Cultural Sensitivity

Cultural sensitivity refers to the process by which health research and intervention respond to the cultural belief systems, behaviors, experiences, and social context of populations. Culturally sensitive approaches acknowledge that conceptualizing determinants of health behaviors and outcomes, conducting research, and creating interventions to reduce disease risks may not rely on universally applied predictors, methods, or settings. In addition, certain constructs may not have the same meaning or may be experienced differently in diverse groups. In epidemiology, cultural sensitivity has relevance to both study design and health promotion.

When conducting research, a culturally sensitive approach is necessary from the beginning of the study design. To appropriately consider the role culture plays in health, local experience and cultural norms must be built into the study methodology. That is, the research question being asked and the extent to which it is appropriately informed by sociocultural factors are critical in conceptualizing the study. For example, if a researcher seeks to investigate the risk factors for experiencing depression and operationalizes depression as a psychological state involving feelings of sadness or being ‘down,’ this very definition will artificially restrict the research findings if the study is conducted in a population that expresses depressive symptomatology primarily in physical terms or through other psychological symptoms, such as boredom.

The measures that are used to assess both health outcomes and risk factors must be carefully considered. This can be particularly true for studies in psychiatric epidemiology, where measurement of mental, as opposed to physical, illness presents unique challenges. For example, conditions such as ‘dependent personality disorder’ are themselves strongly imbued with cultural notions of abnormality and adaptive functioning, and these are likely to be built into the tools that researchers use to assess outcomes. Moreover, many standardized scales with established reliability and validity were initially developed with European American populations, and their validity with culturally diverse groups has not been empirically tested.

However, cultural sensitivity also applies to physical outcomes such as heart disease or other conditions that were once thought to be relatively ‘culture-free.’ In this regard, researchers must attend closely to the ways in which risk factors are defined and assessed. For example, food frequency questionnaires are often used to measure dietary intake. If the measure is not culturally sensitive, it may not include a variety of foods that are commonly consumed in the target population. If this is the case, the researcher may need to modify the instrument by providing additional spaces to report commonly eaten foods. Ideally, however, the measure would already have been validated in the relevant population and would include any foods typically consumed by the population being studied. Examining associations between stress and illness is another relevant example. When assessing stress, researchers must ensure that the measures are notbasedonsourcesofstressthatarelikelytobe irrelevant to the population in question, and they may need to include culturally specific sources of stress, such as racism, discrimination, acculturative stress, or language barriers.

In the research setting, a culturally sensitive approach would also attend to the interaction between researchers and participants. For example, racial/ethnic matching may be necessary, meaning that researchers who interact with participants would be of the same race or ethnic group. This is particularly true for certain topics such as worldview, stigma, identity, and experiences with racism. In these and other contexts, participants’ responses can be significantly affected by the interviewer. Informed consent procedures can also be made more culturally sensitive by paying particular attention to participants’ level of familiarity with the research enterprise and exploring possible feelings of mistrust. Additionally, research has shown that most consent forms are written at literacy levels that are too high for many participants and contain many technical terms and jargon. Poor readability of consent forms is compounded for those with limited English proficiency.

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