traditional power relationships must be transformed. Mutual respect, appropriate responsibility, equity in decision making, and shared commitment to negotiating differences are central to that transformation. Lacking these conditions, the ensuing power differential can become a major barrier to the research process.

  • Identifying risks, mechanisms, triggers, and processes. Attempts to understand risk and protective factors, triggers, and processes regarding the onset of a disorder or problem should allow for the possibility of alternative explanation and circumstances among cultural groups (Neighbors, 1990). For example, risk factors can be unique to a specific population. Consider Levy and Kunitz's (1987) inquiry into suicide among the Hopi. They observed that rates of suicide are high not only among Hopi in “progressive villages” and off-reservation border-towns, but also in traditional villages. Specifically, Hopis at increased risk for suicide include the children of parents who entered into traditionally disapproved marriages, such as across tribes, mesas, and even clans of disparate social status. The labeling of parents as “deviant” in this regard stigmatizes their children, thereby engendering a distinct series of stressors. Typical inquiries about marital status would not have arrived at this discovery, missing an important, systematic risk for suicide and related mental health problems.

  • Employing relevant theoretical frameworks. Choosing theory to guide the intervention entails more than attending to the presumed links between cause and effect. It also must accommodate the relationship between what participants will (or are expected to) learn and those things valued by them. Different groups of people have different attributional styles, even different assumptions about consequences and costs. Numerous illustrations of the kinds of problems that can be caused by these differences can be found in Paul's (1955) book Health, Culture, and Community: Case Studies of Public Reactions to Health Programs. The best is the description by Wellin (1955) of what it took to mount a successful health intervention program in Peru. The problem was dysentery and typhoid; the solution was for people to boil their own water. The difficulty, however, was that the Peruvian community in question lacked an understanding of germ theory. Moreover, the interveners never anticipated that obtaining wood to fuel the fires necessary to boil water was difficult and costly. Analogous examples, both more current and closer to home, include similar disjunctions between conventional intervention models and health beliefs about hypertension among African-Americans (Dressler, 1987), intravenous drug use and HIV infection among African-Americans and Hispanics (Page, Chitwood, Smith, Kane, and McBride, 1990; Singer, Flores,



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