Cultural Leverage

Abstract

The authors reviewed interventions using cultural leverage to narrow racial disparities in health care. Thirty-eight interventions of three types were identified: interventions that modified the health behaviors of individual patients of color, that increased the access of communities of color to the existing health care system, and that modified the health care system to better serve patients of color and their communities. Individual-level interventions typically tapped community members' expertise to shape programs. Access interventions largely involved screening programs, incorporating patient navigators and lay educators. Health care interventions focused on the roles of nurses, counselors, and community health workers to deliver culturally tailored health information. These interventions increased patients' knowledge for self-care, decreased barriers to access, and improved providers' cultural competence. The delivery of processes of care or intermediate health outcomes was significantly improved in 23 interventions. Interventions using cultural leverage show tremendous promise in reducing health disparities, but more research is needed to understand their health effects in combination with other interventions.

Dietary Behaviors of a Racially and Ethnically Diverse Sample of Overweight and Obese Californians

“…For example, given the central importance of close relationships for promoting positive health behaviors, particularly in Latino and Vietnamese populations (August & Sorkin, 2011), and the tendency for poorer eating behaviors to accompany acculturation, interventions targeting multigenerational family units may prove to be more effective than interventions targeting a single individual (Cousins et al, 1992). Such family-based interventions can emphasize healthy food choices that are not only compatible with the culture of origin but also leverage mutually influential close relationships within the family to facilitate behavioral change (Fisher, Burnet, Huang, Chin, & Cagney, 2007). Among African American/Black populations, for whom acculturative processes are largely stabilized over generations, but for whom widespread availability of unhealthy foods is particularly problematic (Hickson et al, 2011), interventions targeting community-based organizations (e.g., faith-based groups) to provide motivation, accountability, and support to promote sustainable health behavior changes may be most beneficial.…”

A Family-Based Diabetes Intervention for Hispanic Adults and Their Family Members

“…The short IPAQ provides information on time spent walking, in vigorous and moderate intensity activities, and in sedentary activities in the last 7 days. Total physical activity measured in minutes per week was used to determine whether participants met the 2008 Physical Activity Guidelines for Americans 26 Reliability and validity for the IPAQ have been established in 12 countries 27 and for patients with T2DM 28 .…”

A Comparison of a Centralized Versus De-centralized Recruitment Schema in Two Community-Based Participatory Research Studies for Cancer Prevention

“…This is of particular relevance when racial and ethnic minorities, such as AAs, are the focus of recruitment efforts. Integrating a CBPR-based recruitment approach may help AA community members to increase familiarity with research, thus mitigating mistrust of researchers and research experiences [7,22]. …”

“…Recruitment partnerships with AA churches, a cornerstone of AA culture and heritage, and involvement of local leaders in intervention research may assist with providing trusted information and advice [22,41]. While some of the benefits of CBPR have been documented, few studies have examined the strengths and weakness of different CBPR-based recruitment strategies [42,43].…”