Treatment Engagement and Multicultural Considerations

  • Mana K. AliEmail author
  • Melody Mickens


Culture is generally defined as a set of attitudes, values, behaviors, and symbols shared by a large group of people and usually communicated from one generation to the next (Hays, 2001). People are multicultural, often identifying with various cultural categories (e.g., sex, age, disability, religion, national origin, race) that are layered and intersect in every possible way. It is insufficient to understand a person’s worldview without appreciating the social positions of their cultural memberships (Crenshaw, 1989; Hays, 2001). An individual’s social position can be best understood by examining how their cultural identities influence their role in Hofstede’s power distance relationship paradigm (Hofstede & Bond, 2016). Belonging to various cultural groups that have historically faced oppression, discrimination, stigmatization, or exclusion may exacerbate barriers in biological, psychological, and social areas of the human experience. Belonging to lower-power groups does not determine poor life experiences, and belonging to a higher-power group does not guarantee positive life experiences (see Table 40.1). The factors that contribute to life inequities are multifactorial, interrelated, and complex. This holds true for health inequities, which are rooted in an amalgamation of individual, provider, health system, societal, and environmental factors. Health inequities have been noted across a number of lower-power cultural groups including disability, minority race/ethnicity, homo- or bi-sexual orientation, female or transgender, and lower socioeconomic status (Farber, Ali, Van Sickle, & Kaslow, 2017).


Cultural considerations Treatment engagement Power dynamics Multiculturalism Treatment adherence Cultural competency 


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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Physical Medicine and RehabilitationJohns Hopkins UniversityBaltimoreUSA
  2. 2.Hunter Holmes McGuire Veterans Affairs Medical CenterRichmondUSA

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