Culturally informed community engagement

Culture

The concept of “culture” is often ambiguous and lacks a concrete definition. In many instances, culture has been narrowly defined, with researchers using socioeconomic status or other demographic characteristics, such as race and ethnicity, as a proxy for culture. However, narrowly defining culture minimizes its complexity and functionality. In this article, we align ourselves with definitions used by Kagawa Singer et al. (2016), Hecht et al. (2003), and Yosso (2005). Kagawa Singer et al. (2016) define culture as follows:

Culture is an internalized and shared schema or framework that is used by group (or subgroup) members as a refracted lens to ‘see’ reality, and in which both the individual and the collective experience the world. This framework is created by, exists in, and adapts to the cognitive, emotional, and material resources and constraints of the group’s ecologic system to ensure the survival and well-being of its members, and to provide individual and communal meaning for and in life. (p. 242)

Hecht et al. (2003, p. 29) emphasize that “memberships in cultures are pluralistic and overlapping,” reflecting the fact that individuals have multicultural identities and culture is dynamic, alive, and multidimensional rather than static and simplistic (Kagawa Singer et al., 2016; Yosso, 2005). Given this understanding of culture as a vital function, researchers should prioritize culture when engaging diverse populations, particularly People and Communities of Color.

Cultural Inclusivity in Health Equity Research

Culture is an integral component of human behavior (Kagawa Singer et al., 2016). However, health behavior as a field and its related theories have been primarily conceptualized through a monocultural lens—one of dominant white researchers, which perpetuates white supremacy culture. White supremacy culture is defined as “the idea (ideology) that white people and the ideas, thoughts, beliefs, and actions of white people are superior to People of Color and their ideas, thoughts, beliefs, and actions.” (Dismantling Racism Works, 2021). It is the lens through which others (non-whites) are evaluated. Further, white supremacy culture embraces the notion that ideas, concepts, theories, and philosophies that are rooted in white origins are better and normal (Okun, 2021). Racial equity educator and activist Dr. Tema Okun developed a list of 18 characteristics of white supremacy culture, including “only one right way,” “paternalism,” “power hoarding,” and “individualism” (Okun, 2021). White supremacy culture implicitly and explicitly devalues and invalidates the cultural perspectives of nondominant others. A consequence of this white supremacy cultural lens is viewing others as deficient and lacking in assets such as knowledge and skills.

Okun (2021) writes that “white supremacy tells us who has value, who doesn’t, what has value, what doesn’t” (p. 3), which directly translates to what research topics and approaches are perceived to have or lack value. The lack of consideration for cultural diversity in research has been attributed to underlying ethnocentric European-American ways of thinking that have persisted in the United States for centuries (Henrich et al., 2010). White supremacy culture is rooted in Eurocentrism, where European-descended (white) individuals are viewed as the standard against which other non-European-descended individuals (e.g., African Americans, Latinos/as) are judged (Okun, 2021). White supremacy culture exists with the expectation for others (non-whites) to assimilate and adapt to this Eurocentric culture, as opposed to embracing inclusivity and diversity (Okun, 2021). A growing body in literature focuses on the importance of decolonizing research (Datta, 2018; Keikelame & Swartz, 2019; Laird et al., 2021; Lopresti et al., 2022). An important step to decolonizing research is to foster inclusivity—embracing and accepting ideologies and approaches derived from a diverse variety of cultures, thus countering Eurocentrism (Godwin, 2020).

Health equity is “achieved when every person has the opportunity to attain [their] full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances” (National Center for Chronic Disease Prevention and Health Promotion, 2022). Recent health equity scholars have emphasized that culture needs to be operationalized in research to more effectively address inequities that People of Color experience (Kagawa Singer et al., 2016). Researchers lay the groundwork for equity when they include diverse community members’ cultural perspectives, thereby dismantling the monocultural lens through which research is typically conceptualized and conducted. This inclusive science approach requires researchers to “de-center” and be intentional about understanding, acknowledging, and including the culture of the diverse community populations that they serve (Polk & Diver, 2020).

Culture and Community Engagement

Community-engaged research involving People of Color largely excludes cultural perspectives, despite the inclusion of cultural attitudes, beliefs, norms, values, and assumptions being recognized as critical to the success of community engagement (Palmer-Wackerly et al., 2014). The exclusion of the presence and voices of People of Color facilitates the absence of their authentic culture in the conceptualization and implementation of community-engaged research. This is especially problematic when much of health equity research is led by dominant white researchers who seek to engage Communities of Color. Kagawa Singer et al. (2016) note that “the assumed universality of the dominant culture’s constructions of reality and salient domains, such as selfhood, family, fairness, and well-being, is problematic” (p.239).

In traditional theory-driven and evidence-based public health research, community-engaged researchers have assumed that incorporating cultural components into pre-existing dominant-created approaches is sufficient and acceptable—deeming these approaches rigorous and valuable. To this extent, many health interventions designed for Communities of Color are culturally adapted, where researchers adapt existing evidence-based programs while retaining core components of the original program (Bernal et al., 2009; Castro et al., 2010). Common cultural adaptations include changing the language, recruitment strategy, or setting in which an intervention is conducted. This approach of “culturally adapting” involves merely attaching a culture to something that was not initially rooted and developed in the context of that culture. In doing so, researchers attempt to “fit” culture into existing dominant models.

More work is needed to understand in the context of health and everyday life what culture is and how it is operationalized from the perspectives of People and Communities of Color. Health researchers need to focus on understanding the existing cultural processes that support health and sustainability in populations that face inequities. By gaining this understanding, health researchers can authentically engage Communities of Color in truly meaningful ways.

Community Cultural Wealth

Throughout history, marginalized Communities of Color have used and passed down shared cultural norms, beliefs, and behaviors to promote resilience, survival, and well-being in societies where these attributes are constantly threatened. Yosso (2005) developed the Community Cultural Wealth (CCW) framework to highlight the abundance of culturally derived resources that students of Color possess and use to support their success in higher education and science, technology, engineering, and mathematics (STEM) fields, where society assumes that students of Color are deficient compared with their white counterparts. Yosso’s scholarship on CCW builds upon the work of sociologist Pierre Bourdieu, who introduced the concept of cultural capital (Bourdieu, 1986). Similar to Yosso, Bourdieu (1986) posits that cultural capital plays an important role in social mobility and is passed down across generations. Yosso’s scholarship specifically focuses on highlighting the cultural capital that People of Color possess and use for social mobility.

Yosso’s (2005) CCW framework is heavily grounded in critical race theory (CRT), which counters white supremacy culture and ethnocentrism by centering the experiences and perspectives of People of Color. One tenet of CRT that informs the CCW framework is the centrality of voices and experiences of People of Color, whereby the experiential knowledge of People of Color is acknowledged as legitimate (Delgado and Stefancic, 2017). By offering a CRT lens, CCW challenges theories that characterize People of Color as being deficient of valuable capital. Yosso (2005) asserts that through a CRT lens, one “can ‘see’ that Communities of Color nurture cultural wealth through at least 6 forms of capital” (p. 77). Thus, the CCW framework comprises six types of capital: social, navigational, linguistic, resistant, familial, and aspirational.

Social capital consists of the networks of people and community resources that People of Color rely upon to navigate and cope with society’s institutions. Navigational capital encompasses the skills that People of Color employ to maneuver through social institutions that were not created with Communities of Color in mind, such as health care institutions, education institutions, and majority-white workplaces. Linguistic capital reflects the multiple language and communication skills that People of Color attain through communication experiences, including multilingual ability, storytelling, visual art, music, or poetry. Resistant capital is grounded in a longstanding history of People of Color’s resistance to subordination and refers to the knowledges and skills that People of Color employ to challenge inequality. Resistant capital closely aligns with the CRT tenet of “commitment to social justice,” which works toward “the empowerment of People of Color and other subordinated groups” (Yosso, 2005 p. 74). Like other forms of capital, resistant capital is passed down intergenerationally through methods such as parents consciously teaching their children to engage in behaviors and adopt attitudes that challenge the status quo (Yosso, 2005). Familial capital includes cultural knowledge gained from family, which comprises biological and fictive kin or extended family networks. The cultural knowledges nurtured by familial capital include a deep sense of communal connection that informs the caring, coping, and consciousness of People of Color. Familial capital embraces collectivism and connectedness to others, so isolation is minimized. Aspirational capital reflects the resilience that People of Color demonstrate and is nurtured by a culture that promotes the possibility of goal attainment, despite the presence of obstacles.

Table 1 presents a fictional example of how each of these types of capital are applied in a scenario where Christina, a Latina woman, has been recently diagnosed with breast cancer. The applied examples demonstrate how she uses CCW to navigate and cope with her breast cancer experience.

These various forms of capital are not typically used on their own but instead tend to overlap and interact synergistically to support the growth, well-being, and resilience of marginalized individuals within environments and institutions, such as education and health care, that historically were not created for them to succeed and thrive (Jaumot-Pascual et al., 2021).

CCW is the antithesis of deficit-focused approaches and thinking, as it pertains to engaging Communities of Color. Deficit approaches to community engagement take on the position that researchers are the experts and know best, even when it comes to the design and implementation of resources that are ultimately meant to benefit Communities of Color. From this perspective, the voices of People of Color are at best limited and are often missing in research planning and implementation. In contrast, the CCW framework centers the experiences of People of Color (Yosso, 2005). CCW embodies and emphasizes the value of the underacknowledged assets that People and Communities of Color possess as potential partners in community-engaged research efforts, challenging the implicit assumption that People of Color are deficient in valuable skills and knowledge.

CCW differs from traditional community engagement frameworks, such as Community-Based Participatory Research and Participatory Action Research, in both its origin and explicit focus on cultural assets. CCW intentionally centers the “cultural knowledge, skills, abilities, and contacts possessed by socially marginalized groups that often go unrecognized and underacknowledged” (Yosso, 2005, p. 69). Additionally, CCW specifically focuses on highlighting the strengths of Communities of Color and People of Color. With ideological origins in CRT and ethnic studies, CCW emerged as a comprehensive framework at the intersection of community and culture to elucidate sources of capital that generate cultural wealth (Yosso, 2005). CCW not only deepens our understanding of critical cultural assets but also encourages researchers and practitioners to align awareness with action, centering culture and integrating these insights at all phases of program development. This focus on cultural wealth as an asset differs slightly from traditional community engagement frameworks, which often begin with a problem rather than existing assets.

To date, CCW has almost exclusively been applied in the context of research on education and STEM. Only two studies have been identified that discuss CCW as a framework for health research. Both of these studies are focused on Hispanic/Latino community engagement and outreach. Manzo et al. (2018) conducted a qualitative study with promotoras (community health workers) to understand how they use CCW as data collectors and to facilitate research with communities of Mexican origin. Fernández et al. (2020) applied the CCW framework to three case-study examples to highlight the culturally derived strengths and skills that muxeres (Latina women) who identify as promotoras (community health workers), madres emprendedoras (women undertaking struggles to support their families), and mamás (mothers of K–12 children) leverage to organize health equity efforts in their communities. We propose that the CCW framework is broadly applicable to health research and is particularly useful for scholars seeking to employ community-engaged research methods in health equity research with Communities of Color.

Applied Example 1: The Use of Familial and Social Capital in a Culturally Tailored Diabetes Self-Management Program for Chinese Americans

Interventions using aspects of CCW are typically designed in collaboration with the Communities of Color they serve, creating partnerships and shared ownership of the program between researchers and community members. In some interventions, researchers may also be community members. Social capital uses community networks to provide individual and group support, particularly when navigating through society’s institutions (Yosso, 2005). The Chinese Community Health Resource Center (CCHRC), a nonprofit community center in San Francisco, initiated and directed a diabetes self-management and education (DSME) program for Chinese Americans, with investigators comprising CCHRC staff and researchers who have experience working with the Chinese American community (Sun et al., 2012). The DSME program shared knowledge from community physicians and health educators, framing diabetes educators as “knowledge holders,” who are revered in Chinese culture. It also provided face-to-face peer support group sessions for participants, addressing issues like medication compliance; monitoring and control of blood glucose, blood pressure, and cholesterol; and eye and foot care. Group support sessions bring community members out of isolation and connect them with others around common issues, creating kinship. Familial capital uses a broad definition of kinship, which includes family, friends, and community members, to “engage a commitment to community well being” and model lessons of caring, coping, and providing, which kin carry with them (Yosso, 2005). This kinship between researchers, community organizations, and Chinese American community members in the DSME program leverages familial and social capital powered by a network of cultural knowledge, creating connection to community resources that facilitate trust, receptivity to, and sustainability of the DSME program (Yosso, 2005; Fernández et al., 2020).

Applied Example 2: The Use of Navigational Capital in a Church-Based Intervention to Increase HIV Testing Among African Americans

Partnerships may also include community advisory boards that consist of respected community members and cultural leaders who develop and/or provide input on the intervention throughout the study process. To increase HIV testing and education in the African American community, the Taking It to the Pews (TIPS) trial partnered with African American churches. A community advisory board consisting of community faith leaders was involved with all aspects of the intervention, from assisting with the development of religiously and culturally tailored materials and activities, to implementation and evaluation of the intervention, to coordination of community meetings to discuss results from the study (Berkley-Patton et al. 2019). The engagement of African American churches as trusted community spaces also involved using navigational capital, providing linkage to culturally informed health care from HIV testing and education events.

Applied Example 3: The Use of Linguistic, Navigational, and Resistant Capital in an Opioid Prevention Intervention for Urban Native Americans

Linguistic capital—which encompasses communication through art, dance, music, poetry, and theater, as well as storytelling traditions, like oral histories, parables, stories, and proverbs (Yosso, 2005; Fernández et al., 2020)—is often incorporated into programs’ curricula for Communities of Color. Dickerson et al. (2022) developed a program for American Indian/Alaska Native (AI/AN) adults 18 to 25 years of age centering tribal and community traditions, like spirituality, food, and storytelling, to prevent opioid use. Resistant capital encompasses not only “the knowledges and skills fostered through oppositional behavior that challenges inequality” but also “maintaining and passing on the multiple dimensions of [CCW]” to develop a cultural knowledge base (Yosso, 2005, p.80). Participants in the opioid prevention intervention discussed the importance of addressing cultural identity, reporting discomfort with their AI/AN identities caused by public ridicule and intimidation. Adults within the AI/AN community shared stories with participants through video showing how they are overcoming the effects of historical trauma and reclaiming presence as AI/AN individuals, leveraging forms of navigational and resistant capital. Encouraged and modeled by facilitators, participants shared stories of their own cultural journeys and used traditional storytelling practices to do so. By sharing their stories, these AI/AN adults helped program participants build resilience, oppose the ridicule of AI/AN identities, and navigate a society that has historically devalued the presence of AI/AN communities.