There is growing emphasis in Israel on the cultural appropriateness of health promotion programs as a way to facilitate health-enhancing behavioral change. The literature indicates that culturally-appropriate programs take into account, among other things, language differences, knowledge, values, customs, health beliefs, religion and religiosity, family roles, the relative emphases on the collective versus the individual, lifestyles (e.g., eating patterns and hospitality), self-efficacy and the sense of trust in the health system.
A significant number of large-scale health promotion programs are implemented in Israel. Some target the general population while others target specific sub-populations. Cultural adaptation of these programs is especially important for the Arab population, which constitutes 20% of Israel’s population. This minority group has both unique needs and unique social, ethnic, and cultural characteristics.
The study goals were to develop criteria for assessing the cultural appropriateness of health promotion programs for the Arab population, to assess the cultural appropriateness of health promotion programs and to identify ways to enhance it.
The study had three major components:
-
The development of criteria of cultural appropriateness;
-
An extensive mapping of existing health promotion programs and the extent of their implementation in the Arab population; and
-
An in-depth analysis of leading, culturally-appropriate organizations and programs.
Projects were examined in five areas: smoking, home accidents, physical activity, nutrition and diabetes control.
The study examined the extent of cultural competence at two levels: the program and the organization. The report indicates that while most health promotion programs in Israel do target also the Arab population, there is substantial variation in their cultural competence. At the organizational level, though almost all the organizations are aware of the importance of cultural appropriateness, there is a great deal of variation in the extent of infrastructure they have created to promote it.
This is the first systematic study of the cultural responsiveness of an Israeli human-service system to the Arab population in Israel. As such, it can serve as a model for similar studies in additional areas of healthcare as well as in other fields such as education and social services.
This study was supported by Michael and Andrea Dubroff of Massachusetts, USA, the Israel National Institute for Health Policy, and an anonymous foundation.