Why culture matters in social marketing health programmes

Author: Radhika Howarth, is a cultural insight specialist, and a behaviour change consultant. Radhika is a subject matter expert in the area of ‘culture and its impact on health and health seeking behaviours’. She has worked on a number of projects designed to gain consumer insight and develop behaviour change communications on public health issues such as cancer, diabetes, and dementia, especially for Black and Minority ethnic communities.

Integrating diversity and cultural competence in Social Marketing. Why culture matters in social marketing health programmes

Our increasing cultural diversity brings both opportunities and challenges in delivering culturally competent social marketing programs. The ISMA  webinar presented by Radhika Howarth looked at the relationship between culture, health and social marketing. It showed how to tap into cultural insights to build deeper relationships with a broader range of consumer demographics to develop culturally relevant approaches that address health inequalities and are truly patient-centred.

Health is a cultural concept because culture frames and shapes how we perceive the world and our experiences. The influence of culture on health is vast.  It affects perceptions of health, illness and death, beliefs about causes of disease, approaches to health promotion, how illness and pain are experienced and expressed, where patients seek help, and the types of treatment patients prefer. 

The need to recognise the impact of culture on health behaviours is more critical now than ever before because of the growing diversity in UK. One in six people living in the UK are from an ethnic minority background, and in some cities like London, Birmingham and Leicester this can rise to 40-45%. The prediction is that by 2015, up to 30% of UK population will be from ethnic minorities.

Diversity of cultures and communities mean a diversity of their needs and that a standardised ‘one size fits all’ approach when it comes to providing services may not always work. The increased diversity requires organisations and health care providers to be culturally competent.  

Cultural competence in health care is the ability of systems to provide care to patients with diverse values, beliefs and behaviours. It implies having the capacity to function effectively within the context of diverse cultures. It is about recognising the needs, understanding what this means without making assumptions and responding to the needs by providing relevant and accessible services. For example, in the context of increasing cancer screening amongst BME elders, a culturally sensitive action would be to provide translated leaflets to inform non-English speaking patients. However, this will not necessarily change behaviours i.e. increase the uptake of the screening services. A culturally competent service will look to address the underlying factors to address the cultural barriers that prevent access from the patient’s perspective.

The Iceberg model is one way to understand culturally driven behaviours.

Adapted from The Iceberg Model by M. Goodman, 2002. Hopkinton, MA: Innovation Associates Organizational Learning

 When we see an iceberg, the portion which is visible above water is, in reality, only a small piece of a much larger whole. Similarly, people often think of culture as the numerous observable characteristics of a group that we can *see* with our eyes, be it their food, dances, music, arts, or greeting rituals.What we don’t see is the drivers of culture which is below the water surface - beliefs, values, religious or spiritual beliefs, approach to family, communication styles, etc.To understand the visible elements or cultural differences it is important to understand the drivers behind them. For example, in the context of cancer screening, the reason for BME people not accessing the service could be related to their cultural beliefs and having a ‘fatalistic attitude’.

 The cultural continuum with collectivistic or individualistic cultures at opposite ends is another way to understand behaviours in the health context. Collectivistic and individualistic cultures can give rise to different views on health, as well as on treatment, diagnoses and causes of illness.Cultures in North America and Western Europe tend to be individualistic.Cultures in China, South Asia, South America and Africa tend to be collectivistic.

Individualist cultures stress the importance of each person taking care of him/herself without depending on others for assistance, e.g. self-care and individual goal setting when managing long term health conditions. In contrast, collectivist cultures may instead stress sharing the burden of care with the group as a whole. Therefore, social marketing interventions that are family centred rather than person centred are more likely to be effective when working with BME communities.

Finally, the key things to consider when planning social marketing interventions for BME communities is to assess the behaviour in the wider cultural context and look below the tip of the iceberg.Family-centred and community-based approaches are effective because BME cultures are 'we culture ' and not 'me culture‘. Messages need to be culturally compliant: the tone and content needs to be culturally relevant for the audience when community with BME communities.

Radhika Howarth has considerable experience of working with hard to reach and marginalised communities and specialises in bringing the voices of excluded and vulnerable communities into the process of policy-making and communications planning. She is fluent in several South Asian languages - Bengali, Urdu and Hindi.