rom the various European cultures with which their predecessors also identified. Beginning in the 1960s, however, the proportion of Europeans among immigrants to the United States has steadily decreased. Thus, an ever increasing number of ethnic communities have developed and continue to develop in this country whose social mores are quite different from the European cultural values that tend to characterize the behaviors of the majority of the American population (Stanford & Schmidt, 1995). When a community's residents represent a broad spectrum of cultures, a situation that is not unusual in urban communities in the United States in the early years of the 21st century, effective community health service programs must be culturally sensitive (Norris, 2001).
Cultural values affect health beliefs, attitudes, and behaviors. This value-belief-attitude-behavior continuum is applicable to health-promotion practitioners as well as to members of a target population. To provide effective health promotion for members of culture-specific populations, health-promotion practitioners must first learn about the relevant cultures and then develop care patterns that are congruent with the values held by the target population (Kulbok, Baldwin, Cox, & Duffy 1997).
Ethnicity serves as a basis for association, self-definition, and participation behaviors that affect group performance and behavior. New members of groups tend to base their actions and interpret other members' actions on the norms they held as members of other groups. Cognitive structures that frequently vary according to ethnicity shape the social realities of group members (Kulbok, Baldwin, Cox, & Duffy 1997).
According to the Health Belief Model, the likelihood that someone will adopt (or continue to engage in) a health-protective behavior is primarily a function of two factors. First, the person must feel that he or she is personally susceptible to (or at risk for) a he...