Culture Counts: A Guide to Best Practices for Developing Health Promotion Initiatives in Mental Health and Substance Use with
In Chapter 1 - Break down barriers:
Some of the barriers that stand between ethnocultural communities and health promotion initiatives are built by the assumptions
of those who create the initiatives. Before starting to develop health promotion initiatives with ethnocultural communities,
it may be helpful to explore a few examples of those assumptions.
My organization is a well-known authority, therefore people will trust the information we provide.
- Members of ethnocultural communities may not even know about your organization, so its reputation may mean nothing to them.
- Members of ethnocultural communities may mistrust mainstream organizations in general due to experiences with similar organizations
in their country of origin (for example, in some places, “mental institutions” have been used to imprison political opponents)
or fears that getting involved may put their status in danger (for example, fear of being deported for having a substance
use problem). They may also have had bad experiences with your organization in the past that may make them resist new initiatives.
“The family delayed hospitalizing the patient because of the fear of deportation associated with mental illness. There was
also an implicit fear that this would stigmatize the whole community and restrict immigration from that particular country.”
--Submitted by the Saskatoon Open Door Society
to the Canadian Task Force on Mental Health Issues
Affecting Immigrants and Refugees, 1988
“Our problem is that we lived in a country with propaganda and we are very selective about what we hear.”
“We do not trust journalists, government and other official sources of information and we usually do opposite from what they
--Comments from Russian community focus group members
- There may not have been services or organizations like yours in a community’s country of origin, so community members may
not understand its purpose.
- Your organization’s information or the way it is presented may go against cultural or religious beliefs and practices, making
it ineffective or unacceptable.
People from ethnocultural communities do not use our materials because of language differences, therefore all we need to do
is to have our materials translated into other languages.
- Translation is not as simple a process as many think. A bad translation means your message will be lost or, worse, that the
wrong message will be sent.
- Translation may be an effective approach, but it must be done by working with the intended audience.Your intended audience
may prefer approaches that do not rely heavily on text.
- A focus on language differences may mean that other important cultural differences, as well as barriers not related to language,
are not taken into account
“The first version of the Russian translation used the word ‘safe’ in place of ‘low-risk.’ This small change would have greatly
altered the meaning of the Low-Risk Drinking Guidelines brochure.”
--Nadia Sokhan, Polycultural Immigrant and Community Services
“Somalis are an oral society. Therefore, the best way [to reach Somalis] is to use Somali TV and radio programs.”
--Member of Somali community focus group
Ethnocultural communities have rigid beliefs that make it difficult to offer information about sensitive topics such as mental
illness and substance use.
- As in any group, including the mainstream, people in ethnocultural communities have a variety of opinions, attitudes and beliefs.
Culture is dynamic. It is influenced both by people’s beliefs and their environment. Acculturation (the adoption of the behaviour
patterns of the host culture) can bring changes in beliefs and health behaviour.
- Members of ethnocultural communities differ in age, ability to use the official languages, education, level of acculturation,
length of time in Canada, family situation and other characteristics, so no single initiative will work for all members of
- People may be more willing to discuss sensitive topics in the right situation. For example, they may talk more openly in a
community setting than in your organization’s office. They may feel more at ease discussing sensitive topics in separate groups
for men and women or for young people and older adults.
- Ethnocultural communities are at different stages of readiness for health promotion initiatives in mental health and substance
use. Some may deny there are problems in their community; others may be too busy with day-to-day challenges such as getting
employment and housing to think about mental health or substance use issues.
“In Russia we drink after work to relax, to warm up in cold weather and to take part in social activities. In Canada we drink
mostly because of homesickness, loneliness and depression.”
--Member of Russian community focus group
“I was expecting some negative calls when we put Low-Risk Drinking Guidelines brochures in temples, but we didn't get any
negative feedback about it. Sometimes the professionals have more fears than people in the community.”
--Baldev Mutta, Punjabi Community Health Centre
All humans experience health, mental health and substance use problems the same way.
- While all humans may experience similar symptoms, culture may affect how those symptoms are described and understood. For
example, what someone trained in Western medicine may call a hallucination caused by a mental disorder or substance use, someone
from a different tradition may call a spiritual experience.
- Mental health disorders and substance use problems, as well as some physical diseases, carry a strong stigma in almost all
cultures. Stigma may be expressed in different ways depending on cultural values: where individualism is highly valued, these
problems may be viewed as a personal failing; where family and community are highly valued, these problems may be viewed as
a stain on other family or community members. The goal of many health promotion initiatives is to get rid of stigma, but it
is clear that one type of initiative is not going to work for all communities.
“The society may know that the person drinks, but it keeps silent until the addict’s problems become open to the public, i.e.,
health, finances, loss of job, family break-down, and it is too late for repair. The person’s excessive drinking stigmatizes
both the person and the family. This means hesitation to marry their children or have financial transactions with them.”
--Key informant in Tamil community focus group
To learn more about culture and mental health and substance use issues: