MPH 550 Module 5 Culture and Health Behavior Example

More Than Translation: Culture, Health Behavior and Culturally Appropriate Health Education

Student Name

Master of Public Health Program, Aspen University

MPH 550: Health Behavior and Health Education

Instructor Name

Month Day, Year

More Than Translation: Culture, Health Behavior and Culturally Appropriate Health Education

Culture shapes what people eat, how they understand illness, whom they trust and how they make decisions. Health education that ignores culture risks being irrelevant or even offensive, while education that relies on stereotypes risks treating individuals as if they were all the same. This paper examines how culture influences health behavior and how health education can be culturally appropriate, applying the ideas to a composite diabetes program for Vietnamese American adults.

Culture and Behavior

Culture includes shared values, beliefs, practices and ways of communicating. It influences diet, physical activity, views on medication, family roles in decisions and attitudes toward health care. Culture is not fixed; it varies within groups and changes across generations, with migration and with contact between groups.

Surface and Deep Structure

Cultural appropriateness can be described at two levels. Surface structure involves matching materials and messages to observable characteristics, such as language, images, foods and settings. Deep structure involves reflecting the cultural, social, historical and psychological forces that influence behavior, such as family obligations, spiritual beliefs or experiences of discrimination. Deep structure determines whether a program has real impact.

Five Strategies

One widely used framework sorts ways of fitting programs to a culture into five groups: peripheral approaches that give materials a familiar look; evidential strategies that present data on the health problem in the group; linguistic strategies that use the group's language; constituent-involving approaches that bring group members in as staff and advisors; and sociocultural strategies that place health issues in the context of the group's values and characteristics (Kreuter et al., 2003). The framework also distinguishes targeting materials to a group from tailoring them to an individual.

The Composite Program

A composite community health center serves a large Vietnamese American population, with high rates of type 2 diabetes among older adults. Its English-language diabetes classes were poorly attended by Vietnamese-speaking patients. The center redesigned the program using the five strategies.

Food and Family

Rice is central to many Vietnamese meals, and advice to cut it out felt unrealistic and disrespectful. The program instead taught portion sizes, brown rice mixtures and balancing rice with vegetables and protein. Because adult children often cook for and advise older parents, family members were invited to sessions, reflecting deep-structure values of family responsibility. Recipes were tested by participants before being printed.

Traditional Medicine

Many participants used herbal remedies. Instead of dismissing them, educators asked about them, explained possible interactions with diabetes medications and encouraged patients to tell their clinicians. Respectful curiosity built trust and made participants more willing to take prescribed medications.

Avoiding Stereotypes

Cultural adaptation can slide into stereotype if it assumes all members of a group share the same beliefs. Evidence on vaccine attitudes illustrates the risk: a review of HPV vaccine acceptability found that African American, Hispanic and White respondents were equally accepting of the vaccine (Brewer & Fazekas, 2007). Assuming lower acceptance in a group could lead to misplaced messaging. Tailoring to individuals, by asking about their own beliefs, helps avoid stereotypes.

Cultural Humility

Cultural humility is a lifelong practice of self-reflection, learning from others and addressing power imbalances between educators and communities. It shifts the goal from mastering facts about a culture to listening, asking and partnering. For health educators, it means treating community members as experts in their own lives.

Social and Economic Context

Culture interacts with social and economic conditions. Some participants worked long hours in nail salons or restaurants, lacked time for exercise and faced language barriers in health care. Social determinants shape health across the social gradient (Marmot, 2005), and cultural programs should address practical barriers such as scheduling and transportation as well as beliefs.

Results

After the redesign, class enrollment among Vietnamese-speaking patients tripled, and participants' average A1C fell by 0.8 percentage points over six months. Participants said the classes felt like they were made for them. The advisory group continues to review materials. Attendance among family members also grew, and several adult children began cooking the rice-based meal plans at home.

Community Health Workers

Bilingual community health workers were central to the redesign. Sharing language and culture with participants, they made home visits, helped with appointments and answered questions between classes. Their presence embodied the constituent-involving strategy and built trust faster than clinic staff alone could.

Generational Differences

Older immigrants and their U.S.-born children often held different beliefs and preferences. The program offered materials in both Vietnamese and English and encouraged intergenerational conversations, recognizing that culture within a family is not uniform.

Evaluating Cultural Fit

The center asked participants whether materials felt relevant and respectful, tracked attendance by language and compared outcomes between Vietnamese- and English-speaking participants. Such evaluation shows whether adaptation reaches its goals and where further changes are needed.

Lessons for Other Groups

The five strategies apply to any cultural group, but their content must come from each community. Health educators working with other populations should begin by listening, forming advisory groups and learning about both surface and deep structure before designing materials.

Limitations

Cultural adaptation takes time and resources, and evidence on which strategies matter most is still developing. Programs should evaluate their adaptations rather than assume that culturally tailored materials automatically work better.

Staff Training

All program staff completed training in cultural humility and in working with interpreters. Clinicians learned common Vietnamese terms for diabetes and blood sugar and how to ask about traditional remedies without judgment.

Conclusion

Culture shapes health behavior at both surface and deep levels, and culturally appropriate health education addresses both. Using peripheral, evidential, linguistic, constituent-involving and sociocultural strategies, the composite program made diabetes education relevant and respectful for Vietnamese American adults. Combining cultural adaptation with individual tailoring and cultural humility helps avoid stereotypes and builds trust.

References

Brewer, N. T., & Fazekas, K. I. (2007). Predictors of HPV vaccine acceptability: A theory-informed, systematic review. Preventive Medicine, 45(2-3), 107-114. https://doi.org/10.1016/j.ypmed.2007.05.013

Kreuter, M. W., Lukwago, S. N., Bucholtz, D. C., Clark, E. M., & Sanders-Thompson, V. (2003). Achieving cultural appropriateness in health promotion programs: Targeted and tailored approaches. Health Education & Behavior, 30(2), 133-146. https://doi.org/10.1177/1090198102251021

Marmot, M. (2005). Social determinants of health inequalities. The Lancet, 365(9464), 1099-1104. https://doi.org/10.1016/S0140-6736(05)71146-6