Culture influences all human behavior and dialectically shapes social institutions and social interactions among populations groups and individuals. Culture has many definitions, but all embody the underlying concept of implicit and explicit guidelines that are inherited and shared by members of a particular society or societal subgroup . These guidelines define ‘‘how to view the world, how to experience it emotionally, and how to behave in it in relation to other people, to supernatural forces or gods, and to the natural environment’’ .
These cultural perspectives are identifiable and transmitted from one generation to the next through distinctive symbols, language, and rituals. Of particular relevance to cross-cultural treatment issues, cultural influences on behavior tend to be relatively invisible. Certain types of behavior seem universal, natural, and nonnegotiable to those influenced by a given culture .
In fact, the influence of culture often becomes evident only when cultural differences are encountered, e.g., in interactions between individuals or groups that have contrasting beliefs, expectations, or values related to a particular issue; that is, one might not perceive that one
is operating within a culture until one has to operate outside of it.
To be theoretically sound, cultural adaptation strategies should link culturally influenced variables to specific aspects of treatment process and outcomes. Examples of such possible links from the client and provider perspective . For example, body image and other attitudes may have an influence primarily through effects on the motivation to seek treatment initially or to continue with treatment. Outreach to increase enrollment in a program might then employ persuasive strategies to increase awareness of the possible health or functional status benefits of modest weight loss (e.g., on blood pressure, breathing difficulties, or knee problems) as separate from potentially less salient social or physical attractiveness issues. Cultural sensitivity in the way treatment is delivered would be helpful in ensuring that participants fully engage in the process (quality of participation). The distinction between factors affecting initial adoption versus long-term behavior changes is informed by Rothman’s proposition that different theoretical models are needed to explain initial adoption and maintenance. For example, whereas initial adoption is related primarily to a desire to achieve a favorable outcome and expectations that these outcomes will be achieved, once adopted, behaviors may be maintained by satisfaction with the outcomes that result.
Thus, offering behavior change content in ways that are relevant to the patient’s lifestyle issues and accessible from the perspective of language and learning style would be expected to facilitate short-term behavior changes. Contextual factors such as the world view, the general salience of health considerations in making lifestyle choices, and the structural constraints would be most relevant at the level of maintaining long-term change. Ultimately then, the rewards of having lost weight must be sufficiently reinforcing (positively) within the applicable context to motivate continued practice of the altered eating and activity patterns or, rather, according to Bouton, to drown out the inherently strong reinforcement for the prior, original, and culturally embedded behavior pattern. Clinical programs may be able to maintain changes by providing continued reinforcement through continued treatment.
On the other hand, given the nature of obesity and its determinants, a better alternative might be to reframe obesity treatment within health promotion paradigms. Health promotion paradigms are broader than clinical paradigms, are more inclusive of contextual issues, and are ahead of clinical paradigms in articulating specific frameworks for addressing cultural variables.
These cultural perspectives are identifiable and transmitted from one generation to the next through distinctive symbols, language, and rituals. Of particular relevance to cross-cultural treatment issues, cultural influences on behavior tend to be relatively invisible. Certain types of behavior seem universal, natural, and nonnegotiable to those influenced by a given culture .
In fact, the influence of culture often becomes evident only when cultural differences are encountered, e.g., in interactions between individuals or groups that have contrasting beliefs, expectations, or values related to a particular issue; that is, one might not perceive that one
is operating within a culture until one has to operate outside of it.
To be theoretically sound, cultural adaptation strategies should link culturally influenced variables to specific aspects of treatment process and outcomes. Examples of such possible links from the client and provider perspective . For example, body image and other attitudes may have an influence primarily through effects on the motivation to seek treatment initially or to continue with treatment. Outreach to increase enrollment in a program might then employ persuasive strategies to increase awareness of the possible health or functional status benefits of modest weight loss (e.g., on blood pressure, breathing difficulties, or knee problems) as separate from potentially less salient social or physical attractiveness issues. Cultural sensitivity in the way treatment is delivered would be helpful in ensuring that participants fully engage in the process (quality of participation). The distinction between factors affecting initial adoption versus long-term behavior changes is informed by Rothman’s proposition that different theoretical models are needed to explain initial adoption and maintenance. For example, whereas initial adoption is related primarily to a desire to achieve a favorable outcome and expectations that these outcomes will be achieved, once adopted, behaviors may be maintained by satisfaction with the outcomes that result.
Thus, offering behavior change content in ways that are relevant to the patient’s lifestyle issues and accessible from the perspective of language and learning style would be expected to facilitate short-term behavior changes. Contextual factors such as the world view, the general salience of health considerations in making lifestyle choices, and the structural constraints would be most relevant at the level of maintaining long-term change. Ultimately then, the rewards of having lost weight must be sufficiently reinforcing (positively) within the applicable context to motivate continued practice of the altered eating and activity patterns or, rather, according to Bouton, to drown out the inherently strong reinforcement for the prior, original, and culturally embedded behavior pattern. Clinical programs may be able to maintain changes by providing continued reinforcement through continued treatment.
On the other hand, given the nature of obesity and its determinants, a better alternative might be to reframe obesity treatment within health promotion paradigms. Health promotion paradigms are broader than clinical paradigms, are more inclusive of contextual issues, and are ahead of clinical paradigms in articulating specific frameworks for addressing cultural variables.
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