Jonathan N. Maupin

Competence, Agreement, and Luck: Testing Whether Some People Agree More with a Cultural Truth than Do Others

The cultural consensus model (CCM) is a frequently used model of cultural diversity, which predicts how individuals from a common cultural background would share knowledge in a specific domain. Cultural competence, or the degree to which an individual agrees with a local cultural truth, is a central concept in CCM, and many uses of competence estimates rest on the assumption that they reflect real variation among individuals in their knowledge of a cultural truth. However, Weller has shown that even in situations where there are no real differences among individuals in their underlying competences, the CCM will still estimate individual competences that appear to vary, sometimes substantially. To address this issue, we describe a test of the null hypothesis that there is no real difference in competence among individuals. We also present tables with specific cutoffs for this test across a range of data set characteristics. These can help researchers decide whether a specific set of data warrants further analyses of individual differences in competence.

Gendered Experiences of Migration and Conceptual Knowledge of Illness

Abstract Migration is a gendered process which may differentially alter conceptual models of illness as variation and change within specific sub-domains reflect unique experiences and interactions. Forty Mexican migrants completed a questionnaire consisting of 30 true/false questions regarding the symptoms, causes, and treatments of 19 illnesses (570 total questions). Results were analyzed using the Cultural Consensus Model and residual agreement analyses to measure patterns of inter-informant agreement. While men and women share overall agreement, they differ significantly in conceptions of treatment. In general, men over-extend the efficacy of treatment options while women restrict the abilities of folk healers and emphasize dietary changes in treating many illnesses. Variations reflect different social roles and interactions as migration patterns and living conditions reinforce gendered roles in medical decision-making. Women have greater experience with illnesses and interactions with biomedical services, which causes them to approximate biomedical providers’ model of treatment.

Weight-related stigma is a significant psychosocial stressor in developing countries: Evidence from Guatemala.

Weight-related stigma is established as a major psychosocial stressor and correlate of depression among people living with obesity in high-income countries. Anti-fat beliefs are rapidly globalizing. The goal of the study is to (1) examine how weight-related stigma, enacted as teasing, is evident among women from a lower-income country and (2) test if such weight-related stigma contributes to depressive symptoms. Modeling data for 12,074 reproductive-age women collected in the 2008-2009 Guatemala National Maternal-Infant Health Survey, we demonstrate that weight-related teasing is (1) experienced by those both underweight and overweight, and (2) a significant psychosocial stressor. Effects are comparable to other factors known to influence womens depressive risk in lower-income countries, such as living in poverty, experiencing food insecurity, or suffering sexual/domestic violence. That womens failure to meet local body norms-whether they are overweight or underweight-serves as such a strong source of psychological distress is particularly concerning in settings like Guatemala where high levels of over- and under-nutrition intersect at the household and community level. Current obesity-centric models of weight-related stigma, developed from studies in high-income countries, fail to recognize that being underweight may create similar forms of psychosocial distress in low-income countries.

Assessing the accuracy of two proxy measures for BMI in a semi-rural, low-resource setting in Guatemala

BackgroundValidation studies of self-reported BMI are limited to populations in high-income countries or urban settings. Here, we assess the accuracy of two proxy measures of measured height, weight and BMI – self-reported values and the Stunkard figure scale – in a semi-rural population in Guatemala.MethodsSelf-reported values and Stunkard figure selection were elicited prior to biometric measurements from a total of 175 non-pregnant women recruited based on a stratified random sample of households, with 92 women providing full data for validation across measures.Results86.3% of participants self-reported weight and 62.3% height. Among those responding, self-reported weight is highly accurate though lower relationships for height contribute to error in reported BMI. The Stunkard scale has a higher response rate (97.1%) and while less accurate in predicting BMI values, more accurately predicts BMI categories.ConclusionsSelf-reported measures are more accurate than the Stunkard scale in estimating BMI values, while the latter is more accurate in estimating BMI categories. High non-response rates and lower correlations between reported and measured height caution against using self-reported biometric data other than raw weight in low-resource settings.

Reaching women in the Peruvian Andes through cervical cancer screening campaigns: assessing attitudes of stakeholders and patients

Background Peru is characterized by high cervical cancer incidence and mortality rates. The country also experiences significant gaps in quality cervical cancer screening coverage for the population. Objective This descriptive mixed methods study conducted in Cusco, Peru, aimed to assess the attitudes and perceptions of medical staff, health care workers, and patients toward a cervical cancer screening program that included both clinic-based and community outreach services conducted by a nongovernmental organization clinic (CerviCusco). The study also explored patient knowledge and attitudes around cervical cancer and about the human papillomavirus (HPV) to inform patient education efforts. Methods The study employed structured interviews with key informants (n=16) primarily from CerviCusco, which provides cervical cancer prevention, screening, diagnosis and treatment services, and surveys with a sample of patients (n=30) receiving services at the clinic and at screening campaigns. Results The majority of key informant medical staff participants felt that the general public had a very negative view of government health services. One theme running throughout the interviews was the perception that the general population lacked a culture of preventive health care and would wait until symptoms were severe before seeking treatment. Regarding services that were received by patients at CerviCusco, the participants responded that the prices were reasonable and more affordable than some private clinics. Patients attending the rural health campaigns liked that the services were free and of good quality. Conclusion CerviCusco has demonstrated its capacity to provide screening outreach campaigns to populations who had not previously had access to liquid-based cytology services. The finding that patients had generally low levels of knowledge about cervical cancer and the HPV vaccine prompted the development of culturally and linguistically appropriate educational and promotional materials to improve the educational component of the periodic campaigns conducted primarily in rural areas of Andean Peru.

Community hygiene norm violators are consistently stigmatized: Evidence from four global sites and implications for sanitation interventions

Community sanitation interventions increasingly leverage presumed innate human disgust emotions and desire for social acceptance to change hygiene norms. While often effective at reducing open defecation and encouraging handwashing, there are growing indications from ethnographic studies that this strategy might create collateral damage, such as reinforcing stigmatized identities in ways that can drive social or economic marginalization. To test fundamental ethnographic propositions regarding the connections between hygiene norm violations and stigmatized social identities, we conducted 267 interviews in four distinct global sites (in Guatemala, Fiji, New Zealand, USA) between May 2015 and March 2016. Based on 148 initial codes applied to 23,278 interview segments, text-based analyses show that stigmatizing labels and other indices of contempt readily and immediately attach to imagined hygiene violators in these diverse social settings. Moral concerns are much more salient at all sites than disease/contagion ones, and hygiene violators are extended little empathy. Contrary to statistical predictions, however, non-empathetic moral reactions to women hygiene violators are no harsher than those of male violators. This improved evidentiary base illuminates why disgust- and shame-based sanitation interventions can so easily create unintended social damage: hygiene norm violations and stigmatizing social devaluations are consistently cognitively connected.

Draw-and-write technique elicits children’s perceptions of health in the USA and Guatemala

Objective: Using the draw-and-write methodology, this study examined cross-cultural similarities and differences in children’s perceptions of health. Design: Cross-sectional design. Setting: One public elementary school in the USA and in Guatemala. Method: The total sample included 161 children 9–10 years of age, 80 in the USA and 81 in Guatemala. Children in each setting were asked to draw-and-write responses to two prompts regarding things that make someone healthy/unhealthy. Responses were coded for the presence of themes for each topic, and statistical tests were performed to test for significant differences by gender and country. Results: Food is central to children’s perceptions of healthy and unhealthy in both locations, as over 90% of children overall depicted food items for both topics. Fruit, in particular, constitutes the majority of depictions for healthy items in both countries, followed by vegetables. In terms of differences, children in the USA were more likely to depict drinking water and exercise as things that make someone healthy and fast food as being unhealthy. Guatemalan children, in contrast, were more likely to depict hygiene and the environment as both healthy and unhealthy. Conclusion: There are more cross-cultural similarities than differences in children’s perceptions of health. While similarities derive from the centrality of food in perceptions of health, differences in perceptions of health emerge from unique national health conditions and initiatives, local socio-ecological contexts and school curricula.

Abstract A53: Causes and barriers associated with the Pap test among Latina farmworkers in Georgia

Background: Latinas are disproportionately burdened with cervical cancer, with mortality rates 50% higher for Latinas than non-Latina whites, largely due to differences in screening rates. Particular Latino subgroups, such as those from migrant farmworker backgrounds, have less access to health services and lower education than other subgroups. In this study, we report survey findings examining knowledge, beliefs and perceptions about causes of cervical cancer and barriers related to use of the Pap test among Mexican farmworker women in South Georgia. Methods: We employed cultural consensus analysis methods to calculate the level of shared knowledge among a convenience sample of 40 Mexican immigrant women (20 women who have been living in the U.S. >10 years; 20 women who have been living in the U.S. ≤10 years) who had not received a Pap test in over 2 years. In a previous study using free lists, we identified 15 causes of cervical cancer and 15 barriers to screening among Latino immigrant populations. We used several types of questions to assess consensus regarding understanding of 15 causes of cervical cancer and 15 barriers to completing the Pap test. For the causes, we asked participants to rank the severity of the items, sort them into no more than four piles, and label each pile. For the barriers, we asked participants to sort them into piles only and label each pile. This methodology allows for the direct measurement of inter-participant agreement regarding the structure and organization of the knowledge domain and the calculation of both individual estimates of cultural competency and the average level of competency for the group on the knowledge domain. We used UCINET to analyze the rank data and Visual Anthropac to analyze the pile sort data to assess the level of cultural model sharing and to visualize categories using multidimensional scaling and cluster analysis. Results: There was consensus among respondents for the rank order of causes of cervical cancer (Eigenratio = 4.9). Out of the 15 culturally identified causes of cervical cancer, the top five were multiple sex partners, HPV, HIV, lack of a regular Pap test, and sexual relations before 16 years of age. When respondents completed the 15 item pile sort for causes, there was also consensus (Eigenratio = 7.4). Using cluster analysis, the items formed 5 clusters: (1) family history, destiny; (2) chemicals in food, poor diet, smoking; (3) birth control pills, abortion, multiple pregnancies; (4) not using condoms, poor hygiene; and (5) multiple sex partners, sexual relations before age 16, HPV, HIV, not getting a regular Pap test. When respondents completed the 15 item pile sort for reasons not to get the Pap test, there was very high consensus (Eigenratio = 14.2). Using cluster analysis, the 5 clusters were: (1) knowledge (do not know the purpose, do not know the cost, do not know where to get it, lack of knowledge about the test), (2) fear (fear of positive results, fear of the exam, wait for symptoms to appear), (3) social and environmental constraints (too expensive, no insurance, no transportation, do not know English); (4) do not have a regular doctor in U.S. and prefer to use services in Mexico; and (5) not convenient and my husband won9t let me go. Conclusions: There was cultural consensus for all three methods among the respondents irrespective of length of time residing in the U.S. There remains possible confusion between HIV and HPV, since these items were sorted into the same piles and ranked high for cervical cancer risk factors. The aggregate findings suggest that cultural models for causes and barriers persist throughout the immigrant9s acculturation process in the U.S. According to this study, barriers to screening encountered constituted a shared cultural domain despite varying time residing in the U.S. Citation Format: John S. Luque, Jonathan Maupin, Yelena Tarasenko, Moya Alfonso, Lisa Watson, Claudia Reyes-Garcia. Causes and barriers associated with the Pap test among Latina farmworkers in Georgia. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A53. doi:10.1158/1538-7755.DISP13-A53