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Cultural Competence

Where will I find the Toolkit section?

Developing Culturally Relevant Health Communication Strategies begins on p.49 of the Toolkit!

What will I find in this section?

  1. The Toolkit encourages practitioners to consider cultural competence throughout the entire Health Equity in Obesity Prevention Planning Process.
  2. For this section, to access specific instructions, tools, and recommendations, we suggest referring to the additional references listed on this website.

Why consider cultural competence?

It is important to communicate effectively to both the disparately affected population(s) of interest as well as other key stakeholders at the community, state, and national levels.

The diagram of the Social Ecological Model (SEM) below depicts how health behaviors of an individual (inner oval) are influenced by the interpersonal, organizational, community, and public policy contexts and environment in which that person exists. Cultural context resides in the interpersonal band, making it a critical consideration when designing any communication plan. All obesity prevention communications should take the culture (e.g., language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups) of the target population into consideration to be effective. Interventions that successfully achieve this goal demonstrate cultural competence – behaviors, attitudes, and policies that come together in a system, agency, or among professionals to enable people to work effectively in a cross-cultural situation.

This model is a visual representation of the Social Ecological Framework (SEM). The inner most circle of this stacked Venn diagram symbolizes the individual or most base level of the SEM; and from there widening circles evolve to indicate the remaining the levels : interpersonal, institutions and organizations, community, and finally the structures and systems level.

When should I consider cultural competence?

Culturally relevant communications and marketing strategies should be created following the development of your program to promote the initiative. However, considerations of cultural competence should also be taken into account throughout each step of the planning process.

How to develop culturally relevant health communication strategies?

There are a variety of approaches to develop a communication plan. The publication A Public Health Communication Planning Framework [PDF–2.71Mb] is an online tool that provides an approach for communication planning. Here are steps to achieving culturally competent communication strategies:

  1. Develop Cultural Competence
    • Learn about populations affected by obesity-related disparities in your area, paying careful attention to subpopulations, level of acculturation, history, rates of obesity, and obesity-related social norms.
    • An excellent presentation of a framework for viewing culture and obesity through a health equity lens can be found at Cultural Competency in Obesity Prevention. [PDF–263Kb]
    • The Network for a Healthy California Retail Program has developed sophisticated materials for promoting fruits and vegetables, available to merchants statewide. Other projects, such as the Healthy Stores Project at the Johns Hopkins Bloomberg School of Public Health, use ethnographic approaches to identify and test appropriate cultural metaphors for healthy eating.
  2. Appropriately frame the communication and social marketing campaign
  3. Pilot test
    • It is important to include qualitative research methods such as key informant interviews and focus groups in order to capture valuable feedback on your plans and messaging to decrease the chance of overlooking any important issues. Pilot testing helps to ensure messages are clear, appropriate, effective, and not offensive to the intended audience.
    • Continue the campaign through adoption and implementation of the program or intervention. To receive the maximum benefit from the hard work of the coalition members, the communication or social marketing campaign should continue through the implementation phase of the program (or the adoption phase if it’s a policy).
  4. Evaluate the impact of the communication or social marketing on the selected population
    • Evaluation reveals how effective your communication and social marketing effort was in reaching the selected population(s). Depending on your initial goals for the communication effort, evaluation will help you determine the extent to which awareness of nutrition, physical activity, and obesity targets increased, or changes occurred in the population’s attitudes, beliefs, knowledge, and behaviors. Evaluation is also used to increase the efficacy of future communication efforts tailored to the population.

Additional communication and marketing resources and tools Include:

  1. USF Health Sciences Center’s Obesity Prevention Coordinators’ Social Marketing Guidebook [PDF–2.6Mb] provides a detailed description of the steps to develop a social marketing plan to address obesity. The appendices contain valuable tools that you can use to execute each step.
  2. DNPAO Website on Social Marketing Resources provides a compendium of resources on social marketing techniques that can be used to address obesity disparities. These include efforts targeted at policy and environmental level change.

The steps above direct the development of culturally competent communication and marketing strategies to promote a finalized program. Remember though that these tools may also be applied during the planning stages to increase potential impact and sustainability.

The following two planning steps are especially important for the consideration of cultural relevance:

  1. Gathering and Using Data
    • Identify the population(s) disproportionately affected by obesity
    • Analyze existing surveillance data on obesity rates by various population characteristics or conduct a population needs assessment to identify the populations who are most disproportionately impacted by obesity. This allows you to identify the group(s) of interest for your obesity disparities initiative and also one of the primary population(s) for your communication efforts.
  2. Develop Multi-Sector Partnerships
    • Include representatives of the selected population(s) in all phases of the program, from formative research and planning through implementation and evaluation.
    • Assemble a small advisory group consisting of members from the intervention target population(s). There are a variety of strategies to recruit advisory group members, ranging from posting signs in strategic places, utilizing the internet, or simple word-of-mouth. This is critical to ensure that the perspectives and concerns of the target population(s) are fully taken into account.

The Washington Department of Health [PDF–1.03Mb] used a social marketing approach to forming coalitions that developed community action plans focusing on environmental and policy approaches to increasing physical activity and healthy eating.

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