Health and Illness: positive concept of health and negative concepts of disease/ illness/ sickness are defined differently in different cultures! 

Culture influences:

• What constitutes health or illness? - culture-specific illnesses
• What causes health or illness? - some cultures take personalistic views, while Western medicine is generally mechanistic
• What should be done for health or against illness. - habits in terms of seeking health care; acceptable health care practices  

Culture: what is it?

Culture can be thought of as a set of implicit and explicit guidelines/information that individuals acquire as members of a particular society or context, regarding, eg how to view the world/ how to experience emotions/ how to behave in relation to other people/ to supernatural forces or gods/ to the natural environment. It also provides a way of transmitting these guidelines to the next generation (enculturation).

Enculturation: a 'lens' through which the individual perceives and understands the world that he inhabits and learns how to live with it. The group or context itself. 

Challenges to definitions/ challenges to define cultures:

• Cultural boundaries are not distinct, often unclear
• Cultures are dynamic and change over time
• There are as many variations within cultures as between cultures 
  
  • Problem with stereotypes: person-related variables are generally continuous and distributed
  • Artificial or false dichotomies should be avoided

 Multiple levels of culture

1. Tertiary level: explicit manifest culture, visible to the outsider, such as social rituals, traditional dress, national cuisine, festive occasions = 'facade of a culture' 
2. Secondary level: underlying shared beliefs and rules, known to the insiders but rarely shared with outsiders = 'social norms'
3. Primary or deepest level: rules that are known to all, obeyed by all, but implicit, and generally out of awareness (hidden, stable and resistant to change) = 'roots'

(Cross-)cultural psychology 

• Absolutist approach: psychological phenomena are the same across cultures, processes and behaviours vary
• Relativist approach: psychological phenomena only exist within the context of a culture
• Somewhere in between: psychological processes are shaped by experience, but all humans share the same biological constraints! 
• General psychology focuses on universals and (sometimes) tries to control for cultural variation
• Cultural psychology focuses on cultural variation in terms of the psychological consequences of culture
  
  • Studies the different meaning systems originating from different environments 
  • Assumes that mind and culture are entangled
  • Assumes that thoughts are shaped by contexts

'Humans seek meaning in their actions, and the shared ideas that make up cultures provide the kinds of meanings that people can derive from their experiences. Cultural meanings are thus entangling with the ways that the mind operates, and we cannot consider the mind separate from its culture.' --> quote from the author of the textbook, he is clearly a relativist 

Universality vs cultural variability 

Whether a process is universal or culturally variable often depends on the level of definition. Abstract definitions generally lead to evidence supporting universality. Concrete definitions generally lead to evidence supporting variability. 

Degrees of universality--> zie bb voor model

• Nonuniversal (cultural invention): cognitive tool not found in all cultures (other criteria are thus irrelevant). Example: abacus (telraam); 
• Existential universal: cognitive tool found in all cultures that serves different function(s)and is available to some degree in different cultures. Example: increased persistence in the face of failure;
• Functional universal: cognitive tool found in all cultures that serves the same function(s) but is accessible to different degrees in different cultures. Example: fairness-based punishments;
• Accessibility universal: cognitive tool found in all culture that serves the same function(s) and is accessible to the same degree. Example: social facilitation.

 Cultural dimensions theory: cultures can be distinguished according to five dimensions: 

1. Individualism-collectivism: how interdependent is a culture?
2. Uncertainty avoidance: how do people deal with ambiguity?
3. Power distance: how hierarchical is a culture?
4. Long-term/short-term orientation: connection with tradition, also economic orientation. Focus on the past or now?
5. Masculinity/femininity: how distinct are gender roles? Distribution of classical male/female traits. How big are the differences between the roles?

 Theoretical constructions: generalizations: groups also vary in homogeneity. Individual differences/ layers within cultures.

Socio-Economic Status

SES also has cultural implications! Interaction with culture and specifically relevant for health.

Differences in health behaviours within western cultures: 

• Lower SES predicts the likelihood of smoking, higher SES predicts recent attempts to quit;
• Lower SES predicts higher alcohol consumption;
• Higher SES predicts a more balanced and healthy food intake. 

Development

Poverty: socioeconomic level influences many variables that impact development and health in children (parental stress, neighbourhood risk, access to health care, social capital, financial investment). 

Acquiring culture: cultural norms (and cultural differences!) are created through different ways of socialization. In general: when you are born, you will learn it. Because we are born open to learning any culture. Younger children across cultures should be relatively similar because there had been relatively little socialization. Older adults should show greater cultural differences between cultures due to more socialization. Cultural differences increase with age. 

 Parenting: Effects of parenting generally studied under Baumrind's typology: 

• Authoritarian: high demands, strict rules, little open parent-child dialogue, parent-centred;
• Authoritative: high expectations of maturity, parent-child dialogue about understanding feelings, independence encouraged (within limits), parental warmth associations, child-oriented;
• Permissive: lots of dialogue, few limits/controls, lots of parental warmth. 

Which is best? Studies usually show authoritative parenting to yield best results in for instance school achievement, and perceived parental warmth. But some suggest the typology is laden with Western notions of development! Many other cultures commonly have a strict, parent-centred parenting style; but these do not fit neatly into Baumrind's "authoritarian" style. In many Asian cultures, parenting style changes according to child's stage of development. There is more explicit communication of parental warmth in Western societies, but more implicit communication of it in Asian societies. "Authoritarian" style fails to capture nuances of culture-specific notions of parenting styles (eg jiao xun or training, in Chinese parenting). 

Universality of life stages

Terrible two's = a developmental milestone in the West. Important for children to assert autonomy and individuality. Serves as a foundation for future mature relationships. But this developmental stage is not seen universally. Some cultures view noncompliance as immaturity, not a step toward personal growth. 

Adolescent rebellion = a developmental milestone considered by Western researches to be natural. Assumed to be due to hormonal changes in puberty. Characterized by disobedience, delinquency, and defiance of authority. But examining ethnographies of 175 pre-industrialized societies revealed that over half of them did not associate adolescence with antisocial behaviour. 

Sensitive period: span of an organism's life when it can gain a new skill relatively easily. Skill acquisition subsequent to this becomes much more difficult. Evident across many different species, across many domains. Not applicable to all domains of learning in humans but applies to language and culture acquisition. 

Migrant development: immigrant stress: many problems that make immigrants develop more poorly. Important sources of stress and health problems: poverty, discrimination, loyalty conflicts, trauma (depending on reasons to leave original country), homesickness, etc.

Immigrant paradox: despite lower SES, immigrant adolescents are less likely to have behavioural psychological, or health problems than national adolescents. Mean immigrant SES markedly lower than that of nationals. Second generation decline: effect becomes smaller. Eventually, convergence or even surpassing in negative direction. Potential explanations:

• Optimism: people are happy that the left their old country/arrived in new country
• Cultural maintenance 
• Othering: not seeing yourself as part of the population, creates distance 
• Measurement invariance/statistical artefact
• Family obligations: related to more positive well-being and adjustment; may help (pride, commitment, repayment, etc); but may also hurt (work, stifling, acculturation conflict, etc), reduces in the second generation (decline effect?)

In Europe: only in sociocultural adaptation, not psychological adaptation!

Netherlands: despite markedly lower SES, immigrants tend to perform as well or better than their national peers. Second generation decline. Smaller effects than in the USA or Canada. 

Downward assimilation: where will most immigrant adolescents live? They start to assimilate toward the wrong groups when they live in "bad neighbourhoods". 

Segmented assimilation: effects of acculturation depend on context. Assimilation may have positive effects in an affluent context. However, most immigrants do not arrive in an affluent context. Assimilation into the lower segment of society, combined with a feeling of discrimination adverse effects. Selective assimilation may help. 

 Dealing with differences

Error of ethnocentrism: Recognize our own ethnocentrism: perceiving one's own culture as standard of comparison. The tendency to judge people from other cultures by comparing them to your own culture. 

Current research practice: selection bias

Who is WEIRD: Western, Educated, Industrialized, Rich, Democratic

• 2003-2007: WEIRD subjects make up 96% of all psychology research but represent only about 12% of the world population. 
• 7% of participants are psychology undergrads. 
• 99% of first authors come from Western Universities. 

 WEIRD countries only make up about 16% of the world's population! Evidence for WEIRD thinking has been shown by contrasting: 

• Industrialized vs non-industrialized societies;
• Western- vs non-Western societies 
• Americans vs other Westerners
• University-educated Americans vs other Americans

WEIRD group even appears to be particularly unusual, with differences appearing in visual perception; fairness; cooperation; spatial reasoning; categorization and inferential induction; moral reasoning; reasoning styles; self-concepts and related motivations; heritability of IQ. But also, our main source of information.  

(Cross-)cultural psychology aims to better understand the full distributions of human psychology and the implications of cross-cultural variation. Learning about cross-cultural variation helps us to interact in a globalizing world, especially in multicultural societies. 

Research methods

Goals:

• Describe: what is happening?
• Explain: why is it happening?
• Predict: what will happen next?
• Change behaviour: how can we alter what happens?

Approaches: Quantitative and qualitative 

Practical aspects 

Methodological equivalence: how easily can you apply measures across cultures? 

• Cognitive test?
• Questionnaires?
• Physiological measures?
• Naturalistic observation?

Extensive piloting and validation! 

Measurement quality: reliability and validity

• Reliability may refer to reproducibility, replicability and precision
• Validity may refer to internal validity, external validity, construct validity and ecological validity.

Central themes:

Universality of a specific trait: often: looking across groups (remember the levels of universality!)

Influence of a specific trait on thinking & behaviour: often: looking with in (multiple) groups

Studying a culture as a whole rather than individuals: often: looking at cultural messages (news, media, etc) for specific traits

Comparisons: what are the right contrasts: depends on the specific research question.  

Instruments: surveys, experiments (behavioural/physiological), observation, interviews, economic games, archival work, field work, etc. 

Questionnaire translation: process of forward and backward translation to achieve 'equilibrium'. Full process: 

1. Two independent forward translations need to be resolved
2. Back-translation needs to be resolved
3. Repeat if necessary
4. Validate in new population! (ideally n>300, so this step is rare..)

Response biases:

• Moderacy bias: always choosing the mean
• Extremity bias: choosing extreme answers (strongly disagree or strongly agree) 
• Acquiescence bias: choosing in agreement with the question

What to do?

1. Forced choice answers (yes/no/etc): nuances are lost
2. Standardization: transform into z-scores, distributed around a 0-average; removes differences in average --> response pattern
3. Reverse-scoring items: reverse the question 

Reference group effects: the response to questions may depend on the group that one is using for reference. For example: how does one respond to the item "I am tall?" To control for this, it's better to use objective and concrete measures, by providing specific scenarios as questions, asking quantitative questions and/or using behavioural and physiological measures. 

Deprivation effects: the tendency for people (or cultures) to value what they would like not what they have. No clear solution for this bias, except to interpret results with caution.

Experimental methods

Important: culture is not a trait that can be manipulated! As usual: 

• Between-group/subject manipulations need random assignment over conditions
• Within-group/subject manipulations need everyone to be exposed to all conditions. 

The dependent variable can come from behavioural responses (ratings, correct answers, etc) and  physiological measures (brain, hormones, heart rate, etc).

Findings are statistically evaluated. Aim to work in a hypothesis-testing, theoretically grounded way!

Unpackaging culture

Unpackaging= identifying underlying variables that create cultural differences 

Three steps: 

1. Identify a theoretically viable variable that can explain a cultural difference. 
2. Confirm cultural differences in the proposed underlying variable. 
3. Show that underlying variable is related to cultural differences in questing. 

Culture-specific method 1: situations sampling: how do people respond to situations regularly experienced.

A two-step method:

1. Participants from each culture generate and describe situations during which they experience some psychological phenomena
2. Another group of participants assess the compiled list of situations generated by both (own and other) cultures in step 1

This allows for two types of analyses: 

1. Examining cultural differences in how participants respond to the same situations
2. Examining cultural differences in the types of experiences/situations that people have

Culture-specific method 2: cultural priming 

Entails inducing cultural ways of thinking that were not enculturated by the participant's cultural group. Assumes that while some ways of thinking may be different between Cultures A and B, Cultures A's way of thinking may still be present, but to a limited extent. When cultural ideas are activated that actually fit more into another culture (priming), then people start to think more in ways of that culture. 

Mixed methods: no single study design is perfect, due to alternative explanations and methodological flaws. The best way to counter such problems is to use multiple, differing methods. Using multiple methods to replicate findings while disproving alternative accounts provides the most compelling evidence.  

Interpretation bias

• Belief perseverance effect: holding on to your views in the face of conflicting evidence
• Self-fulfilling prophecy: expectations lead to thinking you see confirmatory evidence
• Availability bias: overestimation of frequency of occurrence of salient (attention-grabbing) events
• Representativeness bias: faulty categorizing based on inaccurate features
• Fundamental attribution error: overestimating internal causes of behaviour (ie influence of personality) and underestimating situational context  

Cross-cultural health research

Many challenges: language barrier in an already complicated field, limitations of practical settings, eg membership in a cultural group is not always clear-cut; types and prevalence of disorders may be different, eg specific psychiatric syndromes; health communication is more difficult across cultures; translation, adaptation and validation of measures is time-consuming and costly, yet even more necessary in health contexts. 

Summary

• Cultures are difficult to define because cultural boundaries are unclear, and cultures are dynamic 
• Cultural psychology vs. general psychology have different focuses and premises 
• Psychological processes have different degrees of universality 
• Cultural dimensions theory distinguishes different characteristics (dimensions) on which cultures may differ 
• Aspects of culture also impact health and health behaviour 
• Culture is acquired from birth, with cultural differences increasing with age (Parenting styles differ between cultures; Some life stages thought to be universal are actually not)
• Sensitive windows for development for cognition, perception, but also culture! 
• Development of immigrant children depends on many factors: Assimilation / cultural maintenance, Discrimination, SES, Reasons for migration, Reception in new society, more!
• At least some cultural factors are likely to help immigrant children succeed! 
• Immigrant paradox: despite lower SES, immigrant adolescents are less likely to show behavioural, psychological or health problems than national adolescents 
• Most of the current psychology knowledge is based on a WEIRD sample 
• Cross-cultural research, in general, has the same issues and complexities that come up in other psychological domains 
• Studying cultural differences requires extra vigilance for issues and problems in study design related to ethnocentrism 
• Many of these issues have specific fixes, but the best fix is to mix different kinds of methods 
• To truly understand the nature of a cultural difference or phenomenon, one must unpackage it into variables 
• Interpretation biases complicate the interpretation of research findings through basic cognitive biases as well as our own cultural lens! 

Overall considerations

• Studying the impact of culture on thinking and behaviour leads to a more complete understanding than ‘only’ considering universals (Traits can have varying levels of universality)
• Cultures can be distinguished using multiple dimensions 
• The majority of psychological research so far has been carried out with an outlier group, namely westernized psychology students 
• Although most of the same methodological issues apply as in general psychology, additional care needs to be taken.. 
  
  • To counter biases inherent in the measurement methods 
  • To counter biases inherent in the participants, and 
  • To counter biases inherent in the researchers 
• Concepts of health and illness, as well as health-related behaviours, are impacted by culture