Journal Article Review

Brief Background/Introduction

     

This essay uses a culture-centred approach for understanding the health of the population in public health research and intervention. In this study, the theoretical concept of the PEN-3 cultural model has been a tool in order to identify the underlying causes that lead to a particular behavior, belief, and action. The PEN-3 model was described as the core of the culturally development, implementation and evaluation of successful public health intervention ().Moreover, the PEN-3 model was developed by airhihenbuwa in 1995 and it is composed of three important domains, which are cultural identity, relationships and expectations and cultural empowerment. Each of these three domains is composed of three factors forming the acronym PEM. The first domain known as cultural identity (person, extended family, and neighborhood) highlights people around us from someone really close (like a parent) to the community. The second domain is known as cultural empowerment (positive, existential, and negative) identify belief and practices that are positive to our health, before identifying negative health practices that can be barriers. Finally, the last domain is known as relationships and expectations domain (perceptions, enablers, and nurturers) examine the health problems in relation to family influence. In this literature review PEN-3 model has been used to address problems associated with different diseases from cancer, nutrition, HIV, diabetes, and other related issues.

                             

Purpose of the Study

This literature reviews applied the PEN-3 model to address the impact of culture on health belief and behavior. Throughout the paper, we will notice how cultural belief influence health  more than anything.                                              

Methods/Approach (include setting, priority population or sample,  participants, brief overview of data collection procedures and comment on data analyses)

Below is a summary of the table show in theory final literature review. In the original review, each document was reviewed to determine how the model was used to benefit health behaviors. Below is a summary of all the information on each topic.

References	Target population	Health outcome	summary of findings
1.Sheppard et al. (2010). 2.Ka’opua (2008) 3. Sheppard et al 2008	N=34 patients Female. N=60 native Hawaiian women N=22 Latina breast cancer survivor(5)	Breast cancer	In all of the studies perceptions, enablers and nurtures were important to women when making decisions on treatment. Spirituality was suggested in the research because it shows that patients respond better to treatment.
4.White et al (2012) 5.Erwin et al (2010) 6.Erwin et al (2005) 7.Erwin et al (2005)	N=782 Latinas N=112 latinas in New York City N=13 Latina immigrants	Breast cancer and cervical cancer	Results indicate that the family takes important decisions during interventions. Erwin et al  (2005) created a program known as  Esperanza y Vida which analyzes  the relationship between behavior and cultural components that address the specific needs of a diverse Latino population.
8. Scarinci et al.(2012) 9.Williams and amoateng (2012) 10.Osann et al (2011)	N=13 Latina immigrants N=29 Ghanaian men N=12 patients	Cervical cancer	The model shows that lack of knowledge from the participants and their family regarding women’s health care behavior was identified. Subsequent changes were made to the intervention so as to be more culturally suitable.
11.Saulsberry et al. (2013)	Adolescents ages 13-17 are recruited from wait lists for mental health services at community health care provider organizations.	Depression	From the model PEN-3, we can see that depression has correlated with cultural background.
12.Barbara and Krass (2013) 13 MelanconOomen-Early and Rincon 14.Grace et al (2008).	N=24Maltese immigrants in Australia N=100 Mexican American N=129	Diabetes	-Culture influence attitudes to other peer and practitioners. -A family is a strong unit of support positive and negative values influence person's belief and attitudes
15.Yick and Oomen-Early (2009)	Chinese-American and Chinese immigrant community	Domestic violence	PEN-3 model applied the concept to understand the phenomenon of domestic violence among Chinese Americans and Chinese immigrants in the USA.
16.James (2004). 17.Airhihenbuwa et al (1196).	N=40 (19 women and 21 men).	Nutrition Nutrition	They study about cultural food practices of African-Americans including the negative and positive sides.
18.Ochs-Balcom, Rodriguez, and Erwin(2011)	N=African American women (9 breast cancer survivors,5 unaffected family members of breast cancer survivors.)	Breast Cancer	Positive family attitudes and beliefs are reinforced and negative attitudes within the family are rejected.
19.Garces et al (2006).	N=54 Latina immigrants	Health maintenance and health care seeking	Results suggest that positive perceptions can balance negative perceptions.
20.Mieh et al (2013) 21.Sofolahan and Airhihenbuwa. 22.Iwelunmor and Airhihenbuwa 23.Okoror et al (2012). 24. Sofolahan and Airhihenbuwa (2012) 25.Westmass et al (2012) 26.Sofolahan et al (2010) 27.Brown,BeLue and Airhihenbuwa (2010). 28.Iwelunmor,Zungu, and Airhihenbuwa 29.Airhihenbuwa et al. (2009) 30.Green et al (2009). 31.Okoror et al (2007). 32.Iwelunmor et al (2006). 33.Petros et al (2006). 34.Bynum et al (2012) 35. Walker (2000) 36.Underwood et al (1997). 37.Iwelunmor et al (2010)	N=41 home-based caregivers. N=35 women living with HIV and AIDS. N=110 women from three communities in South Africa. N=51 women N=60 women living with HIV and AIDS Surinamese and Dutch-Antilleans in the Netherlands N=17 female nurses at two hospitals in Limpopo South Africa N= 397 Black and colored participants from two South African communities. N=48 women living with HIV and AIDS in two South African. N=453 (345 women and 108 men). N=73 traditional leaders or members of royal families. N=249 (195 women and 52 men) N=204 (150 females and 53 males). N=39 focus group discussions comprising 8 to 10 participants and 28 key informant interviews. N=363 African American College students. N=83 African-Americans N=35 African-American women N=123 mothers with children less than 5 attending an outpatient clinic in south-west Nigeria.	HIV and AIDS Malaria	-explore the primary themes emerged from HIV/AIDS which are: perceptions,home-based caregivers and voicelessness of HBC due to lack of support. -Health care decisions were influenced by partners and cultural expectations. -Findings reveal positive perceptions and AIDS treatment, hope and optimism about existential view. -the resulting highlight three themes: the expectation of care, care delivery Protocols and physical environment (23). -the result revealed three themes: The role of faith in perceptions about childbearing decisions and two patient-health care provider communication(24). -The PEN-3 analyze culture and HIV testing among these communities (25). -The study was divided into two positive attitudes and negative relationships with professionals (26). -Positive perceptions of familial support were important with the disclosure of HIV status (27). -The findings revealed that there could be both positive and negative consequences associated with family disclosure (28). -negative stigmatizing characteristics were blaming HIV/Aids on women(29) -The pen-3 model was applied to understand aspects of indigenous leadership and cultural resources (30). -The food was viewed as an expression of support and acceptance for some HIV-positive women (31). - The findings highlight the positive and supportive aspects of family systems (32). -culture influence perceptions and responsibility of HIV.
38.Gaton,Porter, and Thomas (2007).	N=134 African American women	Major risk factors
39.Kennan et al (2010).	N=102 African American	Maternal Nutrition and Protective.
40.Kennan et al (2009). 41.Hilton et al (2007).	N=36 younger and 20 Older African American women. N=177 participants	Maternal nutrition and protective factors in relation to birth outcome. Cultural beliefs and practices
42. Abernethy et al (2005)	N=655 African American men	Prostate cancer
43.Scarinci et al (2007)	N=108 women in private and public worksites.	Weight control decisions
44. Matthews, Sanchez-Johnsen and Kin (2009). 45.Beech and Scarinci (2003)	N=8 African American smokers N=118 African Americans (65 men and 53 women)

Theoretical Framework

Clearly, there is a great variation in how the authors applied the PEN-3 cultural model in addressing health behaviors through a cultural lens. It is true that all of them incorporated the model as country or language studied. However, it is striking that scholars used the theoretical framework of a PEN-3 model for cultural centralization, specifically in the review of health behaviors. In addition, they integrated culturally-relevant aspects to develop interventions. For instance Erwin et al. (2010) shaped and clarified program content and cancer control intervention structure in Latin America using the PEN-3 framework. On the other hand, Sheppphard et al. (2010) employed PEN-3 model’s quantitative findings to implement and inform the decision-making process for African Americans with cancer.

In addition, most research used the PEN-3 model to direct data analysis, quantitative data collection, and its interpretation. Some of the emergent data analytical approaches include cross-tabulation, recontextualization, and categorization. Regarding categorization, most literature used the model as a planning framework. PEN-3 categorized all the themes in order as generated by the qualitative data. The authors invoked the cross-tabulation approach to arranging the emergent themes whenever two domains intersect or interact. Lastly, the recontextualization framework located the qualitative data themes within the established scientific know-how.

Major Results/Findings

            The review not only expands the existing studies on how the culture impacts health but also, it explores the use of the cultural model in addressing health outcomes and behaviors. Essentially, the focus of the PEN-3 model is to expose the impact of traditional beliefs on people’s actions and health. In the end, it proposes that public health should nurture family behavior rather than focusing on a particular individual. Irrespective of Cancer, smoking, or HIV study, the outcome of this study is that culture is still a fundamental factor in examining the impact of experiences (or conditions) on health and framing of potential solutions. There are implications for this, especially in the design context for sustainable public health intervention strategies to minimize health disparities.

Moreover, compelling and culturally appropriate tactics for a change in behavior call for an awareness of personal-level aspects and factors that relate to cultural norms. They can include the living conditions, geographical locations, food, and growth attributes. The findings show that PEN-3 model is important in implementing and developing cultural heath interventions. For instance, it is clear from the studies that the model challenges the postulation that individual responsibility is a sole product of positive health behavior. Using the PEN-3 model, the researchers dismissed biases on interesting health behaviors. In addition, they engaged the study subjects to promote health outcomes.

I concede that the model has limitations. Therefore, the future studies in this field should be extensive. In fact, they ought to cover the use of qualitative and formative data collection strategies to expound on a rigorous PEN-3 variable evidence base.

Conclusions

Most conventional hypotheses on health behavior habitually aim at an individual to cultivate change. However, the PEN-3 model yields a culture-centered health approach. It expands analytic techniques to contexts that either inhibits or nurture a person. Consequently, the model unpacks individual capability assumptions for examination of contributions of other factors towards improving a healthy behavioral change.

            If human beings are to achieve health equity through implementation and design of effective intervention and public research, then culture should be one of the most fundamental factors, specifically when framing the next strategy. Excluding the cultural context to address individual behavior severely hampers the success of interventions in public health. Since their research in this field is still in its infancy, the understanding of cultural approach is a significant addition with regards to extensive contextual relationships and positive expectations. In outlining the effect of culture on human health, the PEN-3 model provides tools for committed researchers to address modern medical challenges. Still, people must acknowledge that culture can influence health negatively under exceptional conditions. Hence, all the factors in different cultures can eliminate observable inequalities and advance the public health research interventions and missions throughout the planet.

Implications of the Findings for Public Health, Health Promotion, Health Education, Eliminating Health Disparities, Dietetics and Nutrition, Social Work, and/or Future Research

The research has far-reaching consequences for medical professionals in all health sectors. It creates awareness on the importance of cultural consideration, especially during health decision making. In addition, the model provides an opportunity for physicians and health educators to examine cultural practices that are important to positive behavior. Besides, it recognizes the exclusive practices affecting the health sector by pinpointing negative aspects that potentially could impact dietetics and nutrition.

Personal Reactions to the Research Article

On a personal note, the cultural model in this study acts as a theoretical framework to centralize the practice in healthcare. As such, I understand that culture is imperative in interventions, health implementation and the process of evaluation. Besides, I admit that PEN-3 model directs the reviewed literature to a nurturing context that influences a collective health behavior for instance in a family setting.