Abstract: Purpose: The purpose of this study was to discover ways to tailor health care interventions to fit the cultural identity of a minority group of people in order to reduce health disparity. Design/Analysis: A naturalistic approach was used to interview four self-identified Afro-Caribbean Americans about their experiences of living on the margin. Through content analysis, categories emerged from the transcription revealed embracing, non-entitlement, enduring disrespect, and caring for self. Conclusion: Afro-Caribbean Americans have strong values, healthy intentions, and appropriate attitude which are critical combinations for successfully tailoring interventions. Implications are discussed.
Key Words: Cultural Tailoring, Afro-Caribbean Community, Naturalistic Approach
The significance of culturally tailored interventions reflects an intrinsic principle surrounding health disparities for racial and ethnic groups. Indeed, research has enlightened modern inquiry that health services might need modification in order to gain the response that is crucial in minority and underserved communities. While nursing has made considerable effort to provide culturally sensitive health care (Lowe & Archibald, 2009), there is a woefully inadequate supply of urgently needed and culture-specific programs for diverse populations in the United States (U.S.), particularly for the Afro-Caribbean group.
Florida is the third fastest growing immigrant-receiving state, being second only to California and New York (Camarota, 2007). Most Caribbean immigrants come to South Florida because of a) its proximity to the Caribbean, b) the climatic conditions resemble that of the Caribbean, and c) because of the Caribbean connection that is evident upon arrival. The socio-economic challenges of this region force people to leave "paradise" in pursuit of upward social and educational mobility and a few modest extras for themselves and their children. Many reside in poor and underserved communities (Nurse, 2004); these living arrangements often predispose such persons to health risks such as HIV /AIDS.
Like many other cultural groups, Caribbean population has its unique values that are not present in conventional health care approaches. While the strategies to achieve cultural appropriateness might vary (Kreuter, Lukwago, Bucholtz, Clark, & Sanders-Thompson, 2002), Kreuter and Haughton (2006) agree that one way to help reduce health disparity is to incorporate the culture of the specific population in health programs instead of using a one-size-fits-all approach (p. 795). Since the American Nurses Association (ANA) views cultural diversity as priority in its strategic plan (ANA, 2001), and the transcultural movement has been successful in incorporating culture in nursing curricula, licensure, and certification exams, nurses are uniquely positioned to modify or tailor interventions appropriately in order to narrow health disparities. This awareness has provided initial impetus for this preliminary study.
The concept of "cultural tailoring" is quite common among educators. Pasick, D'Onofrio, and Otero-Sabogal (1996) define cultural tailoring as "the development of interventions, training practices and materials to conform to specific characteristics" (p. 145). Also, Eyberg (2005) defines cultural tailoring as "changes made in focus or delivery style of essential elements in an established treatment, based on the unique features of the individual case" (p. 199). While a union of "culture" and "tailoring" might be questionable since "tailoring" suggests individual, and "culture" suggests shared, Kreuter et al. (2002) pointed out that individuals within the culture will "have varying levels of the same cultural beliefs" (p. 137). These beliefs, values, and traditions of various ethnic groups are implied in culturally tailored interventions which in turn will more likely enhance participation. …