Culture Counts: A Guide to Best Practices for Developing Health Promotion Initiatives in Mental Health and Substance Use with Ethnocultural Communities

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.

Assumption:

My organization is a well-known authority, therefore people will trust the information we provide.

Re-think:

• 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.

• 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.

Assumption:

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.

Re-think:

• 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

Assumption:

Ethnocultural communities have rigid beliefs that make it difficult to offer information about sensitive topics such as mental illness and substance use.

Re-think:

• 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 a community.
• 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.

Assumption:

All humans experience health, mental health and substance use problems the same way.

Re-think:

• 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.

To learn more about culture and mental health and substance use issues:

• CAMH: “Beyond the Label” – kit for running workshops on stigma
• CAMH: “Understanding the impact of prejudice and discrimination on people with mental health and substance use problems”
• BC Partners for Mental Health and Addictions Information: “Cross Cultural Mental Health and Addictions Issues” (Canada)
• Multicultural Mental Health Australia: “Cultural Awareness Tool: Understanding Cultural Diversity in Mental Health”
• U.S. Department of Health and Human Services: “Mental Health: Culture, Race and Ethnicity – A Supplement to Mental Health: A Report of the Surgeon General.”

Next >>