Cultural Competence in Designing Health Programs and Any Instructional Design Process - Essay Example

Problems in human behaviours are considered to be one of the leading causes of death in several countries. Different studies have surfaced about it because of the belief that human behaviours are modifiable (Armitage 2009, p.195). An example of it is the study about the tobacco use which, known to many, is a great risk to anybody’s health and a problem which is still preventable (Haddad and Hoeman 2001, p.355). The issue regarding the smoking cessation is serious because the behaviours involve here have health or mental health implications and require long-term attention and it affect a large number of population globally (Prochaska et al 1994, p.39). It is already known to many that the problem in smoking is rampant in Western countries as compared to studies showing data involving Eastern countries like Arab nations. As reported by Haddad and Malak (2002), the problem in Arab countries is serious where there are cases wherein professors show bad example in smoking within the class room and school cafeterias and even allow students to do the same, even during exams (Haddad & Malak, 2002; Kuwait Times 2007). In Syria, for example, it has been reported that almost half of population of the adult males therein are smoking (Maziak 2002, p.189). In Kuwait, despite of the laws enacted therein against smoking in public places and outside smoking rooms and governmental offices, people are still doing so (Kuwait Times 2007). It has been established in numerous researches that factors such as motivation, beliefs, attitudes, coping ability, self-efficacy, dependence on nicotine, sociability and support from the society are all significant elements in an individual’s readiness to cease from smoking. Smoking cessation interventions are devised to help a smoker to be ready in changing their behavior and forever stop from smoking the earliest possible time. However, only a small rate of smokers has the motivation to quit from it and the interventions thus have lower efficacy because smokers are not ready to undergo from it (Dijkstra et al. 1996, p.758; Prochaska 1991). There is a linear relationship between stage of change and behavioural intention (Armitage 2009, p.195). Smokers have to undergo a process of series of stages of change to effectively quit in smoking (DiClemente & Prochaska, 1982; 1983). Likewise, they have to go through different motivational stages from “no motivation to quit” to maintaining the new behavior (Prochasca et al. 1992). One of the considered effective, integrative and comprehensive model in health behavior change is the transtheoretical model (Armitage 2009, p.195; Prochaska & DiClemente, 1983, 1984, 1992) because of it has the ability to integrate with other models (Prochaska & DiClemente, 1983). It consists of at least 14 components which are divided into three categories: 1) stages of change - precontemplation, contemplation, preparation, action and maintenance; 2) dependent variables - decisional balance and self-efficacy/temptation; and 3) independent variables - ten processes of change (Prochaska, Redding, Harlow, Rossi, and Velicer 1994) Stages of Transtheoretical Model 1) Pre–contemplation stage – Refers to those who are not thinking about quitting in smoking and are not adequately conscious about the implications of smoking in their health; 2) Contemplation stage – This is when smokers begin to think seriously about behaviour changing but have not acted yet; 3) Preparation stage – Stage when people start to prepare themselves to quit smoking; 4) Action stage – Stage when smokers become successful in quitting from smoking and have been consistent in doing so (aka overt change stage); 5) Maintenance stage – Stage when the smokers have been successful and consistent in quitting from smoking for six months or more (Prochaska & DiClemente, 1983;1984) According to Prochasca et al. (1992), the first three of the five stages is determined by intention to quit while the two last stages are by the nonsmoking behaviour. Dijkstra et al (1996) found through their study that there are systematic relationships between stages of change, positive and negative expectancies and self-efficacy. The Transtheoretical model, like the Social Cognitive theory, involves the decision balance (pros and cons) (Prochaska et al 1994, p.41) and self-efficacy (Prochaska 2006, p.916). This only confirms the position of Prochaska (1991) that interventions can be more effective by devising specific interventions for specific stage of change and that the Trantheoretical Model has the ability to integrate with other models (Prochaska & DiClemente 1983) Social Cognitive Theory (Bandura 1986) is governed primarily by two psychological factors, namely the outcome expectation (pros and cons) and self-efficacy. Outcome expectations involve the possible consequential rewards or punishments and self-efficacy refers to the perceived capability of an individual to undergo behavior interventions (Dijkstra et al. 2006, p.1036). The decisional balance construct is helpful for stages of change model by determining the different patterns of cognitive and motivational changes during the process of changing (Velicer et al. 1985). The balance between the pros and cons hinges on the specific stage where an individual is currently in. During the precontemplation stage, an individual would anticipate the pros and cons of changing their subject behavior. Ideally, the pros should increase as an individual crosses from pre-contemplation to contemplation while the cons should decrease as an individual crosses from contemplation to action (Kraft et al 1999). Smokers should be more aware of the pros of quitting during the precontemplation stage to successfully move to the next stage (Dijkstra et al. 1996, p.762). As such, smokers should receive information meant to show the positive outcomes (pros) of quitting smoking during the precontemplation stage. This is to counteract the natural tendency of smokers to have little motivation and few reasons in quitting as compared to the smokers in the contemplation stage. In the contemplation stage, the contemplator is more aware of the pros of quitting (Dijkstra et al. 2006, p.1036) and in the action and maintenance stages, individuals tend to predict more pros as compared to cons (Prochaska 1994; Prochaska et al. 1994, p.41). In this stage, contemplators will then benefit from information that will lessen the perceived negative results of ceasing from smoking to help these people who are postponing their behavioural change to recognize that quitting has indeed positive results and avoid thinking anymore of the negative outcomes of quitting (Kraft et al 1999; Dijkstra et al. 2006, p.1036). Contemplators likewise need to have a higher self-efficacy to move to the next stage (preparation) and so on and so forth. Hence, interventions are needed to uplift the self-efficacy of the smokers (Dijkstra et al. 2006, p.1036) or even to others who undergo health behaviour change (Bandura 1997). Self-efficacy is the ability of a person to complete a specific task (Bandura1977) and this is very important in smoking cessation intervention (Dijkstra and de Vries 2000, p.501) as a high self-efficacy may be required to make different factors cause a change in behavior (Bandura,1986). Self-efficacy may be comprehended on two dimensions such as the means of accomplishing the task and the stage in behavior change where a person is currently in. The task in this case is to refrain or stop from smoking (Dijkstra and de Vries 2000, p.502). As found by Dijkstra et al. (1996, p.761), like the statements mentioned in the decisional balance (expected outcomes), individuals have different levels of self-efficacy depending on the stage where they are in. People in the action and maintenance stages tend to have higher self-efficacy as compared to the lower stages (Prochaska & DiClemente 1984, Prochaska et al. 1991; Vries and Backbier 1994). Having an increase in self-efficacy in the preparation stage could help smokers to further their attempt to quit smoking (Dijkstra et al. 2006, p.1036). Moreover, those in the action stage get more social support in comparison to those in the contemplation stage (Vries and Backbier 1994). The result of the aforementioned notes may vary depending on whether they are in stage-matched or mismatched conditions. Having stage-matched interventions is seen to be promising in effectively changing a behavior in the field of applied psychology and health promotion (Dijkstra et al. 2006, p.1035). In regard of this study, generally, smokers in the precontemplation and contemplation stage would benefit most from the combination of information in expectation outcomes and self-efficacy (Dijkstra et al.1998). Individuals in the precontemplation would best benefit from information devised to augment the perceived outcomes of stopping from smoking (Dijkstra et al. 2006, p.1035). Smokers in the contemplation stage are seen to be benefiting most from information that will lessen the perceived negative results of quitting (Prochaska, DiClemente & Norcross, 1992; Kraft, Sutton & McCreath Reynolds, 1999). Smokers in the preparation stage would benefit most from self-efficacy information (Dijkstra et al.1998). According to the study of Dijkstra et al. (2006, p.1035), stage-matched interventions significantly bring more success even against standardised interventions and the amount of progress are affected by the extent of mismatching. There is rarity of intervention programs for smoking cessation in Arab countries and even if there are any, the success rate is very minimal because the programs are not responsive to the distinct cultural influences of the concerned community/country (Haddad and Hoeman 2001, p.355). The shortage of reliable standardized data regarding the population and patterns of tobacco use in a society in Arab countries makes it difficult for authorities and different sectors to solve the problem (Maziak 2002, p.183). Moreover, intervention programs do not appeal to the smokers due to factors such as accessibility and guaranteed efficacy (Haddad and Hoeman 2001, p.355). It is important to consider that designing health programs and any instructional design process should be culturally competent (Al-Faouri 2005, p.S1-62) like modifying a psychometric instrument (e.g. Readiness to Stop Smoking Questionnaire) into a local Arabic language, i.e. A-RSSQ (Haddad and Hoeman 2001, p.355). A comprehensive model of behavior change intervention needs to be generalizable from different range of behavioural problems and different variety of populations having the covered behavioural problem (Prochaska et al 1994, p.39). Also, cultural attitudes and behaviours, the influence of the family and peers and the patterns of smoking are vital elements that should be considered in designing smoking cessation intervention programs. 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