Culture-Centered Approach (CCA)
CCA was developed by Professor Mohan Dutta in his work with vulnerable and marginalised communities in various countries (Dutta, 2007). It is an approach that centers culture by ensuring that the community has voice in defining problems and solutions, provides resources and structural change, and encourages reflexivity of the research team.
First, how do we ensure that the community has a voice? One of the key considerations is to create a safe space for community members to express themselves. Domination from various social practices, rules, and procedures can severely limit opportunities for marginalised communities to engage and participate. For example, community representatives that we’ve engaged with shared how they felt judged, belittled, and were eventually ignored at a GP reception. These are members who a highly regarded in their own communities. Thus, they no longer feel comfortable nor engage with mainstream health services. So, if we want to ensure they have a voice, the feedback we got from this group is “…[we] need to go to the community…not the other way around”. To not only go to them, but to be consistent by ‘turning up’, ‘show your face’, ‘dress appropriately’, and to ‘come to their level’ So our team did! We went to the space where they felt safe and also where we would feel safe – a community social service provider. This was the space where they could express their tino rangatiratanga (self-determination), and be open about their everyday experiences – key aspects for defining problems together.
The second issue relates to the sharing of resources and making structural changes. For example, our community identified the importance of a Kaiarahi – a community champion who has strong networks and relationships in the community and with health services; who acts as the ‘go-between’ for ‘fringe-communities’ and health providers. For us as researchers, it was about enabling that process of employing a Kaiarahi to happen (money, working with community partners to specify the details, sub-contracts etc). This includes getting the health services involved.
The third issue, how can we as researchers be more reflexive in practice? Reflexivity involves self-examination on issues such as power and privilege and how that influences the work you are doing. Reflexivity creates “spaces” to address these issues to improve how the partnership functions. What we do want to share is a working example of being reflexive. So, as researchers, we’re interested in collecting data. It’s a strength that we have; we have access to resources to help us collect that information. So, what we did is draft a health screening questionnaire for end-users. We started with over 80+ questions, but this was eventually whittled down to about 45 and the content was adapted to fit the community. By sharing and co-developing the questionnaire with our community partners and being reflexive about our goals and desires, we were able to develop an instrument that fits the community needs and the research needs.
Dutta MJ. Communicating about culture and health: theorizing culture-centered and cultural sensitivity approaches. Commun Theory. 2007;17(3):304-328.
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