Difficulty: Intermediate | Prerequisites: Ch. 1-2 (biopsychosocial model, research methods)
This unit covers two connected topics. First, how different cultures understand health and illness, from Traditional Chinese Medicine to Curanderismo, and why that matters for treatment. Second, the major psychological theories that try to predict when and why people change their health behaviours. You need the biopsychosocial model from Ch. 1 to see why culture belongs in the conversation at all.
Different cultures have fundamentally different ideas about what causes illness and how to treat it, from Traditional Chinese Medicine's focus on balance to Curanderismo's blend of the natural and supernatural. Health behaviour theories try to explain why people do (or do not) change their habits: the Health Belief Model, Theory of Planned Behaviour, and Transtheoretical Model are the ones you will see most often. Every theory has blind spots, and a recurring critique is that most of them neglect culture, gender, and race.
Traditional Chinese Medicine (TCM)
The most common form of medicine used worldwide. Focused on physiology and psychology, with treatments such as acupuncture aimed at restoring balance in the individual. Efficacy studies are uncommon because the goal (balance) is difficult to measure by Western standards.
Ayurveda
Traditional Indian medicine emphasising balance between different bodily systems, using yoga, herbs, and dietary changes.
Curanderismo
Mexican-American folk healing tied to religion. Treatments are individualised and depend on the person's beliefs. Illness is understood as disharmony between natural and supernatural forces. In simple terms, it is a biopsychosocial approach with a spiritual element added.
Complementary medicine
Traditional or non-Western practices used alongside (with) conventional Western medicine. Think of it as adding acupuncture to a standard treatment plan.
Alternative medicine
Traditional or non-Western practices used instead of conventional Western medicine.
Integrative medicine
Traditional practices used in a coordinated way with conventional Western medicine. For example, using meditation and mindfulness as part of a structured chronic pain treatment programme.
Health Belief Model (HBM)
A theory that predicts health behaviour based on perceived threat (susceptibility and severity) and perceived expectations (benefits and barriers), plus cues to action. Not well rated overall. Think of it as: "Will I get sick, how bad would it be, and is the fix worth the hassle?"
Protection Motivation Theory (PMT)
A fear-based model focused on the individual. Based on the idea that fear motivates protective behaviour, though evidence suggests fear alone is not a strong motivator. More effective when it builds self-efficacy.
Theory of Reasoned Action (TRA)
Assumes people are likely to do what they intend to do, and that intentions are shaped by attitudes toward the behaviour. Critiqued for assuming purely rational behaviour and ignoring emotion.
Theory of Planned Behaviour (TPB)
The most widely used health behaviour theory. Extends the Theory of Reasoned Action by adding perceived behavioural control: a person's sense of how much control they have over the behaviour, shaped by past successes and failures. Still critiqued for lacking room for religion and culture.
Social Cognitive Theory (Bandura)
People learn health behaviours by observing what others do. In simple terms, we copy what we see working for other people.
Transtheoretical Model (TTM)
A stage-based model that treats behaviour change as a cycle, not a one-time event. Predicts behaviours as people approach a problem through stages. Relatively popular. Staged interventions (matched to where a person is in the cycle) tend to be more effective than one-size-fits-all approaches.
Cultural competence continuum
A six-level scale from least to most culturally competent: cultural destructiveness, cultural incapacity, cultural blindness, cultural pre-competence, cultural competence, cultural proficiency. Mnemonic: D-I-B-P-C-P.
Most common form of medicine used worldwide.
Focused on physiology and psychology, aiming to restore balance within the individual.
Acupuncture is one of its central treatments, though efficacy is hard to measure because the treatment goal (restoring balance) does not map neatly onto Western outcome measures.
Efficacy studies in the Western sense are not common.
Evidence-based and high-technology.
Roots in Hippocrates (medicine separated from religion) and William Harvey (blood flow through the body to the heart).
Reductionist philosophy: look for the single smallest unit causing illness and target it.
One of the most dominant medical systems globally.
Not always respectful towards other cultures and their health beliefs.
Traditional Indian medicine.
Seeks balance between different bodily systems.
Treatments include yoga, herbs, and dietary adjustments.
Mexican-American folk healing, tied to religion.
Illness is caused by disharmony between the natural and the supernatural.
Treatments are individualised, shaped by the patient's own beliefs.
Functions as a biopsychosocial approach with a spiritual element.
Spirits are the source of healing.
Ritual ceremony is central: dancing, sweat lodges, herbs.
Historical mistrust of Western medicine.
Some First Nations people combine traditional treatments with Western medicine.
Health beliefs tied to ancestors and ancestral practices.
Originating in Haiti.
Involves spirits and ancestors.
Illness can result from not honouring ancestors, or from others using Lwa (spirits) to cause illness.
These three terms describe how non-Western practices relate to conventional medicine:
Complementary: used with Western medicine.
Alternative: used instead of Western medicine.
Integrative: traditional practices coordinated with conventional Western medicine in a structured way (e.g., meditation and mindfulness as part of a chronic pain treatment plan).
Immigrants who come to America are often healthier, both mentally and physically, than native-born Americans. However, their health declines the longer they live in the US. This is a striking illustration of how social and cultural environments shape health outcomes.
The cultural competence continuum ranks organisations and practitioners on a six-point scale, from most harmful to most skilled. Know the order and what each level means.
Cultural destructiveness (1, worst): actively harmful attitudes, policies, and practices toward other cultures.
Cultural incapacity (2): not deliberately destructive, but lacking the capacity to help minority populations. Bias and paternalism.
Cultural blindness (3): treating all people the same regardless of culture. Sounds fair but ignores real differences in need and experience.
Cultural pre-competence (4): awareness of limitations and a desire to improve, but not yet skilled. The "we know we need to do better" stage.
Cultural competence (5): accepting and respecting differences, continuously self-assessing, expanding cultural knowledge.
Cultural proficiency (6, best): culture is held in high esteem. The organisation conducts research, develops new approaches, and advocates for cultural competence throughout the system.
Mnemonic for the order: D-I-B-P-C-P (Destructiveness, Incapacity, Blindness, Pre-competence, Competence, Proficiency).
The HBM predicts health behaviour through three layers:
Background factors: demographic variables (age), psychosocial variables (family status, stress level), and structural variables (rural vs. urban, healthcare system).
Perceptions: perceived threat (susceptibility: how likely am I to be affected? severity: how bad would it be?) and expectations (benefits of acting vs. barriers to acting).
Action: likelihood of behaviour, driven by cues to action. Cues can be external (media, family, friends) or internal (noticing changes in your own health).
Critiques: no self-efficacy component; perceived severity is not a strong predictor of behaviour; better at predicting one-time decisions (getting a flu jab) than sustained behaviour change. Overall: not well rated.
Based on fear as a motivator, though evidence shows fear alone is not the best driver of behaviour change.
Focused on the individual; says nothing about social groups.
More effective when it gives people information that builds self-efficacy around the change.
Rated so-so.
Core assumption: people are likely to do what they intend to do.
Intentions are based on a person's attitude toward the behaviour and subjective norms (what others think they should do).
Critiques: assumes purely rational behaviour, assumes everyone can freely choose, leaves no room for emotion. Not complex enough.
The most widely used health behaviour theory.
Extends TRA by adding perceived behavioural control: a person's perception of their control over the behaviour, including past successes and failures with changing it.
Has been used to predict unsafe sexual activity.
Still critiqued for not being complex enough: no room for religion and culture.
People learn by observing what others do. Behaviour is shaped by watching models and seeing the consequences of their actions.
Self-efficacy (belief in your own ability to perform a behaviour) is the central concept.
A stage-based, cyclical model: people move through stages as they approach behaviour change, and they can cycle back.
Staged interventions (tailored to the person's current stage) are more effective than standardised one-size-fits-all interventions.
Relatively popular.
Too focused on the individual; neglect group and community-level factors.
Limited ecological validity: lab results may not apply in the real world.
Rely mostly on self-report measures.
Neglect culture, gender, and race.
Students often confuse complementary and alternative medicine. Complementary is used with Western medicine; alternative is used instead of it. Integrative is the coordinated combination.
Students sometimes assume the Health Belief Model includes self-efficacy. It does not. Self-efficacy was added in the Theory of Planned Behaviour (as perceived behavioural control) and is central to Bandura's Social Cognitive Theory.
Students frequently conflate the Theory of Reasoned Action and the Theory of Planned Behaviour. The key difference is one variable: TPB adds perceived behavioural control. If you remember that, you can keep them straight.
Students sometimes think cultural blindness (level 3 on the continuum) is a good thing because it sounds like treating everyone equally. It is not. Ignoring cultural differences means ignoring real differences in health needs and access.
⚠️ Be able to compare and contrast at least three cultural health systems (TCM, Ayurveda, Curanderismo, Western Biomedicine). Know what each emphasises and how it understands illness.
⚠️ Know the difference between complementary, alternative, and integrative medicine. This is a common matching question.
⚠️ Be able to list the six levels of the cultural competence continuum in order. The mnemonic D-I-B-P-C-P is worth memorising.
⚠️ For each health behaviour theory, know its core mechanism and its main critique. The exam often asks you to identify which theory is being described in a scenario.
⚠️ Know that the Theory of Planned Behaviour is the most widely used theory, and that its key addition over the Theory of Reasoned Action is perceived behavioural control.
⚠️ The general critiques of health behaviour theories (too individual, neglect culture/gender/race, rely on self-report) are likely to appear.
True or False: Curanderismo is a purely biological approach to healing. (False: it blends natural and supernatural explanations and incorporates the person's religious beliefs.)
Fill in the blank: The Theory of Planned Behaviour extends the Theory of Reasoned Action by adding ______. (Perceived behavioural control.)
True or False: Cultural blindness is level 5 on the cultural competence continuum. (False: it is level 3. Level 5 is cultural competence.)
Fill in the blank: The health behaviour theory based on fear as a motivator is called ______. (Protection Motivation Theory.)
True or False: The Health Belief Model includes a self-efficacy component. (False: the absence of self-efficacy is one of its main critiques.)
Q: A patient uses acupuncture alongside their chemotherapy treatment. Is this an example of complementary, alternative, or integrative medicine?
A: Complementary medicine, because the acupuncture is being used with (alongside) the conventional Western treatment. If it were used instead of chemotherapy, it would be alternative. If the oncologist and the acupuncturist were coordinating treatment together, it would be integrative.
Q: Which health behaviour theory adds perceived behavioural control to the prediction of health behaviour, and what does that concept mean?
A: The Theory of Planned Behaviour. Perceived behavioural control is a person's perception of how much control they have over the behaviour, shaped by their past successes and failures with changing it.
Q: A public health campaign uses graphic images of lung disease to discourage smoking. Which theory does this approach most closely align with, and what is its main limitation?
A: Protection Motivation Theory, which uses fear as a motivator. Its main limitation is that fear alone is not a strong driver of sustained behaviour change. The campaign would be more effective if it also built self-efficacy by showing smokers that quitting is achievable.
Q: What is the key difference between cultural blindness and cultural competence on the cultural competence continuum?
A: Cultural blindness (level 3) treats everyone the same regardless of culture, ignoring real differences in health needs. Cultural competence (level 5) accepts and respects differences, with ongoing self-assessment and expanding cultural knowledge.
Q: Name two critiques that apply to health behaviour theories in general.
A: Any two of: they are too focused on the individual, they lack ecological validity, they rely on self-report measures, they neglect culture, gender, and race.
The cultural approaches covered here connect directly to the biopsychosocial model from Ch. 1: each cultural health system weights the biological, psychological, and social components differently. Curanderismo, for instance, adds a spiritual element that the standard biopsychosocial model does not include. The behaviour theories in this unit reappear in Ch. 5-6 when you study stress and coping: the Transtheoretical Model's stages map onto how people approach coping with stress, and self-efficacy (from Social Cognitive Theory and TPB) is a predictor of effective coping.
Cultural approaches to health, Traditional Chinese Medicine, TCM, acupuncture, Ayurveda, Curanderismo, Western biomedicine, biomedical model, American Indian medicine, First Nations medicine, Voodoo health beliefs, Lwa, complementary medicine, alternative medicine, integrative medicine, Health Belief Model, HBM, perceived susceptibility, perceived severity, cues to action, Protection Motivation Theory, PMT, Theory of Reasoned Action, TRA, Theory of Planned Behaviour, TPB, perceived behavioural control, Bandura, social cognitive theory, self-efficacy, Transtheoretical Model, TTM, stages of change, cultural competence continuum, cultural destructiveness, cultural incapacity, cultural blindness, cultural proficiency, DIBPCP, Becoming American, immigrant health paradox, PSY 320, health psych exam 1