Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Working with minority groups in developed countries
Box 32.2 Case study 2: different
health beliefs
A wealthy man from a rural area of Africa was overweight
and continually unwell. His wife who had learnt
about healthy eating told him to eat less meat and fat.
Instead, the man sought the advice of a local healer
practised in traditional medicine. The healer diagnosed
dirty blood and attached a device to the man ’ s
forehead to drain the “ dirty ” blood. When sufficient
blood had poured from the wound, the healer declared
him cured.
program processes are explored below, and highlight
the need for reflection on which aspects of the study
design and methodology are fixed and which can be
customized to the group and setting.
A culturally competent approach to public health
research and programs provides the framework for
shared understanding and development of appropriate
strategies through its underlying reliance on community
- based participation (see Box 32.2 ).
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Different c ommunication s tyles
In developed countries we have well - established ways
of communicating and working which are so
entrenched that it is easy to forget that they are a
product of our own cultural framework. In order to
work effectively in partnership with minority groups,
it is necessary to reflect on those processes and the
inherent power imbalance they support in our interactions
with communities. In particular, reliance on
print - based communication as well as emails and
formal meetings for group decision - making is likely
to undermine the potential for communities to make
valuable contributions, and for those contributions to
be valued. Instead, reliance on personal conversations
held informally in normal daily settings can greatly
enhance the process of developing common understandings
and agreements for each stage of the research
and community program. 4,15,16
The use of alternative mediums such as story telling
and art can also be an effective way of exploring issues
in community programs. A traditional African story,
The Cat Olympics , clearly conveys the concept of different
body types:
A running race for cats was held and there were
three cats, a US cat, a European cat and an Ethiopian
cat. They started the race and the Ethiopian cat won
very easily. When they asked the cat, “ How did you
manage to win by such a distance? ” he replied,
“ Because I am a tiger, not a cat. ”
This is a story about comparing groups. Although
the three cats were all the same size, the Western cats
were overweight and the Ethiopian cat was lean and
small as there is not much food to eat, so it looked the
same size as the others, but was in fact a different type
of cat altogether.
Understanding of h istorical c ontext
Recognition of the diversity among and within minority
groups is an important first step to developing an
understanding of how to work together. An important
component of this diversity is the historical context of
the group and the circumstances of migration.
Developing an understanding of the history of the
group you are working with and sharing your own
cultural history provides a cultural framework for a
strong partnership. For example, in Australia, colonization,
the stolen generation and cultural genocide are
embedded as part of the historical context. Yet they
have clearly been experienced quite differently by
white Australians and indigenous Australians.
Engaging c ommunity m embers
Representation of minority groups in community -
based obesity prevention programs requires a commitment
to a range of strategies to overcome the
potential for low literacy, limited health knowledge,
limited understanding of the role of research, and
mistrust of authority. Some of these strategies include
overlapping strategies, support from trusted community
leaders, oral communication/personal contact
using interpreters, and recording of verbal rather than
signed consent. 4,11,16,17
Recruitment for research in Western countries
focuses on individual participation. However, this
may be inconsistent with the cultural framework of
some minority groups that may function and prefer
to respond to research as family groups, social groups
or even as communities. This requires flexibility in the
research and community program design, including
flexibility in relation to the number of participants
involved in interviews and focus groups and the
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