Comment

Understanding research from different cultures

Hae-Ra Han focuses on culture and introduces five new Nurse Researcher articles relating to the subject now available online and in print 

Hae-Ra Han focuses on culture and introduces five new Nurse Researcher articles relating to the subject now available online and in print 

Cultural research
Picture: Nick Lowndes

I still remember the culture shock I experienced when I arrived in the US from South Korea more than a decade ago: most people drove a car rather than walked, social gatherings were family-oriented rather than based on age or gender, and the Baltimore Orioles baseball team were called the ‘O’s as if they were close friends of the family. I was fascinated by the different looks, skin colours and languages which I had never seen or heard before.

I have since been ‘acculturated’ and find it amusing when I visit my home country to see so many people walking or using public transport, all looking similar and only speaking in Korean.

The fluidity of culture

Culture is an organic entity through which we display our beliefs, knowledge and behaviour that are influenced by the language, customs, values, actions and institutions that surround us. Traditionally, culture has been specific to ethnic, racial, religious, or geographically-bound social groups – but not anymore.

Thanks to the internet, information and knowledge can be shared instantly, and so can our beliefs and behaviours. People in North America can make instant connections with people in Africa, Asia or Europe on Twitter or Facebook and can simply press the ‘heart’ button to support shared beliefs, retweet to spread the word and connect with more people, or start a conversation by adding comments or sending messages.

Diversity and connectedness

It has become increasingly common to read stories and comments written by people in different cultures, see pictures taken by them and get excited about what they do. We live in an exciting era of diversity and connectedness. This instant connection on a large scale alongside the almost unlimited diversity of people on the internet requires us to reflect on ourselves so we can better identify who we are, what we have to offer and how we can work with others from diverse backgrounds.

While health research is often carried out locally, potential participants’ experiences may not be confined to the same locality in the era of the internet. Consequently, health researchers should be equipped with the skills and knowledge that enable them to work with people from different cultures or, better yet, to understand the rationale behind the study design, recruitment methods, measurement or intervention approaches of a research article by a study team from a different culture.

Nurse Researcher's focus on culture is, therefore, timely and reminds us of some of the pertinent issues that should be considered when designing and conducting research. Several cultural research considerations are presented, spanning recruitment and engagement of different cultural groups in health research as well as reflections on one’s own cultural research processes.

Ensuring respect

Randolph et al (2018) discuss strategies for recruiting African-American men in health research. As is the case with several groups, African-American men have apprehensions about research rooted in the perception that researchers are culturally insensitive or do not understand them. The strategies for recruiting and engaging African-American men, as suggested in the article, align with a series of common themes which we call ‘behaviours of respect’ for people from diverse backgrounds. They include working with respected gatekeepers in trusted environments and diversity in a research team, and being transparent about what the research is about and how the research team is going to work with study participants.

I agree with the authors’ suggestion that recruitment and engagement of African-American men in health research would be promoted by researchers learning more about their cultural, social and environmental backgrounds.

Tuffour (2018) provides the researcher’s perspective about the challenges that black African insider nurse researchers face when conducting qualitative studies with black participants. Insider researchers may be susceptible to various entanglements and dilemmas such as keeping social distance or taking racial belongingness with participants for granted. There is validity to Tuffour’s reflection on an individual’s standing on a continuum between insider and outsider. It is often true that cultural researchers wear multiple hats as both insiders and outsiders. It is also important to note that unspoken understandings with the participants can provide insightful meanings to their experiences. To this end, reflectivity is beneficial not only to the quality of qualitative studies but also that of quantitative studies.

Research in Arab communities

The articles by Al-amer et al (2018) and Arunasalam (2018) provide implications for future research for qualitative research involving certain cultural groups. Al-amer et al discuss the challenges of interviewing Arab participants within the context of self-care and management of type 2 diabetes and coexisting depression. The authors’ observation of Arabic culture as a culture that values honour as a form of collectivism is intriguing.

The researchers present two significant challenges: having privacy and personal space to discuss sensitive issues and respecting superstitious thinking. As an example, the wife of a male interview participant frequently interrupts the interview to serve food and drink because she possibly perceived that the female interviewer was crossing cultural boundaries and considered her interaction with her husband as inappropriate. This appears to have direct implications for future research that targets Arabic cultural groups.

Arunasalam uses two people-centred research approaches — hermeneutic phenomenology and the ethnographic principle — to illuminate Malaysian nurses’ views and experiences. Arunasalam notes that Malaysian culture promotes agreement rather than critiques. The research text was therefore co-created so that the researcher did not dominate the interpretations.

Cultural equivalence

Finally, Tsai et al (2018) describe the translation process and lessons learned in a dissertation study. The study required translation of multiple surveys to examine nursing students’ knowledge of and attitudes towards overweight or obese children in Taiwan. The authors describe a few key considerations when adapting a research instrument used in one culture for use in another culture: content equivalence, semantic equivalence and conceptual equivalence. Beyond some technical information, the authors write about the importance of planning in advance, having knowledgeable translators, and a cross-cultural study team with a bicultural researcher.

Taken together, all the articles emphasise the importance of cultural respect and how it is relevant to participant recruitment, data collection and adequate translation of research instruments. Cultural respect enables a study team to design and implement research activities that are responsive to the specific cultural beliefs, practices, and needs of diverse participants encompassing patients, family members and health providers. When used as a framework, cultural respect will enable a study team to function effectively and understand the needs of groups participating in research on common ground – and this will ultimately lead to more accurate results.

Hae-Ra Han is department chair, John Hopkins School of Nursing, Department of Community-Public Health, Baltimore, Maryland, United States


References

This article is for subscribers only