Cultural identity and health promotion: Assessing a health education program targeting African immigrants in France

Background The number of African immigrants from Sub-Saharan countries residing in continental France has been steadily rising from an estimate of 20,000 individuals in 1962 to approximately 570,000 individuals in 2004 (CEPED, 2009). In recent years, a decrease in the flow of entries has been observed with an estimated 83,606 Africans entering France in 2007 (CEPED, 2009). The specific health needs of African immigrants in continental France have been highlighted in several studies (Sargent, 2006; Douine, Bouchaud, Moro, Baubet, & Taieb 2012). African immigrants returning to their country of origin in areas endemic to visit friends and relatives (VFR) represent the main risk group for imported malaria (Bouchaud, Cot, Kony, Durand, Schiemann, Palaimazava, Coulaud, Le Bras, & Deloron 2005; Develoux, Le Loup, Dautheville, Belkadi, Magne, Lassel, Bonnard & Pialoux 2012). Regarding reproductive health strategies, this group also face important challenges as they seek to manage their African-based expectations in the context of immigration and health politics (Sargent, 2006). Immigrants in France, especially from West African countries, are also highly affected by HIV/AIDS; which remains a shameful illness in most African communities (Douine et al., 2012). Like their counterparts in the US, African immigrants in France face considerable barriers in maintaining a healthy African diet (CERIN, 2004; Venters & Gany 2011). Moreover, as residents in continental France, they face the high home and leisure injuries (HLI) rate existent in their host country (Chatelus & Thelot, 2011). Although audience-specific education interventions have been demonstrated to be more efficient, very few public health campaigns targeting African immigrants have been recorded (Maibach & Parrot, 1995; Kline, 2007). Reasons listed for the scarcity of work on and with this population commonly include the lack of epidemiological data as well as the French public discourse difficulties to address issues related to African postcolonial migrations (Aina & Cytrynowicz, 2004; Keaton, 2013). In 1999, the first report focusing on foreign populations residing in France was published. This report revealed that there was a higher HIV prevalence among individuals of African descent (Institut de Veille Sanitaire, 1999). In 2008, a public health campaign called Toi-meme tu sais! was launched by INPES (the French National Institute of Prevention and Health Education) to promote positive health seeking practices among African immigrants living in France. Values, beliefs and practices of the intended audiences have now been identified as an essential part of the message content. Effective interventions should therefore be culturally sensitive to these values and situated within the appropriate cultural frameworks rather than the Western so-called scientific culture (Airhihenbuwa, 1995; USDHHS, 2000). [FIGURE 1 OMITTED] One model that has been at the forefront of understanding the influence of culture in general and cultural sensitivity in particular on health is the PEN-3 cultural model (see Figure 1) (Iwelunmor, Newsome & Airhihenbuwa, 2014). Developed by Airhihenbuwa (1989), the model places culture at the core of the development, implementation and evaluation of successful public health interventions (Airhihenbuwa & Webster, 2004; Airhihenbuwa, 2007). He described that to centralize culture in health interventions, three domains of health beliefs and behavior should be taken into account: (1) Cultural Identity, (2) Relationships and Expectations, and (3) Cultural Empowerment. Each domain includes three factors that form the acronym PEN; Person, Extended Family, Neighborhood (for the Cultural Identity domain); Perceptions, Enablers, and Nurturers (for the Relationships and Expectation domain); Positive, Existential and Negative (for the Cultural Empowerment domain). The Cultural Identity domain focuses on the intervention points of entry, which may occur at the level of persons, extended family members, or neighborhoods. …

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