It Mean to Have Culturally Competent Staff?  Considerations –Geography –Urbanicity –Race/Ethnicity –Gender

Operationalization at Different Levels  State-level Considerations  Regional-level Considerations  Community-level Considerations  Programmatic-level Considerations

Overarching Examples & Principles  CSAP’s State Incentive Grant program –Vermont –Louisiana –Maine –Nebraska –North Carolina –Georgia –District of Columbia

Application to Teen TUPC Grantees  Identify needed skill set  Understand the community context  Understand the specific needs of program participants (i.e., what are the underlying contributing factors to tobacco use among the groups you are working with)  Where attributes are needed to have credibility among program participants?

Key Take Home Message  Having culturally competent staff is only second to selecting and implementing culturally competent evidence- based strategies.  Being culturally competent means more than just looking like program participants  Understanding the community context that allows target risk behaviors to operate must be fully assessed to appropriately engage program participants  Staff must demonstrate a working knowledge or understanding challenges and barriers encountered by program participants  Bicultural competence