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Multicultural Health

Chapter 2: Theories and Models

Related to Multicultural Health

Lois Ritter and Donald H. Graham

Overview of Chapter Topics

Personalistic, naturalistic, and biomedical theories of health/illness.
Principal health care approaches in U.S.
Biomedical and holistic
Cultural competence and related models.
Promoting cultural competence within an organization.
Assessment of individual cultural competence.
Assessment of organizational cultural competence.

Theories of Health and Illness

Share some examples of beliefs in a culture about how illness is caused and cured
e.g., Leaving the house with wet hair will give you a cold.

Theories of Health and Illness

Beliefs about health and illness impact people’s behaviors, what they do when they are ill, and where they seek care when illness occurs.
Three major theories about how to maintain health and how illness is caused include:

Personalistic

Naturalistic

Biomedical

Many people’s beliefs are a combination of these theories.

Personalistic Explanations of
Health and Illness

Illness is believed to be caused by the intentional intervention of an agent who may be a supernatural being (a deity or ancestral spirits) or a human being with special powers (a witch or sorcerer).
Illness is considered to be a direct result of the harmful influence of these agents and is often linked to the ill person’s behavior.

Personalistic Explanations of
Health and Illness

Recovery from an illness usually involves healers using supernatural means and rituals or symbolisms used by healers, such as shaman, who are trained in the healing methods.
Preventing personalistic illness includes avoiding situations that can provoke jealousy or envy, wearing certain amulets, adhering to social norms and moral behaviors, adhering to food taboos and restrictions, and performing certain rituals.

Naturalistic Explanations of
Health and Illness

Illness is explained by a natural disequilibrium.
When the body is in balance, health is achieved.
Naturalistic theories tend to view health as a state of harmony between the person and his or her environment; when this balance is upset, illness will result.

Naturalistic Explanations of
Health and Illness

Preventing naturalistic illness includes methods such as proper hygiene, a balanced diet, and meditation.
Three of the widely practiced approaches to curing naturalistically caused illness or explanations as to what causes illness are:

Humoral

Ayurvedic

Vitalistic

Naturalistic Explanations of
Health and Illness

Humoral: Based on the idea that our bodies have four important fluids or humors:

Blood

Phlegm

Black bile

Yellow bile

These 4 fluids are related to seasons, internal organs, physical qualities (hot/cold; wet/dry), and human temperaments.
Curing an illness involves discovering the complexion imbalance and rectifying it.

Naturalistic Explanations of
Health and Illness

Humor and related organ and complexion

Naturalistic Explanations of
Health and Illness

Ayurvedic: Based on the belief system that embraces the ideology that illness is caused by an energy imbalance.
The belief system has a long history and embraces the ideology that disease is a result of an imbalance in vital energies, which distinguish living and nonliving matter.
In ayurvedic medicine, the vital force is called the prana.

Naturalistic Explanations of
Health and Illness

“Ayurveda” is taken from the Sanskrit words ayus, meaning life or life span, and veda, meaning knowledge.
The system links the body’s chakras, or energy centers associated with organs of the body.

Naturalistic Explanations of
Health and Illness

Ayurvedic suggests that three primary principles govern every human body.
These principles are called doshas, which are derived from the 5 elements:

Earth

Air

Water

Fire

Space

Naturalistic Explanations of
Health and Illness

Vitalistic is defined as the concept that bodily functions are due to a vital principle or “life force” distinct from physical forces explainable by the laws of chemistry and physics and detectable by scientific instrumentation.
It is built on the belief that an imbalance in the system vital energies cause disease.
Illness results when the smooth flow of energy is disrupted.
Imbalance is related to the polar opposites yin (female, dark, cold) and yang (male, light, hot) in which one combines the interaction of body fluids and energy channels or meridians.

Biomedical Explanations of
Health and Illness

Illness is identified and cured using scientific evidence.
Cause of illness is physiological in nature.
Spirituality is generally kept separate from health and healing matters.
Mental health problems are generally viewed as disorders of the mind and physicians tend to treat these disorders by affecting brain physiology with pharmaceuticals or with counseling or behavior modification.

Biomedical Explanations of
Health and Illness

Allopathic medicine is the type most familiar to westerners today.
Allopathy is a biologically based approach to healing.
A core assumption of the value system of allopathic medicine is that diagnosis and treatment should be based on scientific data.
The system is built on a molecular understanding of the mechanisms underlying disease, and thus lays the foundation of all medical application, diagnosis, and treatment.

Biomedical Explanations of
Health and Illness

Germ theory of disease is a core component of contemporary allopathic medicine.
The theory proposes that microorganisms are the cause of many diseases.

Pathways to Care

Two general systems:

Biomedical

Holistic

People may select a system based on culture, access to care, health beliefs, and affordability.

Pathways to Care

Biomedical (or allopathic) approach
Often viewed as scientific
Focuses on physical components of illness.
Care provided by licensed professionals such as doctors, nurses, physical therapists.
Holistic approach (alternative or complementary)
Viewed by some as unscientific.
Based on a psychosocial model of health care.
Providers have vast levels of training—few training and licensing standards.

Cultural Competence

Defined: “ Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.” (CDC, 2020).
Cultural competence occurs when an individual or organization has the ability to function effectively within the cultural context of beliefs, behaviors, and needs of the patients or community that they serve.

Cultural Competence

The ability to be culturally competent occurs on a continuum.
This does not mean that people need to understand everything about all cultures.
People need to be respectful of and sensitive to cultural differences.
People must avoid stereotyping, judgment, and misapplication of scientific knowledge.

Cultural Competence Models

Campinha-Bacote’s Process of Cultural Competence in the Delivery of Health Care Services

Purnell’s Model for Cultural Competence

Leininger’s Sunrise Model

Cultural Competence Model

Campinha-Bacote’s model is based on five constructs:

Cultural awareness

Cultural knowledge

Cultural skill

Cultural encounter

Cultural desire

Cultural Competence Model

Purnell’s model is based on concentric social rings:
The individual person
That person’s family
That person’s community
Global society

Cultural Competence Model

Figure 2-3: The Purnell Model for Cultural Competence

Cultural Competence Model

Leininger’s Sunrise model.
Worldview flows into knowledge about individuals, families, groups, communities, and institutions in diverse health care systems.
It includes various dimensions of culture such as religion, economics, kinship/social, tech-nological, educational, legal, political, and philosophical factors.

Sunrise Model

Figure 2-x:
The Sunrise Model

Summary

There are different perspectives about health and illness.
These perspective influence how, where, when, and why we seek care.
There are two primary pathways to care: biomedical and holistic.
Cultural competence is important and occurs on a continuum.