Culture Matters in Communicating the Global Response to COVID-19.

Current communication messages in the COVID-19 pandemic tend to focus more on individual risks than community risks resulting from existing inequities. Culture is central to an effective community-engaged public health communication to reduce collective risks. In this commentary, we discuss the importance of culture in unpacking messages that may be the same globally (physical/social distancing) yet different across cultures and communities (individualist versus collectivist). Structural inequity continues to fuel the disproportionate impact of COVID-19 on black and brown communities nationally and globally. PEN-3 offers a cultural framework for a community-engaged global communication response to COVID-19.

Role of healthcare in childbearing decision-making of WLHA in Nigeria: Application of PEN-3 cultural model.

Healthcare experiences among women living with HIV/AIDS (WLHA), determine their utilisation of sexual and reproductive health services, which ultimately influences their decisions on childbearing. This study aimed to understand the importance of healthcare support in the childbearing decision-making processes of WLHA, and its impact on eliminating new paediatric HIV infections. We conducted in-depth interviews between July and August 2012 with 15 WLHA receiving clinical HIV care at a teaching hospital in Lagos. Using PEN-3 cultural model, as a guide we explored perceptions of healthcare support pre- and post-partum. Findings indicate that faith in God for the delivery of a healthy child is significant during the pre-partum period, while the advice of healthcare workers concerning childbearing and access to available healthcare services carry more weight post-partum. Our findings have important implications for HIV treatment and care programmes geared towards WLHA considering childbearing, and ultimately the UN Global plan to eliminate mother-to-child transmission of HIV, as we move towards the 2030 agenda for sustainable development.

I sleep, because we sleep: a synthesis on the role of culture in sleep behavior research.

AIM: The aim of this study was to synthesize the literature on the cultural aspects of sleep and their relevance to behavioral sleep research. METHODS: A narrative synthesis of the existing literature on sleep was conducted with a focus on its biological, sociological, political, and anthropological aspects. This synthesis was guided by the PEN-3 cultural model, developed by the primary author. RESULTS: The findings highlight the cross-cultural contexts within which people sleep and the role of varied sleeping arrangements in influencing sleep behavior and perspectives. Furthermore, the contexts in which sleep occurs, coupled with the influence of the family, and the positive aspects of sleep helped illustrate why cultural aspects of sleep are vital for a broader understanding of sleep. DISCUSSION: The authors conclude by highlighting the need to integrate studies on the biological, sociological, and political aspects of sleep. Our examination of the literature strongly suggests that careful assessment of epidemiological and clinical sleep data should consider the cultural aspects of sleep as well as the context in which sleep occurs, the role of the family, and positive aspects of sleep.

Childbearing Decision Making: A Qualitative Study of Women Living with HIV/AIDS in Southwest Nigeria.

Using the PEN-3 model, the purpose of this qualitative study was to understand the factors responsible for the childbearing decisions of women living with HIV/AIDS (WLHA) in Lagos, Nigeria. Sixty WLHA who sought care at a teaching hospital in Lagos were recruited to participate in in-depth interviews. The average age of the participants was 30 years, and 48 participants were receiving antiretroviral therapy. Healthcare and spiritual practices, healthcare provider-patient communication about childbearing, and husband/partner support emerged as factors that contribute to the childbearing decisions of WLHA. The findings reveal the importance of discussing sexual reproductive health and childbearing issues with WLHA in the healthcare context prior to pregnancy.

"My mother told me I must not cook anymore"--food, culture, and the context of HIV- and AIDS-related stigma in three communities in South Africa.

The purpose of this study was to examine the role of food as an instrument in expressing and experiencing HIV/AIDS stigma by HIV-positive women and their families, with the goal of reducing discrimination. It goes beyond willingness to share utensils, which has been identified in HIV/AIDS research. As part of an ongoing capacity-building HIV/AIDS stigma project in South Africa, 25 focus groups and 15 key informant interviews were conducted among 195 women and 54 men in three Black communities. Participants were asked to discuss how they were treated in the family as women living with HIV and AIDS, and data was organized using the PEN-3 model. Findings highlight both the positive and negative experiences HIV-positive women encounter. Women would not disclose their HIV status to avoid being isolated from participating in the socio-cultural aspects of food preparation, while others that have disclosed their status have experienced alienation. The symbolic meanings of food should be a major consideration when addressing the elimination of HIV/AIDS stigma in South Africa.

Family systems and HIV/AIDS in South Africa.

This study examines the role of family in the care and support of people living with HIV/AIDS (PLWHA) as a way of reducing the burden of stigma in the family. The PEN-3 model provided the cultural framework for this study. Data were drawn from participants' responses in 27 focus groups interviews conducted in South Africa. Participants were asked to discuss experiences of people living with HIV and AIDS in the family. The results highlight the positive and supportive aspects of the family, acknowledge the existential and unique aspects, and discuss the negative experiences shared by participants. This study's findings stress the need to take into account families' experiences with HIV and AIDS in the development of interventions aimed at reducing the burden of the disease on family systems and improving care and support for PLWHA.

Culture and African contexts of HIV/AIDS prevention, care and support.

Culture plays a vital role in determining the level of health of the individual, the family and the community. This is particularly relevant in the context of Africa, where the values of extended family and community significantly influence the behaviour of the individual. The behaviour of the individual in relation to family and community is one major cultural factor that has implications for sexual behaviour and HIV/AIDS prevention and control efforts. As the impact of HIV/AIDS in Africa remains unabated, a culture-centered approach to prevention, care and support is increasingly recognised as a critical strategy. In this article PEN-3, a model developed to centralise culture in health promotion interventions, is presented as a framework to be used in HIV/AIDS prevention, care and support in Africa. The three domains of the PEN-3 model incorporate specific constructs: relationships and expectations, cultural empowerment, and cultural identity. The cultural empowerment and relationships and expectations domains are 'assessment/appraisal' domains used for cultural assessment. Community identity is the 'application/transformation' domain that helps the public health practitioner assist the community to identify the point of entry of the intervention. In this paper the authors describe PEN-3 and then present examples of how the assessment/appraisal domains can be utilised to frame HIV/AIDS-related concerns in the context of Africa.

A critical assessment of theories/models used in health communication for HIV/AIDS.

Most theories and models used to develop human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) communication are based on social psychology that emphasizes individualism. Researchers including communication and health scholars are now questioning the presumed global relevance of these models and thus the need to develop innovative theories and models that take into account regional contexts. In this paper, we discuss the commonly used theories and models in HIV/AIDS communication. Furthermore, we argue that the flaws in the application of the commonly used "classical" models in health communication are because of contextual differences in locations where these models are applied. That is to say that these theories and models are being applied in contexts for which they were not designed. For example, the differences in health behaviors are often the function of culture. Therefore, culture should be viewed for its strength and not always as a barrier. The metaphorical coupling of "culture" and "barrier" needs to be exposed, deconstructed, and reconstructed so that new, positive, cultural linkages can be forged. The HIV/AIDS pandemic has served as a flashpoint to either highlight the importance or deny the relevance of theories and models while at the same time addressing the importance of culture in the development and implementation of communication programs.

Toward a new communications framework for HIV/AIDS.

In response to the overwhelming burden of new cases of human immunodeficiency virus (HIV) in Africa, Asia, Latin America, and the Caribbean, the Joint United Nations Programme on HIV/AIDS (UNAIDS), in 1997, initiated a project to examine the application of existing communication theories/models to HIV/acquired immune deficiency virus (AIDS) prevention and care in these regions. In the past 2 years, 103 leading researchers and practitioners from different parts of the world were invited by the UNAIDS to participate in one of five consultative workshops designed to review these theories/models and rethink their adequacy for Africa, Asia, Latin America, and the Caribbean. A new communications framework for HIV/AIDS was developed to move from a focus on the individual to a focus on five domains of "contexts" that influence behaviors: government policy, socioeconomic status (SES), culture, gender relations, and spirituality.

Cultural identity and health lifestyles among African Americans: a new direction for health intervention research?

OBJECTIVES: To assess associations of cultural and personal identity variables with socioeconomic status (SES) and health lifestyle in African Americans. DESIGN: Cross-sectional. METHODS: A questionnaire administered to 333 African Americans, ages 40-70 years, at enrollment in a nutrition education study assessed: African-American cultural identity (15 items scored 1 [low] to 4 [high]); reference group (two questions about perceived success in the Black or White way of life-scored as bi-cultural if "yes" to both); personal identity (4 items on: self-concept as attractive, self-confident, satisfied and friendly-scored 1 [no/not sure] or 2 [yes]); and selected demographic and lifestyle variables. RESULTS: Cultural identity factors reflecting participation in and belonging to African-American culture and bi-cultural reference group were related to higher SES, lower fat diets, not smoking, current drinking, and higher leisure time physical activity (cultural identity only), particularly in women (P<.001 to P = .06). Associations of cultural identity with physical activity and of bi-cultural reference group with low-fat eating and not smoking (females) remained significant at P<.05 after adjustment for SES. CONCLUSIONS: A greater emphasis is needed on aspects of cultural identity that are positively related to health lifestyles as distinct from aspects that might act as barriers.

Cultural aspects of African American eating patterns.

The high mortality from diet-related diseases among African Americans strongly suggests a need to adopt diets lower in total fat, saturated fat and salt and higher in fiber. However, such changes would be contrary to some traditional African American cultural practices. Focus group interviews were used to explore cultural aspects of eating patterns among low- and middle-income African Americans recruited from an urban community in Pennsylvania. In total, 21 males and 32 females, aged 13-65+ years were recruited using a networking technique. Participants identified eating practices commonly attributed to African Americans and felt that these were largely independent of socioeconomic status. They were uncertain about links between African American eating patterns and African origins but clear about influences of slavery and economic disadvantage. The perception that African American food patterns were characteristically adaptive to external conditions, suggest that, for effective dietary change in African American communities, changes in the food availability will need to precede or take place in parallel with changes recommended to individuals. Cultural attitudes about where and with whom food is eaten emerged as being equivalent in importance to attitudes about specific foods. These findings emphasize the importance of continued efforts to identify ways to increase the relevance of cultural context and meanings in dietary counseling so that health and nutrition interventions are anchored in values as perceived, in this case, by African Americans.

Health promotion and the discourse on culture: implications for empowerment.

To invoke the primacy of culture in health education activities is not only to challenge approaches to health education that overlook or downplay this domain, but to also deepen and extend the possibilities of progressive approaches that focus on culture. Border pedagogy, which seeks to establish a countervoice to Eurocentrism and patriarchy, enhances and magnifies the possibilities that were opened up when critical pedagogy invoked the engagement of students in the production of knowledge. This process of engaging the teacher/interventionists and the students/audiences in the production of meaning, value, pleasure, and knowledge should be central to the mission of health education. It is only through such dialogue where varied cultural expressions are affirmed and centralized that the production of cultural identity can be legitimating and empowering relative to health promotion.

Psychomotor and visual performance under the time-course effect of alcohol.

This study examined reaction time (RT), anticipation time (AT), and visual performance under the influence of blood alcohol concentration (BAC), using a repeated-measures design. Subjects (8 men and 8 women), 21 to 40 yr. of age, participated in both single- and double-dose sessions, in which they drank approximately 2.3 oz. and 4.6 oz. of 86-proof vodka, respectively. The breath BAC was measured at 5-min. intervals. The RT, AT, and visual performance were tested every 20 min. for 140 min. in both sessions. In general, results indicated that RT, AT, and stereoscopic vision were impaired more in the rising BAC curve than the falling BAC curve. In addition, the impairment tended to be greater for the double-dose than the single-dose session. The far and near visual acuities were not affected by the BAC.

Predicting alcohol impairment: perceived intoxication versus BAC.

The purpose of this study was to report the relationship among perceived intoxication, performance impairment, and actual blood alcohol concentration (BAC) levels. Fifteen subjects, aged 21 to 40, completed both single- and double-dose sessions of alcohol consumption. BACs, reaction and anticipation time, and perceived intoxication data were collected during both sessions. Analysis of data showed that perceived intoxication was significantly related to performance impairment, but the actual BAC was not.

Variability in behavioral impairment involved in the rising and falling BAC curve.

The purpose of this pilot study was to measure variability in behavior impairment at specific levels of the rising and falling blood alcohol concentration (BAC) curve. Behavior impairment was measured for anticipation and reaction time in addition to a variety of visual skills. Also of interest was the variability in impairment involved at specific BAC levels under single-dose and double-dose conditions. The experimental design was a variation on a 2 x 2 factorial with repeated measures on the dose of alcohol. All subjects took part in two experimental sessions, single-dose and double-dose. Sixteen (8 male and 8 female) paid subjects ages 21-40 participated in the study. Testing procedures included repeated measures on reaction time, anticipation time, perceptual vision acuity and depth perception. Breath-alcohol measures were sampled continuously at 5-minute intervals and used to plot absorption time, peak BAC and elimination time. Results showed that the average peak BAC for the double-dose was significantly higher than that of the single-dose condition. However, there were no significant differences between the single-dose and double-dose condition in either absorption time or elimination time. The performance pattern for reaction time, anticipation time and depth perception showed more impairment in the rising BAC limb than in the falling BAC limb. It is noteworthy that specific individuals exhibited different levels of impairment at a given BAC level, depending on whether the session was single- or double-dose, suggesting that one's current BAC level is less a measure of impairment than is the total quantity of alcohol consumed. A follow-up procedure to examine practice effects was conducted on eight volunteer students. Identical testing procedures, using no alcohol, produced no significant practice effects after a 3-hour period.

HIV/AIDS education and prevention among African-Americans: a focus on culture.

African-Americans have emerged as the "second wave" of the AIDS epidemic. Epidemiologic evidence indicates that African-Americans adults as well as adolescents have a disproportionately higher risk of AIDS and human immunodeficiency virus (HIV) infection. While programs designed to increase self-protective behaviors are urgently needed to avert a further increase in HIV infection among this population, there is little understanding of African-American sociocultural factors that may influence the acceptance of HIV information and the adoption of HIV-preventive behaviors. This paper describes African-American cultural values and mores which may be related to risk-taking behavior. Barriers to the effective dissemination of HIV prevention education are identified and strategies that may be effective in surmounting these barriers and implementing culturally-appropriate HIV behavioral modification programs are described.

A conceptual model for culturally appropriate health education programs in developing countries.

Increasing numbers of health educators in industrial nations are showing interest in and developing health education programs for developing nations. Cultural sensitivity and appropriateness, or the lack thereof, are often cited as significant factors in program successes or failures. In this article, a conceptual model (The PEN-3 Model) that focuses on cultural appropriateness in the development of health education programs in developing countries is presented. Health educators are encouraged to use this model to ensure empowerment through promotion of positive behaviors, and to recognize and appreciate unfamiliar behaviors while attempting to modify negative behaviors.