Culture-centered Approach Research Articles

Structure as Depressant: Theorizing Narratives of Mental Health among Migrant Domestic Workers

ABSTRACT Articulating that domestic workers in Singapore are marked by their subalternity, erased from the hegemonic discursive spaces in spite of their visibility as objects in the neoliberal economy, this manuscript draws on the culture-centered approach to conceptualize listening as a structurally transformative anchor to theorizing mental health. The narratives offered by workers reveal critical insights into the way structure functions to create conditions of mental health suffering in the performance of precarious domestic work, intricately tied to the erasure of voice. The material violence on the bodies of workers relates to the everyday challenges to mental health. A lack of access to infrastructures of information and communication add to the conditions of marginality. In listening to these storied descriptions of suffering in precariousness, we hear voices revealing limited alternatives to mental health care in poor working conditions, with workers entrapped in a cycle of stress, worry, and fear.

“What If I Aint Ate in 2 Days, Why the Hell Would I Want You to Poke Into My Arm”: A Critical Cultural Analysis of Testing Makes Us Stronger

Despite medical advancements, Black gay, bisexual and other men who have sex with men (BMSM) are the group most disproportionately impacted by HIV in the United States. Recent figures estimate one in two Black MSM will be diagnosed with HIV in their lifetime. From 2011 to 2015, the Center for Disease Control ran Testing Makes Us Stronger, a health communication campaign designed to increase rates of HIV testing in the Black MSM community. Past studies document the campaign’s visibility, but fail to explain the continuous rise of HIV transmissions within the Black MSM community. Previous research on Testing Makes Us Stronger analyzes exposure to the campaign, but fails to capture the experiences and opinions of its target audience. Using the Culture-Centered Approach, this study conducted 20 semi-structured phone interviews to unveil how culture and systemic inequities influence rates of HIV transmission in the Black MSM community. Thematic analysis found three key themes: (1) trans invisibility, (2) call for holistic approaches and (3) importance of local organizations. Findings from the study suggest HIV campaigns would benefit from working in tandem with other organizations designed to combat systemic inequalities. Keywords: HIV, Black MSM, testing, campaign, critical health

Culture, Structure, and Health: Narratives of Low-income Bangladeshi Migrant Workers from the United Arab Emirates

ABSTRACT Increasingly, health scholars are paying attention to the health experiences of immigrant communities, particularly in the backdrop of the global flows of goods, services, and people across borders. In spite of the increasing public health emphasis on health outcomes of immigrants within the Middle Eastern (ME) countries, immigrant communities are often constructed as monoliths and the voices of immigrant communities are traditionally absent from mainstream health policy and program discourses. The health experiences of immigrants, their access to resources, and the health trajectories through the life-course followed by them and their descendants influence the deep-seated patterns of ethnic health disparities documented in the ME. Based on the culture-centered approach, we engaged in in-depth face-to-face interviews, and focus groups discussions with a total of 44 research participants, to understand how low-income Bangladeshi migrant workers in the United Arab Emirates (UAE), who live at the borders of mainstream Arab society, define, construct, and negotiate health issues. Participants articulate in their narratives their nuanced cultural understanding of good health as a complex, holistic practice, the achievement of which is obstructed by barriers such as immigration and insurance structures. Further, they enact their agency in resource impoverished circumstances to protect their mental health and physical well-being through daily strategies and acts of resistance.

Male partners’ influence on women’s acceptance and use of PrEP products across two high HIV-burdened districts in South Africa

The demonstrated efficacy of pre-exposure prophylaxis (PrEP) has brought hope of controlling the epidemic among women with limited HIV preventation options. Several studies have demonstrated the importance of male partner involvement in female sexual and reproductive health but there is limited research on male involvement in the adoption of HIV prevention methods among women. Using a culture-centred approach, this article discusses perceptions of female-initiated HIV prevention methods among men and women. The data were collected using eight sex-specific focus group discussions with a sample of men and women aged between 18 and 49 years from selected urban and rural settings in two provinces of South Africa, KwaZulu-Natal and Mpumalanga. Thematic analysis was utilised to identify four key themes: increased infidelity in relationships and risky behaviour; association of PrEP with casual relationships; a partner’s right to know that women are reducing their risk of HIV infection; and that men need to engage in decision-making on HIV risk reduction. The article highlights the importance of partner engagement and knowledge sharing of female-initiated prevention methods as part of a combination HIV-prevention strategy, and the urgency of creating enabling environments to utilise female-initiated methods.

Soul Food: [Re]framing the African-American Farming Crisis Using the Culture-Centered Approach

Historically, African-American farmers faced a long and challenging struggle to own land and operate independently. In recent years, several factors, including unfair policy legislation, institutionalized racism, the mechanization of agriculture and increases in agricultural technology have exacerbated land loss and decreases in farm ownership. Currently, African-American farmers are vastly underrepresented, comprising just 2% of the nation’s farmers, 0.5% of farmland and 0.2% of total agricultural sales. As a site for inquiry, this topic has been examined across many academic sub-disciplines, however, the literature not explored how the erasure of the African-American farmer influences the conversation about broader diet-related health disparities in the U.S. This overlooked perspective represents a novel approach to rethinking public health interventions and may improve methods for communicating messages about healthy eating to the African American community. In this essay, we extend Dutta’s (2008) Culture-Centered Approach (CCA) to foreground the lived experiences and perspectives of a small cohort of African-American farmers (n=12) living in the U.S. Mid-South as an entry point to address this underexamined area of research and inform future methodological directions of study. Two key themes emerged from the thematic analysis: (1) erasure of the African-American farming tradition and land loss; and (2) solutions to change. Drawing on the understanding that systematic land loss in the African-American community has contributed to wealth disparities between African-Americans and Whites, we argue that the erasure of the African-American farming tradition within mainstream discourses has created communication inequities that disenfranchise the African-American community and may contribute to broader health inequities in food system. Our findings may offer important insights into the methodological development of more effective health campaigns within these communities.

Refugee Articulations of Health: A Culture-Centered Exploration of Burmese Refugees’ Resettlement in the United States

ABSTRACT Grounded in the culture-centered approach that emphasizes dialogic engagement with communities at the margins to disrupt mainstream health discourses, this article explores articulations of health by the Burmese refugee community in the United States post resettlement. Due to forced migration, often fleeing violent political regimes in their home countries and surviving itinerantly in refugee camps and host countries, they face further disenfranchisement upon resettlement as a subset of immigrants who are thrust into an unfamiliar sociocultural setting with marginal federal support. Against this backdrop, the present research explores the narratives of Burmese refugees in the United States through in-depth interviews focusing on their meaning-making practices surrounding health and displays of agency in the face of structural healthcare barriers. The participants’ narratives articulate health as communal and familial safety in contrast to the mainstream discourse of disease prevention and individual lifestyle choices. They describe structural barriers to healthcare access in the form of the employment-insurance nexus, and also an intricate web of lack of access to health services resulting from linguistic isolation. Within such constraints they locate agency by utilizing community networks as mediators for infrastructural and cultural access and engage in practices seeking out providers with interpreters from within the Burmese community, as well as utilizing technology such as listservs and e-mails through informal networks often ignored by mainstream healthcare providers in the community.

A Meta-Theoretical Systematic Review of the Culture-Centered Approach to Health Communication: Toward a Refined, “Nested” Model

Abstract While the influence of the culture-centered approach (CCA; Dutta, 2008 ) on health communication scholarship is undeniable, there has been no evaluation of its application in the field. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews (Moher, Liberati, Tetzlaff & Altman, 2009), we analyzed a corpus of empirical, peer-reviewed literature (n = 47) that used the CCA. Our findings demonstrate that (a) the ontological axis of the CCA (culture, structure, and agency) was widely used as a heuristic for defining health problems; and (b) studies varied widely in their adoption of the CCA’s epistemological axis (that of dialogic co-construction with marginalized communities), either at the level of problem definition, problem interpretation, and/or community participation. Finally, while most studies reported self-reflexivity in design, we coded for methodological and philosophical reflexivity to assess fidelity to the CCA axiology. Based on the variations and consistencies in its use, we offer a refined, “nested” conceptualization of the CCA.

Public relations, indigeneity and colonization: Indigenous resistance as dialogic anchor

Cultural communication has been put forth in the context of globalization and the emergence of Indigenous movements as a framework for dialogue to be carried out by organizations (Love & Tilley, 2014). Concepts of Māori communication for instance have been foregrounded in the public relations literature to anchor strategies of effective engagement through dialogue, leading to the building of trust in Indigenous communities (Love & Tilley, 2014). Similarly, Indigenous engagement has been foregrounded as a key resource in achieving global sustainable development (Dutta, 2013, 2019). This turn to Indigenous cultural communication is broadly situated in the framing of indigeneity as a category to be developed within frameworks of dialogue and engagement, constituted within the structures of transnational capitalism (Dutta, 2019).Drawing from Dutta’s (2008) theorizing of the cultural sensitivity and culture-centered approaches to communication, we critically interrogate the hegemony of Indigenous dialogue as a strategy deployed by dominant organizations. Whereas cultural sensitivity incorporates cultural characteristics to serve organizational goals, cultural-centering serves as an anchor for collaborating with cultural communities at the margins in building “communicative infrastructures” for voice. Arguing that superficial markers of culture incorporated into engagement is a communicative inversion that serves the colonizing tools of transnational capital, we attend to culturally centered communication strategies of engagement that are grounded in resistance and emerge from within the voices of Indigenous movements that are increasingly threatened by ever-expanding colonial missions of globalization.Comparing across two case studies, one about the struggle of the Dongria Kondh in the Odisha state of Eastern India against mining capitalism, and the other a critical review of the use of Māori cultural knowledge in the public relations literature, we articulate indigeneity as a site of resistance within the meta-theoretical framework of the culture-centered approach (Dutta, 2008, 2011). In conceptualizing Indigenous resistance as an agonistic anchor to communication, we attend to the impossibilities of dialogue, and simultaneously to the role of communicative infrastructures in inverting neoliberal hegemony. Dialogue is radically transformed, not in generating consensus but rather in its capacity to disrupt the neoliberal status quo through the presence of Indigenous voices. Indigenous resistance “renders impure” the ontological category of dialogue, on one hand, attending to the limits of dialogue, and on the other hand, turns dialogic tools into the hands of Indigenous social movements. Dialogue as a communication infrastructure located materially within Indigenous resistance movements turns the power of communication into the hands of Indigenous communities.

Voices of Farmer-Widows Amid the Agrarian Crisis in India

This article centers the voices of the widows of farmers from Yavatmal, Maharashtra, who give meaning to the patriarchal structures that unfold amid neoliberal agriculture in India. The theoretical framework of the culture-centered approach presented in the article works in solidarity with transnational feminist scholarship to interrupt the dominant discourse of development that reproduces the disempowerment experienced by these widows. Based on in-depth interviews conducted across villages, this article foregrounds the meanings and explanations of India’s agrarian crisis through the voices of widows of farmers. Their narratives position the suicides of their husbands amid the high-investment Bt cotton farming that incurred debts from which it became impossible to recover. By deploying voices of the gendered subaltern to interrogate the agrarian crisis, the article highlights the multiple structures that make widows’ lives precarious. Their reflective journeys address the communicative erasures faced by the widows within households and the larger discourse of neoliberal development of agriculture.

Exploring the Health Narratives of Chinese Female Migrant Workers through Culture-Centered and Gender Perspectives

ABSTRACT Female migrant workers (FMWs) represent a marginalized group in China who not only face health disparities but also lack a voice in society. Drawing on the culture-centered approach (CCA) and gender perspective to co-construct health meanings with FMWs, this research aimed to answer the question of how FMWs narrate their health and to reveal the agency of the cultural members. The in-depth interview method was applied to record the health narratives of 30 participants from October 2016 to December 2016. The results showed that FMWs’ understandings of health were beset by the cultural system of gender in poverty, exploited working conditions, and discrimination in the medical context. The participants identified minimum wage and medical insurance as the key structural obstacles to healthy lives in the city. Moreover, FMWs had the agency to exercise health practices that challenge the domination of biomedicine. With gender issue threaded throughout the contextualized health narratives, the role of the gender perspective could be viewed as a “contact zone” in CCA. FMWs’ agency and its interactions with structures and culture indicate the significance of engaging the voices at the margins in health communication research and praxis.

Painting a Community-Based Definition of Health: A Culture-Centered Approach to Listening to Rural Voice in Chaquizhca, Ecuador

The terms “health” and “well-being” are commonly used in health communication research. These terms, despite calls for a consensus definition, are rarely explicitly defined. We argue that, instead of imposing a universal definition of health or well-being, communities can be better served if we adopt a culture-centered approach and listen to their local, contextualized definitions of health. To demonstrate community articulation of a definition of health, we offer an analysis of wall art created by and with a community and our service and research team. After understanding a definition offered by a rural community in Chaquizca, Ecuador, we articulate how a community-based definition of health can become a way to culture-centered way to operationalize definitions offered by the World Health Organization in ways that better serve local communities.

Listening to the Voices of Community Health Workers: A Multilevel, Culture-Centered Approach to Overcoming Structural Barriers in U.S. Latinx Communities.

Community Health Workers (CHWs) are often incorporated into efforts to reduce health disparities for vulnerable populations. However, their voices are rarely the focus of research when considering how to increase their job effectiveness and sustainability. The current study addresses this gap by privileging the voices of 28 CHWs who work with Latinx communities in Nebraska through in-depth, semistructured interviews. Using a multilevel, Culture-Centered Approach (CCA) to Health Communication, we identified two key structural communication issues: (a) increasing language accommodation and (b) increasing (and stabilizing) network integration across three ecological levels of health behavior (individual, microsystem, and exosystem). This study shows the uniquely valuable perspective that CHWs have as they navigate hierarchical health care structures and community cultures to meet the needs of their Latinx clients. Findings suggest that CHWs should be included in health care organization and policy discussions to reduce health disparities for Latinx populations.

Culture-centeredness in community-based participatory research: contributions to health education intervention research.

Health education research emphasizes the importance of cultural understanding and fit to achieve meaningful psycho-social research outcomes, community responsiveness and external validity to enhance health equity. However, many interventions address cultural fit through cultural competence and sensitivity approaches that are often superficial. The purpose of this study was to better situate culture within health education by operationalizing and testing new measures of the deeply grounded culture-centered approach (CCA) within the context of community-based participatory research (CBPR). A nation-wide mixed method sample of 200 CBPR partnerships included a survey questionnaire and in-depth case studies. The questionnaire enabled the development of a CCA scale using concepts of community voice/agency, reflexivity and structural transformation. Higher-order confirmatory factor analysis demonstrated factorial validity of the scale. Correlations supported convergent validity with positive associations between the CCA and partnership processes and capacity and health outcomes. Qualitative data from two CBPR case studies provided complementary socio-cultural historic background and cultural knowledge, grounding health education interventions and research design in specific contexts and communities. The CCA scale and case study analysis demonstrate key tools that community-academic research partnerships can use to assess deeper levels of culture centeredness for health education research.

A Qualitative Exploration of “Mother First” Identity and Antiretroviral Adherence among African American Women Living with HIV in the Mid-South Region of the United States

ABSTRACT The majority of African American women living with HIV are of child-bearing age and large numbers of these women express a desire to have children. Extant research suggests that motherhood provides HIV-positive women with a sense of hope and normalcy and, in some cases, is associated with positive HIV-related health behaviors. Guided by the tenets of the culture-centered approach (CCA), this qualitative study sought to understand the relationship between motherhood identity and ART adherence among a sample of 50 African American women living with HIV in the Mid-South region of the United States. Our theoretically-informed thematic analysis of in-depth interviews with all 50 women produced three primary themes: (1) experiencing HIV through the lens of motherhood, (2) the physical and social realities of the “mother first” orientation while living with HIV, and (3) the impact of the “mother first” orientation on ART adherence and self-care. These findings identify how participants’ “mother first” identity orientation interacts with their sociocultural environment to enable and constrain their attempts at ART adherence. The findings also provide empirical evidence to support the CCA’s theorizing regarding the ways in which the materiality of structures interact with symbolic cultural meanings to (re)produce health inequalities.

Community food assistance, informal social networks, and the labor of care

In 2016, the Atlanta Community Food Bank (ACFB) launched the Stabilizing Lives project to develop programs and policies that could better address clients’ needs as well as including clientele as part of the planning process. The ACFB partnered with a research team at the University of Georgia to conduct a participatory research project aimed at developing deeper insights into the factors contributing to both instability and stability in the lives of pantry clientele. This article describes the outcomes this research, offering both a substantive contribution to scholarship on food insecurity and emergency food systems and a methodological innovation through a staged mixed-method participatory research project. Through use of a culture-centered approach, this project created discursive spaces within which to outline emergency food models that support informal networks of care. We used a range of methods, including photo elicitation, concept mapping, individual interviews, and focus groups, to facilitate conversation among agency staff, volunteers, and clientele about the effectiveness of current program models and potential new ideas. Specifically, we suggest that through such practices, food pantries and local agencies may help inform new program models that contribute to household stability, and push back against the sometimes alienating and atomizing paradigm found in current emergency food programs.

Space within the Scientific Discourse for the Voice of the Other? Expressions of Community Voice in the Scientific Discourse of Community-Based Participatory Research

ABSTRACTCommunity-based participatory research (CBPR) has captured public health attention and support because it is positioned as an approach that involves researchers and communities as equitable partners in addressing health disparities. However, it is unknown the extent to which CBPR creates a participatory space in the scientific discourse to signal “community voice,” which we define as textual expression of community-centered perspectives on collective roles, interests, and worldviews. In this study, we utilized the culture-centered approach to examine the expression of community voice in the abstracts and public health relevance statements of 253 extramural CBPR projects in the U.S. that received funding from the National Institute of Health and Centers for Disease Control and Prevention in 2009. We found that project abstracts and public health relevance statements contain four textual domains, or potential sites of contest to signal the articulation of community agency and voice within the CBPR projects. These domains include: 1) the rationale for the community health issue, 2) the roles of community partners, 3) community-centered outcomes of the partnership, and 4) elements of participatory research process. The degree of culture-centeredness of the texts is suggested in the extent to which articulations of community agency and voice are signaled across the four domains. We conclude that the dynamics of CBPR may shape culture-centered expressions of problem identification, solution configuration, structural transformations, reflexivity, values, and agency in the project abstracts and public health relevance statements.

Geographic and Race/Ethnicity Differences in Patient Perceptions of Diabetes.

Objectives: The present study takes a culture-centered approach to better understand how the experiences of culture affect patient’s perception of type 2 diabetes mellitus (T2DM). This study explores personal models of T2DM and compares personal models across regional and race/ethnicity differences. Methods: In a practice-based research network, a cross-sectional survey was distributed to patients diagnosed with T2DM at medical centers in Nevada and Georgia. In analyses of covariance, controlling for age, health literacy, and patient activation, geographic location, and race/ethnicity were tested onto 5 dimensions of illness representation. Results: Among 685 patients, race/ethnicity was significantly associated with lower reported understanding diabetes (P < .01) and less perceived longevity of diabetes (P < .001). Geographic location was significantly associated with seriousness of the disease (P < .005) and impact of diabetes (P < .001). Conclusion: Non-Hispanic White Americans report greater understanding and perceive a longer disease course than non-Hispanic Black Americans and Asian Americans. Regionally, patients in Nevada perceive T2DM as more serious and having more impact on their lives than patients living in Georgia. Primary care physicians should elicit patient perceptions of diabetes within the context of the patient’s ethnic and geographic culture group to improve discussions about diabetes self-management. Specifically, primary care physicians should address the seriousness of a diabetes diagnosis and the chronic nature of the disease with patients who belong to communities with a higher prevalence of the disease.

Antibiotic-related meanings, experiences and information sources of women in the economic margins of urban Manila

PurposeDrawing insights from the culture-centered approach (Dutta-Bergman, 2004; Dutta, 2007), the purpose of this paper is to explore the meanings of, experiences with, and information sources for antibiotics among at-risk yet understudied populations in urban and economic margins in the Global South.Design/methodology/approachGiven the exploratory purpose of this paper, it used qualitative approach specifically focus group discussions with mothers, guardians and female senior citizens from Manila, Philippines.FindingsAntibiotics had multiple meanings – from purposes and modes of acquisition to side-effects. Experiences with antibiotics were not only tied to financial difficulties, but also in administering antibiotics to children or wards and managing side-effects. Furthermore, medical doctors were the most accessed and preferred sources of antibiotics-related information.Originality/valueTo date, this paper is one of the few to argue that knowing the conditions into which antibiotics are situated in the Global South is critical for strengthening global public health campaigns and policies against antimicrobial resistance a and reducing global health inequity.

Bridging Theory to Practice: Utilizing the CultureCentered Approach (CCA) to Address Gaps in Community Based Participatory Research (CBPR) Processes

Bridging Theory to Practice: Utilizing the CultureCentered Approach (CCA) to Address Gaps in Community Based Participatory Research (CBPR) Processes

Calibrating the tilted scale: (re)constructing fairness in fair wage discourse

ABSTRACTGuided by the practical question, ‘What is a fair wage?’, this paper takes a culture-centered approach to the discursive construction of a fair wage in the context of industrialized labor. Specifically, this study juxtaposes discursive constructions within (a) corporate social responsibility (CSR) communications concerning wage policies and practices and (b) industrial workers’ narratives about their experiences with wages. Thus, I demonstrate a mutually constitutive process in which the meaning of ‘fair wage’ results from and reifies the structures of supply chain labor. Specifically, I explore how wage fairness is understood in the context of legal and government mandates, international organizations’ recommendations, and the issue of labor sustainability. The culture-centered emphasis of the study explores the possibility of bringing alternative voices to mainstream articulations of labor rights.