Framing the impact of culture on health: a systematic review of the PEN-3 cultural model and its application in public health research and interventions

Iwelunmor, Juliet; Newsome, Valerie; Airhihenbuwa, Collins O.

doi:10.1080/13557858.2013.857768

Cited by 259Cultural Competency in Health CarePublic Health and Social InequalitiesIndigenous Health, Education, and Rights

Framing the impact of culture on health: a systematic review of the PEN-3 cultural model and its application in public health research and interventions

Open access

Iwelunmor, Juliet, Newsome, Valerie, Airhihenbuwa, Collins O.·2014·Ethnicity & Health

DOI 10.1080/13557858.2013.857768PMC PMC4589260

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Abstract

OBJECTIVE: This paper reviews available studies that applied the PEN-3 cultural model to address the impact of culture on health behaviors. METHODS: We search electronic databases and conducted a thematic analysis of empirical studies that applied the PEN-3 cultural model to address the impact of culture on health behaviors. Studies were mapped to describe their methods, target population and the health behaviors or health outcomes studied. Forty-five studies met the inclusion criteria. RESULTS: The studies reviewed used the PEN-3 model as a theoretical framework to centralize culture in the study of health behaviors and to integrate culturally relevant factors in the development of interventions. The model was also used as an analysis tool, to sift through text and data in order to separate, define and delineate emerging themes. PEN-3 model was also significant with exploring not only how cultural context shapes health beliefs and practices, but also how family systems play a critical role in enabling or nurturing positive health behaviors and health outcomes. Finally, the studies reviewed highlighted the utility of the model with examining cultural practices that are critical to positive health behaviors, unique practices that have a neutral impact on health and the negative factors that are likely to have an adverse influence on health. DISCUSSION: The limitations of model and the role for future studies are discussed relative to the importance of using PEN-3 cultural model to explore the influence of culture in promoting positive health behaviors, eliminating health disparities and designing and implementing sustainable public health interventions.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review of 45 studies finds that the PEN-3 cultural model was used to centralize culture in health behavior research and interventions, often as a theoretical framework and qualitative analysis tool. It highlights cultural context, family as an intervention entry point, and positive aspects of culture, while noting limited quantitative testing and transferability concerns.

Key findings

Of 153 unique references initially retrieved after duplicate removal, 45 articles met inclusion criteria for the review.
Reviewed studies used PEN-3 as a theoretical framework to centralize culture in health behavior study and intervention development, and as an analysis tool to categorize themes, cross-tabulate the Relationships and Expectations domain with the Cultural Empowerment domain into a 3 × 3 table, and recontextualize findings.
Three key themes consistently emerged: the importance of context, the role of family as an intervention point of entry, and the need to explore positive aspects of culture on health behaviors.
The model was applied across health issues including HIV/AIDS, cancer, hypertension, diabetes, malaria, nutrition, smoking, reproductive desires, physical inactivity, stress, and domestic violence.

Methods

Systematic search of literature published between 1989 and 2013 using Google Scholar, Medline, Proquest, Psyinfo, Social Science citation index, Sociological abstracts, and Web of Science, with keywords including “PEN-3 cultural model” and “PEN-3 cultural model + Disease.”
Inclusion criteria required use of PEN-3 as a theoretical framework, reported health behavior or health outcome data illustrating its use in data collection and/or analysis and presentation of results, and inclusion of men, women, children, or communities in data collection; review articles, books, and dissertations were excluded.
PRISMA guidelines guided reporting; abstracts were initially screened by one reviewer, full texts were retrieved and re-screened independently by two reviewers, quality was appraised, and thematic analysis identified common themes across the literature.

Limitations

The paper states that almost all reviewed studies used PEN-3 to generate and analyze formative/qualitative data, and none appeared to test any construct or domain of the model quantitatively.
The paper states a transferability limitation: findings from qualitative studies using PEN-3 may not transfer from one context to another, so caution is recommended and PEN-3 should always begin with qualitative study to capture each context’s uniqueness.
The paper states it is not clear which studies returned to the community to share lessons learned from the assessment phase, and recommends this as a critical part of using PEN-3; evident from the text, the review also excluded review articles, books, and dissertations, which may omit relevant applications.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1080/13557858.2013.857768

Cites

63 of 63 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

6 of 22 cited sources checked · 6 supported · 0 flagged

Findingcitation
In tailoring their overall recruitment and study protocol, Ochs-Balcom et al. reinforced positive themes and revised negative themes in a variety of ways.
“In tailoring their overall recruitment and study protocol, the authors reinforced positive themes and revised negative themes in a variety of ways.”
Quote in the paperNot a substantial claim1 of 1 sources checked
- cites Ochs-Balcom, Rodriguez, and Erwin 2011 source
Premisecitation
Among Native Hawaiian women, talk story, a culturally familiar style of discussion, was used to engage women in dialog on the importance of breast cancer screening.
“For example, among Native Hawaiian women, Ka’opua (2008) utilized talk story, a culturally familiar style of discussion to engage women in dialog on the importance of breast cancer screening.”
Quote in the paperNot a substantial claim1 of 1 sources checked
- cites Ka’opua 2008 source
Findingcitation
Ochs-Balcom, Rodriguez, and Erwin (2011) utilized the PEN-3 model to identify positive and negative themes relevant to establishing community partnership to optimize recruitment of African-American women in a breast cancer epidemiology study.
“Ochs-Balcom, Rodriguez, and Erwin (2011) utilized the PEN-3 model to identify positive and negative themes relevant to establishing community partnership to optimize recruitment of African-American women in a breast cancer epidemiology study.”
Quote in the paperNot a substantial claim1 of 1 sources checked
- cites Ochs-Balcom, Rodriguez, and Erwin 2011 source
Findingown data
The PEN-3 model was significant with exploring how family systems play a critical role in enabling or nurturing positive health behaviors and health outcomes.
“PEN-3 model was also significant with exploring not only how cultural context shapes health beliefs and practices, but also how family systems play a critical role in enabling or nurturing positive health behaviors and health outcomes.”
Quote in the paperSubstantial claim
Findingcitation
The importance of centralizing cultural contexts in the study of health behaviors or health outcomes was significant in research studies utilizing the PEN-3 cultural model.
“The importance of centralizing cultural contexts in the study of health behaviors or health outcomes was significant in research studies utilizing the PEN-3 cultural model.”
Quote in the paperSubstantial claim

Findingown data
Forty-five studies met the inclusion criteria for the systematic review.
“Forty-five studies met the inclusion criteria.”
- Also stated in: § Results · plain
  “45 articles meeting the inclusion criteria were retained for this review.”
Quote in the paperSubstantial claim
Findingcitation
Studies using the PEN-3 model demonstrated how cultural context matters when developing interventions and/or clinical trials focused on addressing health behaviors.
“Indeed, studies using the PEN-3 model demonstrated how cultural context matters when developing interventions and/or clinical trials focused on addressing health behaviors such as nutrition attitudes”
Quote in the paperSubstantial claim
Findingown data
The PEN-3 model was significant with exploring how cultural context shapes health beliefs and practices.
“PEN-3 model was also significant with exploring not only how cultural context shapes health beliefs and practices, but also how family systems play a critical role in enabling or nurturing positive health behaviors and health outcomes.”
Quote in the paperSubstantial claim
Findingnone given
The reviewed studies vary greatly in their application of the PEN-3 cultural model to address health behaviors through a cultural lens.
“The reviewed studies vary greatly in their application of the PEN-3 cultural model to address health behaviors through a cultural lens.”
Quote in the paperNot a substantial claim
Findingown data
Data analytical approaches that emerged with the use of PEN-3 include categorization, cross-tabulation, and recontextualization.
“Data analytical approaches that emerged with the use of PEN-3 include: (1) Categorization, (2) Cross-Tabulation, and (3) Recontextualization.”
Quote in the paperNot a substantial claim
Findingcitation
Another data analysis approach commonly used with the PEN-3 cultural model in reviewed studies was cross-tabulation.
“Another data analysis approach commonly used with the PEN-3 cultural model in reviewed studies was cross-tabulation.”
Quote in the paperNot a substantial claim
Findingown data
With categorization, it was common for studies to utilize the PEN-3 model as an organizing framework to categorize themes generated from qualitative data into one of the three domains of the model.
“With categorization, it was common for studies to utilize the PEN-3 model as an organizing framework to categorize themes generated from qualitative data into one of the three domains of the model.”
Quote in the paperNot a substantial claim
Findingown data
Several studies used the PEN-3 cultural model to guide data collection, analysis, and interpretation of qualitative data generated.
“Additionally, several studies also used the PEN-3 cultural model to guide data collection, analysis, and interpretation of qualitative data generated.”
Quote in the paperNot a substantial claim
Findingown data
The reviewed studies used the PEN-3 model as an analysis tool to sift through text and data in order to separate, define and delineate emerging themes.
“The model was also used as an analysis tool, to sift through text and data in order to separate, define and delineate emerging themes.”
Quote in the paperNot a substantial claim
Findingcitation
With cross-tabulation, it was common for existing studies to cross-tabulate the Relationships and Expectations domain with the Cultural Empowerment domain to generate a 3 × 3 table containing nine categories.
“With this approach, it was common for existing studies to cross-tabulate the Relationships and Expectations (i.e., perceptions, enablers, nurturers) domain with the Cultural Empowerment (i.e., positive, existential, and negative) domain of the PEN-3 model to generate a 3 × 3 table containing nine categories.”
Quote in the paperNot a substantial claim
Findingnone given
There were no differences in the application of the model by language or country studied.
“there were no differences in the application of the model by language or country studied”
Quote in the paperNot a substantial claim
Findingcitation
In the context of HIV and AIDS, the PEN-3 cultural model was used to examine the influence of cultural context in explaining stigma and HIV disclosure in South Africa.
“In the context of HIV and AIDS, the PEN-3 cultural model was used to examine the influence of cultural context in explaining stigma and HIV disclosure in South Africa.”
Quote in the paperNot a substantial claim
Findingreasoning
None of the studies reviewed appear to actually test any construct or domain of the PEN-3 model in a quantitative manner.
“None of the studies reviewed appear to actually test any construct or domain of the model in a quantitative manner.”
Quote in the paperSubstantial claim
Findingnone given
Various studies used the PEN-3 model as an 'analysis tool' to sift through text and data in order to separate, define, and delineate the comments of participants into themes that illustrate how culture influences health behaviors.
“Various studies used the PEN-3 model as an ‘analysis tool’ to sift through text and data in order to separate, define, and delineate the comments of participants into themes that illustrate how culture influences health behaviors.”
Quote in the paperSubstantial claim
Findingreasoning
The reviewed studies showed that the PEN-3 model provided the opportunity to challenge the assumption that positive health behavior is solely the function of individual responsibility.
“For example, the studies reviewed showed that the model provided the opportunity to challenge the assumption that positive health behavior is solely the function of individual responsibility.”
Quote in the paperSubstantial claim
Findingreasoning
Almost all of the studies reviewed utilized the PEN-3 model to generate and analyze formative/qualitative data.
“almost all of the studies reviewed utilized PEN-3 model to generate and analyze formative/qualitative data.”
Quote in the paperSubstantial claim
Interpretationcitation
Positive aspects of culture can help promote healthy behaviors that lead to improved health outcomes.
“Like individual behaviors, positive aspects of culture can help promote healthy behaviors (i.e., knowledge of screening and testing, dietary habits, etc.) that lead to improved health outcomes.”
Quote in the paperSubstantial claim
Premisecitation
The PEN-3 cultural model provides researchers and interventionists a strategy for identifying and encouraging positive health behaviors.
“A central feature of the PEN-3 cultural model is that it provides researchers and interventionists a strategy for identifying and encouraging positive health behaviors (Airhihenbuwa and Webster 2004).”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites Airhihenbuwa and Webster 2004 source
Interpretationreasoning
While addressing individual behaviors is necessary, a focus on individual behavior alone at the exclusion of the cultural context limits the success of public health interventions.
“While addressing individual behaviors is necessary, a focus on individual behavior alone at the exclusion of the cultural context limits the success of public health interventions.”
Quote in the paperSubstantial claim
Interpretationreasoning
The findings reported in this review demonstrate that the PEN-3 model is critical in developing and implementing health interventions anchored in culture.
“The findings reported here demonstrate that the PEN-3 model is critical in developing and implementing health interventions anchored in culture.”
Quote in the paperSubstantial claim
Interpretationcitation
As evidenced through its use in the reviewed studies, the PEN-3 model has opened space for researchers to discuss behavior and culture from a positive perspective.
“As evidenced through its use in these studies, the PEN-3 model has opened space for researchers to discuss behavior and culture from a positive perspective.”
Quote in the paperSubstantial claim
Interpretationreasoning
Findings from formative/qualitative data underscore the PEN-3 model's foundation and premise in offering a strategy to excavate and unpack rich descriptions of the complex array of factors, whether positive or negative, at the individual, family, or community levels, for influencing health behaviors.
“findings from formative/qualitative data do underscore the model’s foundation and premise in offering a strategy to excavate and unpack rich descriptions of the complex array of factors whether positive or negative, or at the individual, family, or community levels for influencing health behaviors.”
Quote in the paperSubstantial claim
Premisecitation
Cultural values such as personalismo were central in enabling Latinas to expand their knowledge of treatment options and create a better understanding and willingness to take chemotherapy.
“Similarly, in describing breast cancer treatment experiences, Sheppard et al. (2008) noted that cultural values such as personalismo (warm and personal relationships with individuals, i.e., clinicians) were central in enabling Latinas to expand their knowledge of treatment options and create a better understanding and willingness to take chemotherapy.”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites Sheppard et al. 2008
  Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Interpretationreasoning
For different conditions, behaviors, or experiences such as HIV/AIDS, cancer, or smoking, culture remains the key to effectively examining their impact on health and thus framing solutions.
“Whether it is HIV/AIDS, cancer, or smoking, the findings of this review indicate that for different conditions/behaviors/experiences, culture remains the key to effectively examining their impact on health and thus framing solutions.”
Quote in the paperSubstantial claim

Classified as probably not a substantial claim. 36
May combine two claims. 23

Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
The assessment phase of the PEN-3 model provided the opportunity to arrange emerging themes at the intersection of two domains to assess for any domain interactions.
“This approach which is often referred to as the assessment phase of the PEN-3 model provided the opportunity to arrange the emerging themes at the intersection of two domains to assess for any domain interactions (Airhihenbuwa et al. 2009; Airhihenbuwa and Webster 2004).”
Quote in the paperNot a substantial claim1 of 2 sources checked
- cites Airhihenbuwa et al. 2009 source
- cites Airhihenbuwa and Webster 2004 source
Classified as probably not a substantial claim.
Interpretationcitation
Understanding how families cope with health and illness is central to developing sustainable public health interventions aimed at reducing HIV and AIDS stigma, particularly with identifying key members of the family who have made a difference in the lives of PLWHA.
“In describing the impact of AIDS-related stigma, using the PEN-3 model, Airhihenbuwa et al. (2009) noted that understanding how families cope with health and illness is central to developing sustainable public health interventions aimed at reducing HIV and AIDS stigma, particularly with identifying key members of the family who have made a difference in the lives of PLWHA.”
Quote in the paperSubstantial claim1 of 1 sources checked
- cites Airhihenbuwa et al. 2009 source
May combine two claims.
Findingcitation
In Ochs-Balcom et al. (2011), positive themes included the need for more information about breast cancer and potential benefits to younger generations, while negative themes included lack of knowledge regarding research participation, issues related to confidentiality of data, and breast cancer research in general.
“While the need for more information about breast cancer and potential benefits to younger generations were among the positive themes identified, negative themes included lack of knowledge regarding research participation, issues related to confidentiality of data, and breast cancer research in general (Ochs-Balcom, Rodriguez, and Erwin 2011).”
Quote in the paperNot a substantial claim1 of 1 sources checked
- cites Ochs-Balcom, Rodriguez, and Erwin 2011 source
May combine two claims.
Findingown data
Three key themes consistently emerged in the reviewed studies: the importance of context, the role of family as an intervention point of entry, and the need to explore the positive aspects of culture on health behaviors.
“Indeed, three key themes consistently emerged and appear to help provide an in-depth understanding of how PEN-3 centralizes culture in the study of health behaviors and health outcomes. These themes include the importance of context, the role of family as an intervention point of entry, and the need to explore the positive aspects of culture on health behaviors.”
Quote in the paperSubstantial claim
May combine two claims.
Findingown data
Some studies utilized all three domains of the model to categorize themes, while others used only one domain depending on the nature of the study.
“Also, while some studies utilized all three domains of the model to categorize the themes generated for data analysis, it was not uncommon for studies to use only one of the domains to be applied depending on the nature of the study.”
Quote in the paperNot a substantial claim
May combine two claims.
Findingown data
The reviewed studies used the PEN-3 model as a theoretical framework to centralize culture in the study of health behaviors and to integrate culturally relevant factors in the development of interventions.
“The studies reviewed used the PEN-3 model as a theoretical framework to centralize culture in the study of health behaviors and to integrate culturally relevant factors in the development of interventions.”
- Also stated in: § Application of PEN-3 cultural model in studies reviewed · hedged
  “it was common for studies to use the PEN-3 model as a theoretical framework to centralize culture in the study of health behaviors and to integrate culturally relevant factors in the development of interventions.”
Quote in the paperSubstantial claim
May combine two claims.
Findingreasoning
The reviewed studies highlighted the utility of the model with examining cultural practices that are critical to positive health behaviors, unique practices that have a neutral impact on health and the negative factors that are likely to have an adverse influence on health.
“Finally, the studies reviewed highlighted the utility of the model with examining cultural practices that are critical to positive health behaviors, unique practices that have a neutral impact on health and the negative factors that are likely to have an adverse influence on health.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingnone given
Some findings in this review show similar outcomes in different study populations.
“even though some of the findings in this review show similar outcomes in different study populations.”
Quote in the paperNot a substantial claim
May combine two claims.
Findingreasoning
The studies reviewed show that regardless of the health outcome or health behavior of interest, the PEN-3 cultural model provides the opportunity to examine cultural practices that are critical to positive health behaviors, acknowledges unique practices that have a neutral impact on health, and identifies negative factors that are likely to have an adverse influence on health.
“The studies reviewed show that regardless of the health outcome or health behavior of interest, the PEN-3 cultural model provides the opportunity to examine cultural practices that are critical to positive health behaviors, acknowledges unique practices that have a neutral impact on health, and identifies negative factors that are likely to have an adverse influence on health.”
Quote in the paperSubstantial claim
May combine two claims.
Findingreasoning
The PEN-3 cultural model helped to focus research not only on the context that nurtures the health behavior of interest but also on the role of the collective (e.g., family) in influencing health behaviors.
“the PEN-3 cultural model helped to focus research not only on the context that nurtures the health behavior of interest but also on the role of the collective (e.g., family) in influencing health behaviors.”
Quote in the paperSubstantial claim
May combine two claims.
Findingcitation
With the PEN-3 model, authors unpacked biases regarding the health behaviors of interest and engaged research participants themselves with efforts aimed at promoting positive health outcomes.
“With the PEN-3 model, authors unpacked biases regarding the health behaviors of interest, and engaged research participants themselves with efforts aimed at promoting positive health outcomes (White et al. 2012).”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites White et al. 2012
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingreasoning
It is not clear which of the reviewed studies included returning to the community to share lessons learned in the assessment phase, as it was not reported.
“It is not clear which of these studies included this aspect of the model as it was not reported.”
Quote in the paperNot a substantial claim
May combine two claims.
Findingreasoning
Studies use the PEN-3 model to explore not only how cultural context shapes beliefs and practices, but also how family systems play a critical role in enabling or nurturing positive health behaviors and health outcomes.
“Studies also use the model to explore not only how cultural context shapes beliefs and practices, but also how family systems play a critical role in enabling or nurturing positive health behaviors and health outcomes.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown data
PRISMA guidelines were used to guide reporting of the documents reviewed.
“PRISMA guidelines were used to guide reporting of the documents reviewed and a flow diagram is shown in Figure 2.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone given
The abstracts of all documents were initially screened by one reviewer; full-text documents were retrieved and re-screened by two reviewers independently.
“The abstracts of all of the documents were initially screened by one reviewer; however, the full-text documents were retrieved and re-screened by two reviewers independently.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.
Interpretationreasoning
Cultural context provides a clearer lens through which researchers might view and understand health behavior, while highlighting variables that may be most salient in future intervention design.
“Cultural context also provides a clearer lens through which researchers might view and understand health behavior, while highlighting variables that may be most salient in future intervention design.”
Quote in the paperNot a substantial claim
Classified as probably not a substantial claim.
Study design and conductnone given
The quality of the documents retrieved was appraised for appropriateness of the methodology used in the study including description of purpose, target population, context, ethics, rigor of data collection and analysis, relevance and richness of findings, and clarity of discussions or conclusions.
“The quality of the documents retrieved was appraised for appropriateness of the methodology used in the study including the description of the purpose, target population, and context for the study, ethics, rigor of data collection and analysis, relevance and richness of the findings, as well as the clarity of the discussions or conclusions of the overall study.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
The growth of Positive Psychology is an example of compelling evidence of the benefit of focusing on positive aspects of behavior, actions, and indeed culture.
“The growth of Positive Psychology, however, which emerged in 2000 is an example of a compelling evidence of the benefit of focusing on positive aspects of behavior, actions, and indeed culture.”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites Seligman and Csikszentmihalyi 2000 source
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
This field of psychology encouraged a paradigm shift from a focus on negative aspects of individuals and related pathology to identifying and bolstering positive personal attributes for understanding how people thrive and survive even in situations and environments of adversity.
“This field of psychology encouraged a paradigm shift from a focus on negative aspects of individuals and related pathology to identifying and bolstering positive personal attributes for understanding how people thrive and survive even in situations and environments of adversity (Seligman and Csikszentmihalyi 2000).”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites Seligman and Csikszentmihalyi 2000 source
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Premisereasoning
Prevention researchers began to realize that focusing research and practice on personal weakness and symptomatology left clinicians ill-prepared for preventing illness.
“Prevention researchers began to realize that focusing research and practice on personal weakness and symptomatology left clinicians ill-prepared for preventing illness.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation
Family systems can be sources of support, unique indigenous entities, and sources of stress when addressing the care and support needs of family members living with HIV and AIDS.
“In a paper on family systems and HIV and AIDS, Iwelunmor et al. (2006) reported that family systems can be sources of support, unique indigenous entities, and sources of stress when addressing the care and support needs of family members living with HIV and AIDS.”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites Iwelunmor et al. 2006
  Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim.
Study design and conductown data
Thematic analysis was applied across the available literature to identify common themes that emerge when the PEN-3 cultural model is applied to address cultural aspects of health behaviors.
“Furthermore, thematic analysis was applied across the available literature to identify common themes that emerge when the PEN-3 cultural model is applied to address cultural aspects of health behaviors.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Interpretationcitation
The need to take into account families' experiences with HIV and AIDS was critical in the development of interventions aimed at reducing the burden of HIV and AIDS-related stigma in the family and improve care and support for PLWHA.
“However, the need to take into account families’ experiences with HIV and AIDS was critical in the development of interventions aimed at reducing the burden of HIV and AIDS-related stigma in the family and improve care and support for PLWHA (Iwelunmor et al. 2006).”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites Iwelunmor et al. 2006
  Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S2 (checkable), S4 (based).
Interpretationreasoning
Given the overwhelming need for effective public health research and interventions that address health behaviors from a collective rather than an individual perspective, a cultural approach to health offers the opportunity to identify the broader contextual relationships and expectations whether positive, unique, or negative.
“Moreover, given the overwhelming need for effective public health research and interventions that address health behaviors from a collective rather than an individual perspective, a cultural approach to health offers the opportunity to identify the broader contextual relationships and expectations whether positive, unique, or negative.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.
Interpretationreasoning
Together, positive, unique, and negative factors are essential to eliminating inequities in health and advancing the mission of public health research and interventions globally.
“Together, these factors are essential to eliminating inequities in health and advancing the mission of public health research and interventions globally.”
Quote in the paperNot a substantial claim
- Rests on an assumption: Every culture has something positive, something unique, and something negative.
Probably not a substantial claim: may not pass S2 (checkable).
Interpretationreasoning
In this way, the construction and interpretation of health behaviors are examined as functions of broader cultural contexts, particularly in relation to how culture defines the roles of persons and their expectations in family and community relationships.
“In this way, the construction and interpretation of health behaviors are examined as functions of broader cultural contexts particularly in relation to how culture defines the roles of persons, and their expectations in family and community relationships.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation
Food, particularly 'soul food' is a positive and existential dietary behavior practiced among African Americans and used to celebrate and affirm culture.
“Within the context of nutrition, in describing how culture impacts dietary habits, James (2004) noted that food, particularly ‘soul food’ is a positive and existential dietary behavior practiced among African Africans and used to celebrate and affirm culture.”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites James 2004 source
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
The PEN-3 model takes the thematic interpretation of qualitative data into an analysis process that sorts beliefs and concepts into discrete domains that can then be contextualized with specific behaviors, delivery and messages.
“‘the model takes the thematic interpretation of qualitative data into an analysis process that sorts beliefs and concepts into discrete domains that can then be contextualized with specific behaviors, delivery and messages’ (Erwin et al. 2010).”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites Erwin et al. 2010 source
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
With Recontextualization, the goal is to locate themes generated from qualitative data within the context of established knowledge.
“With Recontextualization, Morse and Field (1995) suggest that the goal is to locate the themes generated from qualitative data within the context of established knowledge.”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites Morse and Field 1995
May combine two claims.
Premisecitation
Infant feeding practices among low-income African-American women were 'learned' from family members and others within the community and 'shared' with other new mothers within the community.
“Underwood et al. (1997) reported that infant feeding practices among low-income African-American women were ‘learned’ from family members and others within the community and ‘shared’ with other new mothers within the community as well.”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites Underwood et al. 1997 source
Classified as probably not a substantial claim. May combine two claims.
Interpretationreasoning
PEN-3 enables an examination of the perceptions people may have about a health behavior, the resources or institutional forces that enable or disenable actions toward the health behavior, and the influence of family, friends, and communities in nurturing the behavior.
“PEN-3 also enables an examination of the perceptions people may have about a health behavior, the resources or institutional forces that enable or disenable actions toward the health behavior and the influence of family, friends, and communities in nurturing the behavior.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation
African-American women are key agents of cultural transformation as they are usually concerned with the family's health, responsible for food preparation, set standards for healthful and unhealthy eating, and provide access to other family members.
“In determining targets for public health interventions as part of the Cultural Identity domain of the PEN-3 model, James (2004) reported that African-American women are key agents of cultural transformation as they are usually concerned with the family’s health, responsible for food preparation, set standards for healthful and unhealthy eating, and provide access to other family members.”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites James 2004 source
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
Frying foods is known to be harmful to health.
“frying foods, which is known to be harmful to health (James 2004).”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites James 2004 source
Classified as probably not a substantial claim.
Interpretationreasoning
PEN-3 unpacks assumptions surrounding individual responsibilities or capabilities so as to expand and examine the role other factors play in inhibiting and/or nurturing healthy behavior change.
“In doing so, this approach unpacks assumptions surrounding individual responsibilities or capabilities so as to expand and examine the role other factors play in inhibiting and/or nurturing healthy behavior change.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.
Interpretationreasoning
Qualitative findings using the PEN-3 cultural model continue to be very important and provide some key outcomes on which quantitative design could be used to advance current use of the model to better understand culture and health.
“Qualitative findings using the PEN-3 cultural model continue to be very important and they do provide some key outcomes on which quantitative design could be used to advance current use of the model to better understand culture and health.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S2 (checkable).
Interpretationreasoning
Culturally appropriate and compelling strategies for behavior change require an understanding not only of individual-level factors but also of factors related to cultural norms, including conditions in which people live, grow, eat, and die.
“Furthermore, culturally appropriate and compelling strategies for behavior change will require an understanding not only of individual-level factors but also of factors related to cultural norms including conditions in which people live, grow, eat, and die.”
Quote in the paperNot a substantial claim
Classified as probably not a substantial claim. May combine two claims.
Interpretationreasoning
Whereas many conventional health behavior theories often focus on the individual to promote change, PEN-3 offers a culture-centered approach to health that extends analysis to the totality of the contexts that either inhibit or nurture the individual.
“Whereas many of the conventional health behavior theories often focus on the individual to promote change, PEN-3 offers a culture-centered approach to health that extends analysis to the totality of the contexts that either inhibit or nurture the individual.”
Quote in the paperSubstantial claim
Classified as probably not a substantial claim. May combine two claims.
Interpretationreasoning
What is central to PEN-3 is to ensure that interventions are developed not only with the bad in mind, but to begin with identifying and promoting the good while recognizing the unique aspects of culture with respect to health.
“What is central to PEN-3, then is to ensure that interventions are developed not only with the bad in mind (as is often the case), but to begin with identifying and promoting the good while recognizing the unique aspects of culture with respect to health.”
Quote in the paperSubstantial claim
- Rests on an assumption: Every culture has something positive, something unique, and something negative.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation
Food myths, inaccurate information, and negative behaviors surrounding food choices and dietary intake are common among African-Americans.
“food myths, inaccurate information, and negative behaviors surrounding food choices and dietary intake are common among African-Americans”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites James 2004 source
Classified as probably not a substantial claim. May combine two claims.
Interpretationreasoning
In framing the impact of culture on health, the PEN-3 cultural model offers a tool for those committed to addressing health issues and problems to do so by acknowledging aspects of culture that may negatively influence health, but always identifying a strength-based approach to public health intervention and education utilizing positive aspects of culture.
“In framing the impact of culture on health, the PEN-3 cultural model offers a tool for those who are committed to addressing health issues and problems to do so by acknowledging those aspects of culture that may negatively influence health, but always identifying a strength-based approach to public health intervention and education utilizing positive aspects of culture.”
Quote in the paperSubstantial claim
- Rests on an assumption: Every culture has something positive, something unique, and something negative.
Classified as probably not a substantial claim.
Interpretationreasoning
Discussing the positive aspects of culture and behavior while reframing cultural occurrences traditionally viewed as negative allows researchers to develop culturally congruent explanations and culturally relevant interventions for health.
“Discussing the positive aspects of culture and behavior, while reframing those cultural occurrences traditionally viewed as negative allows researchers to develop culturally congruent explanations and culturally relevant interventions for health.”
Quote in the paperSubstantial claim
Classified as probably not a substantial claim.
Interpretationreasoning
Taken together, the 45 articles presented in this review highlight the importance of exploring the impact of culture on health, particularly in designing effective public health interventions.
“Taken together, the 45 articles presented in this review highlight the importance of exploring the impact of culture on health, particularly in designing effective public health interventions.”
Quote in the paperSubstantial claim
Classified as probably not a substantial claim. May combine two claims.
Premisecitation
The PEN-3 cultural model focuses on the impact of culture on health beliefs and actions, and proposes that public health and health promotion should not focus only on the individual, but instead on cultural context that nurtures a person's health behavior in his or her family and community.
“The PEN-3 cultural model focuses on the impact of culture on health beliefs and actions, and proposes that public health and health promotion should not focus only on the individual, but instead on cultural context that nurtures a person’s health behavior in his or her family and community (Airhihenbuwa 2007b).”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites Airhihenbuwa 2007b
  Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S2 (checkable).
Interpretationreasoning
PEN-3 offers the opportunity to view culture as the raison d'etre of health behavior.
“PEN-3 offers the opportunity to view culture as the raison d’etre of health behavior as culture gives meanings to the coexistence of what is good, indifferent, and bad.”
Quote in the paperNot a substantial claim
- Rests on an assumption: Culture gives meanings to the coexistence of what is good, indifferent, and bad.
Probably not a substantial claim: may not pass S2 (checkable).
Interpretationreasoning
The PEN-3 model represents an important approach over other efforts that primarily focus solely on Western constructs of individual factors that influence health behaviors.
“It also represents an important approach over other efforts that primarily focus solely on Western constructs of individual factors that influence health behaviors.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S2 (checkable).
Interpretationreasoning
Caution should be exercised in transferring findings generated using the PEN-3 model to other contexts because cultural aspects of health behaviors in one setting may not be applicable to other settings.
“Indeed, caution should be exercised in transferring the findings generated using the PEN-3 model to other contexts as cultural aspects of health behaviors in one setting may not be applicable to other settings.”
Quote in the paperNot a substantial claim

46 of 46

The paper relies on this without support.
There is a need to understand how the PEN-3 cultural model has been applied in studies, including the approach used to guide data collection and analysis, common thematic representations, limitations, and future directions.
“There is a need, however, to understand how this model has been applied in these studies, what approach (if any) is used to guide data collection and analysis, common thematic representations generated from the application of the model, limitations associated with using this model, and future directions with respect to application of the model.”
The paper relies on this without support.
Every culture has something positive, something unique, and something negative.
“Every culture has something positive, something unique, and something negative.”
The authors state this as an assumption.
The way that people perceive their health is rooted in relationships and interactions characteristic of their culture.
“with the understanding that the way that people perceive their health is rooted in relationships and interactions characteristic of their culture”
The paper relies on this without support.
Culture gives meanings to the coexistence of what is good, indifferent, and bad.
“culture gives meanings to the coexistence of what is good, indifferent, and bad.”

4 of 4

Positive psychology: An introduction.
Seligman, M. E. P., & Csikszentmihalyi, M. (2000) · American Psychologist · doi:10.1037/0003-066x.55.1.5 · Cited by 11,351 · cited 1× · see citing works
“…encouraged a paradigm shift from a focus on negative aspects of individuals and related pathology to identifying and bolstering positive personal attributes for understanding how people thrive and survive even in situations and environments of adversity (Seligman and Csikszentmihalyi 2000).”
Background
Journal of the National Medical Association
(2010) · Journal of the National Medical Association · doi:10.1016/s0027-9684(15)30622-2 · Cited by 5,338 · see citing works
AIDS Education and Prevention
誠一, 市. (2004) · The Journal of AIDS Research · doi:10.11391/aidsr1999.6.104 · Cited by 3,233 · see citing works
The Significance of Saturation
Morse, J. M. (1995) · Qualitative Health Research · doi:10.1177/104973239500500201 · Cited by 2,663 · see citing works
Untitled work
(1995) · Medical Entomology and Zoology · Cited by 2,472 · see citing works
Communicating About Culture and Health: Theorizing Culture-Centered and Cultural Sensitivity Approaches
Dutta, M. J. (2007) · Communication Theory · doi:10.1111/j.1468-2885.2007.00297.x · Cited by 442 · see citing works
Factors influencing food choices, dietary intake, and nutrition-related attitudes among African Americans: application of a culturally sensitive model
James, D. (2004) · Ethnicity & Health · doi:10.1080/1355785042000285375 · Cited by 407 · see citing works
Health and Culture: Beyond the Western Paradigm
Airhihenbuwa, C. O. (1995) · Cited by 362 · see citing works
Self-citation
Health and Culture-Beyond the Western Paradigm
Parvanta, C. F. (1996) · Journal of Human Lactation · doi:10.1177/089033449601200332 · Cited by 335 · cited 5× · see citing works
“It focuses on the role of culture as a connecting web by which individual perceptions and actions regarding health are shaped and defined (Airhihenbuwa 1995, 2007a, 2007b), while acknowledging that these perceptions and actions are building blocks in constructing health beliefs that are reproduced…”
BackgroundInfluential
The Role of Culture in Health Literacy and Chronic Disease Screening and Management
Shaw, S. J., Torres, C. H., Armin, J. S., Orzech, K., & Vivian, J. (2008) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-008-9135-5 · Cited by 257 · cited 3× · see citing works
“1 Sheppard et al. (2010) In-depth interviews N = 34 (14 breast cancer patients in active treatment, 10 survivor advocates, and 10 cancer providers) Treatment decisions Breast cancer Reported key perceptions (such as sharing/hearing stories of survival, strong faith), enablers (patient-provider relationship, need/desir…”
Background
Cultural aspects of African American eating patterns
Airhihenbuwa, C. O., Kumanyika, S., Agurs, T. D., Lowe, A., Saunders, D., & Morssink, C. B. (1996) · Ethnicity & Health · doi:10.1080/13557858.1996.9961793 · Cited by 255 · cited 2× · see citing works
“17 Airhihenbuwa et al. (1996) Focus groups N = 21 AfricanAmerican males and 32 AfricanAmerican females Cultural aspects of eating patterns Nutrition The model helped to elicit perceptions about cultural food practices of African-Americans including the negative (i.e., harmful to health), the…”
BackgroundSelf-citation
Culture and African contexts of HIV/AIDS prevention, care and support
Airhihenbuwa, C. O., & Webster, J. D. (2004) · SAHARA-J: Journal of Social Aspects of HIV/AIDS · doi:10.1080/17290376.2004.9724822 · Cited by 246 · cited 2× · see citing works
“The model also places culture at the core of the development, implementation, and evaluation of successful public health interventions (Airhihenbuwa and Webster 2004; Airhihenbuwa 1995, 2007a).”
BackgroundSelf-citation
Cultural factors and children's oral health care: a qualitative study of carers of young children
Hilton, I. V., Stephen, S. M., Barker, J. C., & Weintraub, J. A. (2007) · Community Dentistry And Oral Epidemiology · doi:10.1111/j.1600-0528.2006.00356.x · Cited by 179 · cited 1× · see citing works
“41 Hilton et al. (2007) Focus groups N = 177 participants Cultural beliefs and practices Oral care The PEN-3 model facilitated and insured examination of the focus group data in a culturally sensitive and appropriate manner.”
Background
Prevention of type 2 diabetes in British Bangladeshis: qualitative study of community, religious, and professional perspectives
Grace, C., Begum, R., Subhani, S., et al. (2008) · BMJ · doi:10.1136/bmj.a1931 · Cited by 165 · cited 3× · see citing works
“14 Grace et al. (2008) Focus groups and semistructured interviews N = 129 (80 lay people, 29 Islamic scholars and religious leaders and 20 health professionals) Lay beliefs and attitudes Diabetes Participants accepted the concept of diabetes prevention; however. practical and structural barriers to…”
Background
HIV/AIDS and ‘othering’ in South Africa: The blame goes on
Petros, G., Airhihenbuwa, C. O., Simbayi, L. C., Ramlagan, S., & Brown, B. J. (2006) · Culture Health & Sexuality · doi:10.1080/13691050500391489 · Cited by 153 · cited 3× · see citing works
“Petros et al. (2006) used the PEN-3 model to explore how people living with HIV experience ‘othering.’”
BackgroundMethodSelf-citation
An examination of sociocultural factors associated with health and health care seeking among latina immigrants
Garcés, I. C., Scarinci, I. C., & Harrison, L. L. (2006) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-006-9008-8 · Cited by 144 · see citing works
Contextualizing diversity and culture within cancer control interventions for Latinas: Changing interventions, not cultures
Erwin, D. O., Treviño, M., Saad-Harfouche, F. G., Rodriguez, E. M., Gage, E., & Jandorf, L. (2010) · Social Science & Medicine · doi:10.1016/j.socscimed.2010.05.005 · Cited by 123 · see citing works
Eliminating Health Disparities in the African American Population: The Interface of Culture, Gender, and Power
Airhihenbuwa, C. O., & Liburd, L. C. (2006) · Health Education & Behavior · doi:10.1177/1090198106287731 · Cited by 115 · cited 8× · see citing works
“(2008) x x x Yick and Oomen-Early (2009) x x x Kline (2007) x x x Okoror et al. (2007) x x Scarinci et al. (2007) x x Garcés et al.”
BackgroundMethodInfluentialSelf-citation
Healing Our Differences: The Crisis of Global Health and the Politics of Identity
Airhihenbuwa, C. O. (2006) · Cited by 108 · see citing works
Self-citation
Stigma, Culture, and HIV and AIDS in the Western Cape, South Africa: An Application of the PEN-3 Cultural Model for Community-Based Research
Airhihenbuwa, C., Okoror, T., Shefer, T., Brown, D., Iwelunmor, J., Smith, E., Adam, M., Simbayi, L., Zungu, N., Dlakulu, R., et al. (2009) · Journal of Black Psychology · doi:10.1177/0095798408329941 · Cited by 102 · cited 4× · see citing works
“…(James 2004; Airhihenbuwa et al. 1996), depression prevention (Saulsberry et al. 2013), domestic violence (Yick and Oomen-Early 2009), HIV and AIDS (Airhihenbuwa et al. 2009; Iwelunmor, Zungu, and Airhihenbuwa 2010; Okoror et al. 2012; Westmaas et al. 2012; Green et al. 2009; Mieh, Iwelunmor, and…”
BackgroundMethodInfluentialSelf-citation
Development of a Theory-Based (PEN-3 and Health Belief Model), Culturally Relevant Intervention on Cervical Cancer Prevention Among Latina Immigrants Using Intervention Mapping
Scarinci, I. C., Bandura, L., Hidalgo, B., & Cherrington, A. (2011) · Health Promotion Practice · doi:10.1177/1524839910366416 · Cited by 102 · cited 2× · see citing works
“Scarinci et al. (2012) also identified specific cultural values considered central to the Latino culture that may play a role in cervical cancer prevention.”
Background
Perspectives on AIDS in Africa: Strategies for Prevention and Control
Airhihenbuwa, C. O. (1989) · AIDS Education and Prevention · doi:10.1521/aeap.1989.1.1.57 · Cited by 84 · cited 11× · see citing works
“21 Sofolahan and Airhihenbuwa (2013) Focus group discussions N = 35 women living with HIV and AIDS Reproductive desires HIV and AIDS The results showed that the sexual reproductive health care needs of women were not being addressed by many HCWs. Additionally, the results found that health care decisions were influenc…”
BackgroundInfluentialSelf-citation
Knowledge and beliefs about cervical cancer screening among men in Kumasi, Ghana.
Williams, M. S., & Amoateng, P. (2012) · Europe PMC (PubMed Central) · Cited by 82 · see citing works
Family Systems and HIV/AIDS in South Africa
Iwelunmor, J., Airhihenbuwa, C. O., Okoror, T. A., Brown, D., & BeLue, R. (2008) · International Quarterly of Community Health Education · doi:10.2190/iq.27.4.d · Cited by 79 · cited 11× · see citing works
“32 Iwelunmor et al. (2006) Focus groups N = 204 (150 females and 54 males) Caregiving HIV and AIDS The findings highlight the positive and supportive aspects of family systems, acknowledge that family systems are unique (existential) indigenous entities, and note that family systems can be sources of stress when carin…”
BackgroundInfluentialSelf-citation
A Conceptual Model for Culturally Appropriate Health Education Programs in Developing Countries
Airhihenbuwa, C. O. (1990) · International Quarterly of Community Health Education · doi:10.2190/lpkh-pmpj-dbw9-fp6x · Cited by 77 · cited 2× · see citing works
“…by Airhihenbuwa (1989) in response to the apparent omission of culture in explaining health outcomes in existing health behavior theories and models (Airhihenbuwa 1990), the PEN-3 cultural model centralizes culture in the study of health beliefs, behaviors, and health outcomes (Airhihenbuwa 1995).”
BackgroundSelf-citation
Development of decision‐support intervention for Black women with breast cancer
Sheppard, V. B., Williams, K. P., Harrison, T. M., Jennings, Y., Lucas, W., Stephen, J. C., Robinson, D. H. Z., Mandelblatt, J. S., & Taylor, K. L. (2009) · Psycho-Oncology · doi:10.1002/pon.1530 · Cited by 66 · cited 4× · see citing works
“Sheppard et al. (2010) utilized qualitative findings related to the PEN-3 domains to inform the implementation of a decision to support intervention for black women with breast cancer.”
BackgroundMethodInfluential
Latina a LatinaSM: developing a breast cancer decision support intervention
Sheppard, V. B., Figueiredo, M. I., Cañar, J., et al. (2007) · Psycho-Oncology · doi:10.1002/pon.1239 · Cited by 58 · see citing works
Development of a Culturally Targeted Smoking Cessation Intervention for African American Smokers
Matthews, A. K., Sánchez-Johnsen, L., & King, A. C. (2009) · Journal of Community Health · doi:10.1007/s10900-009-9181-5 · Cited by 57 · cited 1× · see citing works
“…desires (Sofolahan and Airhihenbuwa 2012, 2013), physical inactivity, stress (Gaston, Porter, and Thomas 2007), smoking (Beech and Scarinci 2003; Matthews, Sánchez-Johnsen, and King 2009; Scarinci et al. 2007), and cancer screening and awareness (Erwin et al. 2010; Osann et al. 2011; White et…”
Background
Of Culture and Multiverse: Renouncing “the Universal Truth” in Health
Airhihenbuwa, C. O. (1999) · Health Education · doi:10.1080/10556699.1999.10603409 · Cited by 56 · cited 3× · see citing works
“Culture in this context refers to shared values, norms, and codes that collectively shape a group’s beliefs, attitudes, and behavior through their interaction in and with their environments (Airhihenbuwa 1999).”
BackgroundInfluentialSelf-citation
Incorporating Cultural Constructs and Demographic Diversity in the Research and Development of a Latina Breast and Cervical Cancer Education Program
Erwin, D. O., Johnson, V., Feliciano, L., Zamora, D., & Jandorf, L. H. (2005) · Journal of Cancer Education · doi:10.1207/s15430154jce2001_12 · Cited by 55 · cited 1× · see citing works
“7 Erwin et al. (2005) Focus groups and questionnaires.”
Prime Time Sister Circles: evaluating a gender-specific, culturally relevant health intervention to decrease major risk factors in mid-life African-American women.
Gaston, M. H., Porter, G., & Thomas, V. G. (2007) · PubMed Central · Cited by 53 · see citing works
Cultural Sensitivity and Health Promotion: Assessing Breast Cancer Education Pamphlets Designed for African American Women
Kline, K. N. (2007) · Health Communication · doi:10.1080/10410230701283454 · Cited by 52 · cited 2× · see citing works
“4 Kline (2007) Generative rhetorical criticism N = 7 educational pamphlets on breast cancer Cultural sensitivity Breast cancer In thematizing the messages in the pamphlets using the PEN-3 framework, the findings revealed that although messages were not inaccurate, they were constituted by…”
Method
Developing a Culturally Responsive Breast Cancer Screening Promotion with Native Hawaiian Women in Churches
Ka'opua, L. S. (2008) · Health & Social Work · doi:10.1093/hsw/33.3.169 · Cited by 51 · see citing works
Untitled work
(2012) · PubMed · Cited by 50 · see citing works
Working to Close the Gap: Identifying Predictors of HPV Vaccine Uptake among Young African American Women
Bynum, S. A., Brandt, H. M., Sharpe, P. A., Williams, M. S., & Kerr, J. (2011) · Journal of Health Care for the Poor and Underserved · doi:10.1353/hpu.2011.0060 · Cited by 50 · see citing works
2007 SOPHE Presidential Address: On Being Comfortable With Being Uncomfortable: Centering an Africanist Vision in Our Gateway to Global Health
Airhihenbuwa, C. O. (2006) · Health Education & Behavior · doi:10.1177/1090198106291377 · Cited by 47 · cited 6× · see citing works
“It focuses on the role of culture as a connecting web by which individual perceptions and actions regarding health are shaped and defined (Airhihenbuwa 1995, 2007a, 2007b), while acknowledging that these perceptions and actions are building blocks in constructing health beliefs that are reproduced…”
BackgroundInfluentialSelf-citation
Chicago Urban Resiliency Building (CURB): An Internet-Based Depression-Prevention Intervention for Urban African-American and Latino Adolescents
Saulsberry, A., Corden, M. E., Taylor-Crawford, K., Crawford, T. J., Johnson, M., Froemel, J., Walls, A., Fogel, J., Marko-Holguin, M., & Voorhees, B. W. V. (2012) · Journal of Child and Family Studies · doi:10.1007/s10826-012-9627-8 · Cited by 41 · cited 3× · see citing works
“1996), depression prevention (Saulsberry et al. 2013), domestic violence (Yick and Oomen-Early 2009), HIV and AIDS (Airhihenbuwa et al.”
BackgroundMethodInfluential
Sociocultural factors associated with cigarette smoking among women in Brazilian worksites: a qualitative study
Scarinci, I. C., Silveira, A. F., dos Santos, D. F., & Beech, B. M. (2007) · Health Promotion International · doi:10.1093/heapro/dam012 · Cited by 41 · cited 2× · see citing works
“43 Scarinci et al. (2007) Focus groups N = 108 women in private and public worksites.”
Background
HIV and AIDS-related stigma in the context of family support and race in South Africa
Brown, D., BeLue, R., & Airhihenbuwa, C. O. (2010) · Ethnicity and Health · doi:10.1080/13557858.2010.486029 · Cited by 41 · cited 1× · see citing works
“27 Brown, BeLue, and Airhihenbuwa (2010) Focus groups, key informant interviews, and questionnaires N = 397 Black and colored participants from two South African communities.”
BackgroundSelf-citation
HIV Positive Women's Perceptions of Stigma in Health Care Settings in Western Cape, South Africa
Okoror, T. A., BeLue, R., Zungu, N., Adam, A. M., & Airhihenbuwa, C. O. (2012) · Health Care For Women International · doi:10.1080/07399332.2012.736566 · Cited by 39 · cited 4× · see citing works
“23 Okoror et al. (2012) Focus groups N = 51 women Stigma perceptions HIV and AIDS The results highlight the emergent themes: expectation of care (perceptions), care delivery protocols (enablers), and physical environment (nurturers).”
BackgroundMethodInfluentialSelf-citation
Infant Feeding Practices of Low-Income African American Women in a Central City Community
Underwood, S., Pridham, K., Brown, L., Clark, T., Frazier, W., Limbo, R., Schroeder, M., & Thoyre, S. (1997) · Journal of Community Health Nursing · doi:10.1207/s15327655jchn1403_6 · Cited by 38 · cited 3× · see citing works
“36 Underwood et al. (1997) Focus groups N = 35 AfricanAmerican women Infant feeding practices Nutritionalrelated illnesses A better understanding of the infant feeding practices of low-income African-American women particularly in relation to the role cultural beliefs and life experiences play in…”
BackgroundInfluential
Recruiting African American Men for Cancer Screening Studies: Applying a Culturally Based Model
Abernethy, A. D., Magat, M. M., Houston-Armstrong, T. R., Arnold, H. L., Bjorck, J. P., & Gorsuch, R. L. (2005) · Health Education & Behavior · doi:10.1177/1090198104272253 · Cited by 38 · cited 8× · see citing works
“42 Abernethy et al. (2005) Crosssectional design N = 655 AfricanAmerican men Screening Prostate cancer The influence of cultural values on recruitment of African American men for prostate cancer screening study as it allowed recruitment efforts to address cultural values that were particularly…”
BackgroundMethodInfluential
Smoking Attitudes and Practices among Low-Income African-Americans: Qualitative Assessment of Contributing Factors
Beech, B. M., & Scarinci, I. C. (2003) · American Journal of Health Promotion · doi:10.4278/0890-1171-17.4.240 · Cited by 34 · cited 2× · see citing works
“…2013), reproductive desires (Sofolahan and Airhihenbuwa 2012, 2013), physical inactivity, stress (Gaston, Porter, and Thomas 2007), smoking (Beech and Scarinci 2003; Matthews, Sánchez-Johnsen, and King 2009; Scarinci et al. 2007), and cancer screening and awareness (Erwin et al. 2010;…”
BackgroundMethod
Rethinking HIV/AIDS Disclosure Among Women Within the Context of Motherhood in South Africa
Iwelunmor, J., Zungu, N. P., & Airhihenbuwa, C. O. (2010) · American Journal of Public Health · doi:10.2105/ajph.2009.168989 · Cited by 32 · see citing works
Self-citation
Child malaria treatment decisions by mothers of children less than five years of age attending an outpatient clinic in south-west Nigeria: an application of the PEN-3 cultural model
Iwelunmor, J., Oladipo, I., Adelakun, A. A., & Airhihenbuwa, C. O. (2010) · Malaria Journal · doi:10.1186/1475-2875-9-354 · Cited by 30 · cited 3× · see citing works
“Similarly, using the PEN-3 model as a guide, Iwelunmor et al. (2010) concluded that the discourse on motherhood in South Africa cannot be separated from the history of institutional discrimination that occurred during the apartheid era.”
BackgroundMethodInfluentialSelf-citation
Do Health Beliefs, Health Care System Distrust, and Racial Pride Influence HPV Vaccine Acceptability among African American College Females?
Bynum, S. A., Brandt, H. M., Ingram, L. A., Friedman, D. B., Tanner, A. H., & Sharpe, P. A. (2011) · Journal of Health Psychology · doi:10.1177/1359105311412833 · Cited by 29 · cited 1× · see citing works
“34 Bynum et al. (2012) Questionnaire N = 363 African- Health beliefs, vaccine Human papillomavirus Meaningful set of factors to address beliefs and attitudes to HPV vaccination were produced with the PEN-3 model E thnicity & H ealth 31 Table 1 (Continued) No.”
Method
“My Mother Told Me I Must Not Cook Anymore”—Food, Culture, and the Context of HIV− and AIDS-Related Stigma in Three Communities in South Africa
Okoror, T. A., Airhihenbuwa, C. O., Zungu, M., Makofani, D. M., Brown, D., & Iwelunmor, J. (2008) · International Quarterly of Community Health Education · doi:10.2190/iq.28.3.c · Cited by 29 · cited 1× · see citing works
“31 Okoror et al. (2007) Focus groups and key informant interviews N = 249 (195 women and 54 men) Stigma and racism HIV and AIDS Food was viewed as an expression of support and acceptance for some HIV-positive women and as an expression of rejection for others.”
BackgroundSelf-citation
Healthy Eating and Harambee: Curriculum Development for a Culturally-Centered Bio-Medically Oriented Nutrition Education Program to Reach African American Women of Childbearing Age
Kannan, S., Sparks, A., Webster, J. D., Krishnakumar, A., & Lumeng, J. C. (2009) · Maternal and Child Health Journal · doi:10.1007/s10995-009-0507-9 · Cited by 28 · cited 2× · see citing works
“39 Kannan et al. (2010) Evaluation of a pre-test-postN = 102 AfricanAmerican Healthy eating Maternal nutrition and protective The importance of a nutritionally balanced culturally based meals for the family using the Soul Food pyramid, teaching about essential micronutrients, encouraging eating a…”
Method
The Role of Culture in Health Literacy and Chronic Disease Screening and Management
Shaw, S. J., Torres, C. H., Armin, J. S., et al. (2008) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-008-9149-z · Cited by 28 · cited 2× · see citing works
“…interest in the influence of culture but also the realization of its importance in eliminating health disparities, addressing health literacy, and designing and implementing effective public health interventions (Airhihenbuwa and Liburd 2006; Shaw et al. 2009; Airhihenbuwa *Corresponding author.”
Background
Using the PEN-3 Model to Assess Knowledge, Attitudes, and Beliefs about Diabetes Type 2 among Mexican American and Mexican Native Men and Women in North Texas
Melancon, J., Oomen‐Early, J., & del Rincon, L. M. (2009) · The international electronic journal of health education · Cited by 27 · see citing works
Cultural Expectations and Reproductive Desires: Experiences of South African Women Living With HIV/AIDS (WLHA)
Sofolahan-Oladeinde, Y., & Airhihenbuwa, C. O. (2012) · Health Care For Women International · doi:10.1080/07399332.2012.721415 · Cited by 26 · cited 2× · see citing works
“21 Sofolahan and Airhihenbuwa (2013) Focus group discussions N = 35 women living with HIV and AIDS Reproductive desires HIV and AIDS The results showed that the sexual reproductive health care needs of women were not being addressed by many HCWs. Additionally, the results found that health care…”
BackgroundSelf-citation
Using the PEN-3 model to plan culturally competent domestic violence intervention and prevention services in Chinese American and immigrant communities
Yick, A. G., & Oomen‐Early, J. (2009) · Health Education · doi:10.1108/09654280910936585 · Cited by 26 · cited 1× · see citing works
“…behaviors such as nutrition attitudes (James 2004; Airhihenbuwa et al. 1996), depression prevention (Saulsberry et al. 2013), domestic violence (Yick and Oomen-Early 2009), HIV and AIDS (Airhihenbuwa et al. 2009; Iwelunmor, Zungu, and Airhihenbuwa 2010; Okoror et al. 2012; Westmaas et al.…”
Background
Recruitment and retention results for a population-based cervical cancer biobehavioral clinical trial
Osann, K., Wenzel, L. B., Doğan, A., Hsieh, S., Chase, D. M., Sappington, S., Monk, B. J., & Nelson, E. L. (2011) · Gynecologic Oncology · doi:10.1016/j.ygyno.2011.02.007 · Cited by 25 · cited 3× · see citing works
“2007), and cancer screening and awareness (Erwin et al. 2010; Osann et al. 2011; White et al. 2012).”
BackgroundMethod
Self management of type 2 diabetes by Maltese immigrants in Australia: can community pharmacies play a supporting role?
Barbara, S., & Krass, I. (2012) · International Journal of Pharmacy Practice · doi:10.1111/ijpp.12011 · Cited by 24 · cited 6× · see citing works
“In Australia, Barbara and Krass (2013) noted that several cultural influences and traditions among Maltese immigrants influenced their motivation regarding self-management of diabetes.”
BackgroundInfluential
Determinants of intention to get tested for STI/HIV among the Surinamese and Antilleans in the Netherlands: results of an online survey
Westmaas, A. H., Kok, G., Vriens, P., Götz, H. M., Richardus, J. H., & Voeten, H. A. C. M. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-961 · Cited by 22 · cited 1× · see citing works
“…domestic violence (Yick and Oomen-Early 2009), HIV and AIDS (Airhihenbuwa et al. 2009; Iwelunmor, Zungu, and Airhihenbuwa 2010; Okoror et al. 2012; Westmaas et al. 2012; Green et al. 2009; Mieh, Iwelunmor, and Airhihenbuwa 2013), reproductive desires (Sofolahan and Airhihenbuwa 2012, 2013),…”
Background
An educational intervention for hypertension management in older African Americans.
Cc, W. (2000) · PubMed · Cited by 21 · see citing works
Childbearing Decision Making: A Qualitative Study of Women Living with HIV/AIDS in Southwest Nigeria
Sofolahan-Oladeinde, Y., & Airhihenbuwa, C. O. (2012) · AIDS Research and Treatment · doi:10.1155/2012/478065 · Cited by 20 · see citing works
Self-citation
Using a Cultural Framework to Assess the Nutrition Influences in Relation to Birth Outcomes Among African American Women of Childbearing Age: Application of the PEN-3 Theoretical Model
Kannan, S., Webster, D., Sparks, A., Acker, C. M., Greene‐Moton, E., Tropiano, E., & French-Turner, T. M. (2008) · Health Promotion Practice · doi:10.1177/1524839907301406 · Cited by 18 · cited 2× · see citing works
“4 Kline (2007) Generative rhetorical criticism N = 7 educational pamphlets on breast cancer Cultural sensitivity Breast cancer In thematizing the messages in the pamphlets using the PEN-3 framework, the findings revealed that although messages were not inaccurate, they were constituted by rhetorical choices that empha…”
BackgroundMethod
Mobilising indigenous resources for anthropologically designed HIV-prevention and behaviour-change interventions in southern Africa
Green, E. C., Dlamini, C., D'Errico, N. C., et al. (2009) · African Journal of AIDS Research · doi:10.2989/ajar.2009.8.4.3.1040 · Cited by 16 · see citing works
Establishing a community partnership to optimize recruitment of African American pedigrees for a genetic epidemiology study
Ochs-Balcom, H. M., Rodriguez, E. M., & Erwin, D. O. (2011) · Journal of Community Genetics · doi:10.1007/s12687-011-0059-8 · Cited by 16 · cited 4× · see citing works
“…cancer and potential benefits to younger generations were among the positive themes identified, negative themes included lack of knowledge regarding research participation, issues related to confidentiality of data, and breast cancer research in general (Ochs-Balcom, Rodriguez, and Erwin 2011).”
BackgroundMethodInfluential
Home-Based Caregiving for People Living with HIV/AIDS in South Africa
Mieh, T. M., Iwelunmor, J., & Airhihenbuwa, C. O. (2013) · Journal of Health Care for the Poor and Underserved · doi:10.1353/hpu.2013.0091 · Cited by 14 · cited 2× · see citing works
“20 Mieh et al. (2013) Focus groups N = 41 homebased caregivers Care-giving HIV and AIDS Three primary themes emerged from our analyses: (1) perceptions associated with HIV/AIDS caregiving (positive perceptions: knowledge about HIV/AIDS and personal reflection of HIV/AIDS stigma and discrimination);…”
BackgroundSelf-citation
Cultural Implications of Death and Loss from AIDS Among Women in South Africa
Iwelunmor, J., & Airhihenbuwa, C. O. (2012) · Death Studies · doi:10.1080/07481187.2011.553332 · Cited by 9 · cited 1× · see citing works
“22 Iwelunmor and Airhihenbuwa (2012) Focus groups N = 110 women from three communities in South Africa Beliefs and attitudes HIV and AIDS Findings reveal positive perceptions (such as use of HIV and AIDS treatment, hope and optimism about one’s future), existential views (i.e., HIV and AIDS is not…”
BackgroundSelf-citation
“I Have Lost Sexual Interest …”—Challenges of Balancing Personal and Professional Lives among Nurses Caring for People Living with HIV and AIDS in Limpopo, South Africa
Sofolahan-Oladeinde, Y., Airhihenbuwa, C. O., Makofane, D., & Mashaba, E. (2011) · International Quarterly of Community Health Education · doi:10.2190/iq.31.2.d · Cited by 7 · cited 1× · see citing works
“26 Sofolahan et al. (2010) Focus groups N = 17 female nurses at two hospitals in Limpopo South Africa Attitudes and experiences of nurses HIV and AIDS The themes that emerged were grouped into positive attitudes of nurses relative to PLWHA’s (people living with HIV and AIDS) gender, existential…”
BackgroundSelf-citation

Flagged first, then by citations

1 of the 64 references couldn’t be matched to a known paper.

Research works printed but not linked: 8

Airhihenbuwa C. O., 2004, Journal of Social Aspects of HIV/AIDS Research Alliance, 1, 1
Melancon J., 2009, International Electronic Journal of Health Education, 12, 203
10.2190/IQ.28.3 · DOI
Singhal A., 2003, MICA Communications Review, 1, 21
10.1155/2012/47806 · DOI
Walker C., 2000, Ethnicity and Disease, 10, 165
White K., 2012, Ethnicity and Disease, 22, 274
Williams M. S., 2012, Ghana Medical Journal, 46, 147

Sorted by citations

COVID-19 Confinement and Health Risk Behaviors in Spain
López‐Bueno, R., Calatayud, J., Casaña, J., Casajús, J. A., Smith, L., Tully, M. A., Andersen, L. L., & Sánchez, G. F. L. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01426 · Cited by 249 · see citing works
Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework
Iwelunmor, J., Blackstone, S., Veira, D., Nwaozuru, U., Airhihenbuwa, C., Munodawafa, D., Kalipeni, E., Jutal, A., Shelley, D., & Ogedegbe, G. (2015) · Implementation Science · doi:10.1186/s13012-016-0392-8 · Cited by 219 · see citing works
“behaviors and interventions in the sub-Saharan Africa context [28].”
BackgroundSelf-citation
Overcoming barriers to physical activity in underserved populations
Bantham, A., Ross, S. E. T., Sebastião, É., et al. (2020) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2020.11.002 · Cited by 174 · see citing works
Cultural and Contextual Adaptation of Digital Health Interventions: Narrative Review
Naderbagi, A., Loblay, V., Zahed, I. U. M., Ekambareshwar, M., Poulsen, A., Song, Y. J. C., Ospina‐Pinillos, L., Krausz, M. R., Kamel, M. M., Hickie, I. B., et al. (2024) · Journal of Medical Internet Research · doi:10.2196/55130 · Cited by 160 · see citing works
Culture Matters in Communicating the Global Response to COVID-19
Airhihenbuwa, C. O., Iwelunmor, J., Munodawafa, D., Ford, C. L., Oni, T., Agyemang, C. O., Mota, C. S., Ikuomola, O. B., Simbayi, L. C., Fallah, M. P., et al. (2020) · Preventing Chronic Disease · doi:10.5888/pcd17.200245 · Cited by 141 · see citing works
Self-citation
Cultural factors influencing self-care by persons with cardiovascular disease: An integrative review
Osokpo, O. H., & Riegel, B. J. (2019) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2019.06.014 · Cited by 126 · see citing works
Cultural Sensitivity and Cultural Tailoring: Lessons Learned and Refinements After Two Decades of Incorporating Culture in Health Communication Research
Griffith, D. M., Efird, C. R., Baskin, M. L., Hooper, M. W., Davis, R. E., & Resnicow, K. (2023) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-060722-031158 · Cited by 91 · see citing works
Mindfulness for Global Public Health: Critical Analysis and Agenda
Oman, D. (2025) · Mindfulness · doi:10.1007/s12671-023-02089-5 · Cited by 87 · see citing works
“…linguistic, constituent-involving, peripheral, religious, collectivist, perceptions of time, and cultural (ethno/racial) pride (see also overview by Barrera et al., 2013, p. 201; and frameworks by Airhi-henbuwa, 1995; Bernal et al., 2009; Iwelunmor et al., 2014; Padela et al., 2018, p. 93).”
Interventions to Reduce Healthcare Disparities in Cancer Screening Among Minority Adults: a Systematic Review
Liu, D., Schuchard, H., Burston, B., Yamashita, T., & Albert, S. M. (2020) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-020-00763-1 · Cited by 77 · see citing works
“This approach utilizes three primary domains including (1) the individual’s cultural identity as an intervention point of entry; (2) the recognition that relationships and expectations support health seeking practices; and (3) the idea that cultural empowerment can generate both beneficial and harmful health practices…”
A Meta-Theoretical Systematic Review of the Culture-Centered Approach to Health Communication: Toward a Refined, “Nested” Model
Sastry, S., Stephenson, M., Dillon, P., et al. (2019) · Communication Theory · doi:10.1093/ct/qtz024 · Cited by 71 · see citing works
Forging a New Frontier: Providing Palliative Care to People With Cancer in Rural and Remote Areas
Bakitas, M. A., Allen-Watts, K., Malone, E. B., Dionne-Odom, J. N., McCammon, S. D., Taylor, R. A., Tucker, R. O., & Elk, R. A. (2020) · Journal of Clinical Oncology · doi:10.1200/jco.18.02432 · Cited by 65 · see citing works
The Influence of Ethnic and Mainstream Cultures on African Americans’ Health Behaviors: A Qualitative Study
Swierad, E., Vartanian, L. R., & King, M. (2017) · Behavioral Sciences · doi:10.3390/bs7030049 · Cited by 64 · see citing works
“This finding suggests that the influence of ethnic and mainstream culture on African American’s health behaviors should be examined in the relation to their broader psycho-socio-environmental context (consistent with ecological models of health behaviors, such as the PEN-3 model [10]).”
Background
I sleep, because we sleep: a synthesis on the role of culture in sleep behavior research
Airhihenbuwa, C. O., Iwelunmor, J., Ezepue, C., Williams, N. J., & Jean‐Louis, G. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2015.07.020 · Cited by 63 · see citing works
“The authors also argue that all cultures have something positive that must be recognized and promoted, while identifying the negative as well [6,10].”
BackgroundInfluentialSelf-citation
Illness perceptions and explanatory models of viral hepatitis B & C among immigrants and refugees: a narrative systematic review
Owiti, J. A., Greenhalgh, T., Sweeney, L., Foster, G. R., & Bhui, K. S. (2015) · BMC Public Health · doi:10.1186/s12889-015-1476-0 · Cited by 60 · see citing works
“Death [48,52,68,75,80,81,85,86,88,89,91,92,94,96,98] Short life expectancy [52] Owiti et al.”
BackgroundMethodInfluential
Socio-cultural factors influencing the prevention of mother-to-child transmission of HIV in Nigeria: a synthesis of the literature
Iwelunmor, J., Ezeanolue, E. E., Airhihenbuwa, C. O., Obiefune, M. C., Ezeanolue, C. O., & Ogedegbe, G. G. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-771 · Cited by 49 · see citing works
Self-citation
Socio-cultural beliefs and perceptions influencing diagnosis and treatment of breast cancer among women in Ghana: a systematic review
Afaya, A., Anaba, E. A., Bam, V. B., Afaya, R. A., Yahaya, A., Seidu, A., & Ahinkorah, B. O. (2024) · BMC Women s Health · doi:10.1186/s12905-024-03106-y · Cited by 50 · see citing works
“Cultural beliefs within certain communities across the globe are considered a determinant of health risk perceptions and behaviors in promoting or seeking health care in diverse populations [12].”
Background
Adherence to Low-Carbohydrate Diets in Patients with Diabetes: A Narrative Review
Kumar, N., Merrill, J., Carlson, S. M., German, J. C., & Yancy, W. (2022) · Diabetes, Metabolic Syndrome and Obesity : Targets and Therapy · doi:10.2147/dmso.s292742 · Cited by 39 · see citing works
“Today, there is increased recognition for the impact of culture on health.(73) Culture refers to shared values, beliefs and social behaviors that collectively shape a”
Background
Cultural factors affecting the self-care of cancer survivors: An integrative review
Yeom, J. W., Yeom, I., Park, H.-Y., & Lim, S.-H. (2022) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2022.102165 · Cited by 44 · see citing works
Interventions for increasing colorectal cancer screening uptake among African-American men: A systematic review and meta-analysis
Rogers, C. R., Matthews, P., Xu, L., Boucher, K. M., Riley, C., Huntington, M., Duc, N. L., Okuyemi, K. S., & Foster, M. (2020) · PLoS ONE · doi:10.1371/journal.pone.0238354 · Cited by 43 · see citing works
Social norms and its correlates as a pathway to smoking among young Latino adults
Echeverría, S. E., Gundersen, D. A., Manderski, M. T. B., & Delnevo, C. D. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.11.034 · Cited by 42 · see citing works
“We are doctors”: Drivers of animal health practices among Maasai pastoralists and implications for antimicrobial use and antimicrobial resistance
Mangesho, P. E., Caudell, M. A., Mwakapeje, E., et al. (2021) · Preventive Veterinary Medicine · doi:10.1016/j.prevetmed.2021.105266 · Cited by 36 · see citing works
Sociocultural Perceptions and Enablers to Seeking Mental Health Support Among Bhutanese Refugees in Western Massachusetts
Poudel‐Tandukar, K., Jacelon, C. S., Chandler, G. E., Gautam, B., & Palmer, P. H. (2019) · International Quarterly of Community Health Education · doi:10.1177/0272684x18819962 · Cited by 36 · see citing works
Suicidality and suicide prevention in culturally and linguistically diverse (CALD) communities: A systematic review
Bowden, M., McCoy, A., & Reavley, N. J. (2019) · International Journal of Mental Health · doi:10.1080/00207411.2019.1694204 · Cited by 35 · see citing works
Understanding factors that promote uptake of HIV self-testing among young people in Nigeria: Framing youth narratives using the PEN-3 cultural model
Mason, S., Ezechi, O., Obiezu‐Umeh, C., Nwaozuru, U., BeLue, R., Airhihenbuwa, C. O., Gbaja-Biamila, T. A., Oladele, D. A., Musa, A. Z., Modi, K., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0268945 · Cited by 34 · see citing works
“The Cultural Identity domain includes the factors Person, Extended Family, and Neighborhood, and posits that health interventions should extend beyond the individual and incorporate family and neighborhood contexts as intervention access points and targets to health behavior change [31, 33].”
BackgroundInfluentialSelf-citation
Cultural and religious structures influencing the use of maternal health services in Nigeria: a focused ethnographic research
Opara, U. C., Iheanacho, P., & Petrucka, P. M. (2024) · Reproductive Health · doi:10.1186/s12978-024-01933-8 · Cited by 44 · see citing works
What makes community‐based physical activity programs for culturally and linguistically diverse older adults effective? A systematic review
Montayre, J., Neville, S. J., Dunn, I., et al. (2020) · Australasian Journal on Ageing · doi:10.1111/ajag.12815 · Cited by 33 · see citing works
Adherence to Low-Carbohydrate Diets in Patients with Diabetes: A Narrative Review
Kumar, N., Merrill, J. D., Carlson, S., German, J., & Yancy, W. S. (2022) · Dove Medical Press (Taylor and Francis Group) · Cited by 33 · see citing works
“As a Community, We Need to be More Health Conscious”: Pastors’ Perceptions on the Health Status of the Black Church and African-American Communities
Gross, T. T., Story, C. R., Harvey, I. S., Allsopp, M. A. K., & Whitt‐Glover, M. C. (2017) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-017-0401-x · Cited by 31 · see citing works
“The PEN 3 model, as designed by Airhihenbuwa [2], regards points of culture as places for intervention [34].”
Method
Exploring the impact of cultural beliefs in the self-management of type 2 diabetes among Black sub-Saharan Africans in the UK – a qualitative study informed by the PEN-3 cultural model
Omodara, D., Gibson, L. M., & Bowpitt, G. (2021) · Ethnicity and Health · doi:10.1080/13557858.2021.1881764 · Cited by 32 · see citing works
“Utilising the concepts of PEN-3 cultural model (see Figure 1) helps to identify and contextualise the role of cultural belief systems in shaping the understanding of and actions towards health and illness (Cowdery, Parker, and Thompson 2010; Iwelunmor, Newsome, and Airhihenbuwa 2014).”
Background
Maintaining cultural identity: A systematic mixed studies review of cultural influences on the self‐care of African immigrants living with non‐communicable disease
Osokpo, O. H., James, R., & Riegel, B. J. (2021) · Journal of Advanced Nursing · doi:10.1111/jan.14804 · Cited by 30 · see citing works
Perceived stress and worldview influence sleep quality in Bolivian and United States university students
Doolin, J., Vilches, J. E., Cooper, C. M., Gipson, C. S., & Sørensen, W. Ø. (2018) · Sleep Health · doi:10.1016/j.sleh.2018.08.006 · Cited by 31 · see citing works
A Systematic Review of Literature on Culturally Adapted Obesity Prevention Interventions for African American Youth
Lofton, S., Julion, W. A., McNaughton, D. B., Bergren, M. D., & Keim, K. S. (2015) · The Journal of School Nursing · doi:10.1177/1059840515605508 · Cited by 28 · see citing works
“…and described the concepts within the cultural empowerment domain, that is, positive health practices; existential behavior, for example, such as spirituality and cultural traditions and negativebehaviors; and how they were applied in each intervention (Airhihenbuwa, 1995; Iwelunmor et al., 2014).”
Background
Intersectionality Impacts Survivorship: Identity-Informed Recommendations to Improve the Quality of Life of African American Breast Cancer Survivors in Health Promotion Programming
Garza, R. H., Williams, M. Y., Ntiri, S. O., Hampton, M. D., & Yan, Q. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912807 · Cited by 29 · see citing works
“Collins Airhihenbuwa, focuses on placing culture at the forefront of health promotion [16].”
Background
The Promise of Qualitative Research to Inform Theory to Address Health Equity
Shelton, R. C., Griffith, D. M., & Kegler, M. C. (2017) · Health Education & Behavior · doi:10.1177/1090198117728548 · Cited by 27 · see citing works
A qualitative research synthesis of contextual factors contributing to female overweight and obesity over the life course in sub-Saharan Africa
Ozodiegwu, I. D., Littleton, M. A., Nwabueze, C., Famojuro, O., Quinn, M., Wallace, R. L., & Mamudu, H. M. (2019) · PLoS ONE · doi:10.1371/journal.pone.0224612 · Cited by 27 · see citing works
“The PEN-3 model is a theoretical framework used to foreground culture in the development, implementation and evaluation of health interventions [47].”
Method
Making the connection between health equity and sustainability
Shelton, R. C., Hailemariam, M., & Iwelunmor, J. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1226175 · Cited by 30 · see citing works
“Frameworks like the PEN-3 cultural model offer potential to shepherd in new pathways of knowing, including increasing understanding of the complexity of factors that shape health inequities that continue to persist, but from a lens that is positive yet transparent about challenges and resources that matter in efforts…”
BackgroundSelf-citation
HIV, cancer, and coping: The cumulative burden of a cancer diagnosis among people living with HIV
Knettel, B. A., Corrigan, K. L., Cherenack, E. M., Ho, N., Carr, S., Cahill, J., Chino, J., Ubel, P. A., Watt, M. H., & Suneja, G. (2021) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2020.1867691 · Cited by 26 · see citing works
Family and cultural influences on cervical cancer screening among immigrant Latinas in Miami-Dade County, USA
Madhivanan, P., Valderrama, D., Krupp, K., & Ibañez, G. E. (2015) · Culture Health & Sexuality · doi:10.1080/13691058.2015.1116125 · Cited by 25 · see citing works
“The PEN-3 theoretical model used in this study has been widely validated in research on cancer, HIV, cardiovascular disease, malaria, nutrition, smoking and other health issues requiring an understanding of the cultural context of health decision-making (Iwelunmor, Newsome, and Airhihenbuwa 2014).”
Method
Psychological distress among orphaned youth and youth reporting sexual exploitation in Kampala, Uganda
Perry, E. W., Culbreth, R. E., Swahn, M. H., Kasirye, R., & Self-Brown, S. (2020) · Children and Youth Services Review · doi:10.1016/j.childyouth.2020.105587 · Cited by 29 · see citing works
“Holistic and coordinated public health efforts are needed, that are anchored in cultural competency, in order to achieve sustainable public health impact to reduce health disparities and the social determinants of mental health among this population (Airhihenbuwa, 1989, 1995; Doku et al., 2019; Iwelunmor et al., 2014).”
Background
Ethnic Minorities’ Perceptions of COVID-19 Vaccines and Challenges in the Pandemic: A Qualitative Study to Inform COVID-19 Prevention Interventions
Zhou, S., Villalobos, J. P., Munoz, A., & Bull, S. S. (2022) · Health Communication · doi:10.1080/10410236.2022.2093557 · Cited by 25 · see citing works
“Currently in the U.S., three COVID vaccines are authorized and available for everyone ages five years or older.”
BackgroundInfluential
Residential Location and Kidney Transplant Outcomes in Indigenous Compared With Nonindigenous Australians
Barraclough, K. A., Grace, B. S., Lawton, P. D., et al. (2015) · Transplantation · doi:10.1097/tp.0000000000001007 · Cited by 24 · see citing works
“Other difficult tomeasure but potentially relevant factors include living conditions, sanitation, support systems, and cultural beliefs impacting health and treatment.(27,28) Causes of graft failure also varied with Indigenous status and residential location.”
Background
Factors Affecting Self-Care Performance in Adolescents with Type I Diabetes According to the PEN-3 Cultural Model
Shahbazi, H., Ghofranipour, F., Amiri, P., & Rajab, A. (2018) · International Journal of Endocrinology and Metabolism · doi:10.5812/ijem.62582 · Cited by 23 · see citing works
“It provides the opportunity to examine cultural practices that are critical to positive health behaviors, acknowledges unique practices, and identifies negative factors that have an adverse influence on health (21, 22).”
Background
Claim Your Space
Airhihenbuwa, C. O., Ogedegbe, G. G., Iwelunmor, J., Jean‐Louis, G., Williams, N. J., Zizi, F., & Okuyemi, K. S. (2016) · Health Education & Behavior · doi:10.1177/1090198116633455 · Cited by 24 · see citing works
“If you cannot identify something positive, then you should not remain in the community, otherwise you are likely to focus on research constraints, and may in fact become part of the problem (C. O. Airhihenbuwa, 2007a, 2007b; Iwelunmor et al., 2014).”
InfluentialSelf-citation
Diabetes Knowledge, Management, and Prevention Among Haitian Immigrants in Philadelphia
Moise, R. K., Conserve, D. F., Elewonibi, B. “., Francis, L. A., & BeLue, R. (2017) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721717715418 · Cited by 22 · see citing works
Facilitators, Barriers, and Structural Determinants of Physical Activity in Nulliparous Pregnant Women: A Qualitative Study
Kianfard, L., Niknami, S., Shokravi, F. A., & Rakhshanderou, S. (2022) · Journal of Pregnancy · doi:10.1155/2022/5543684 · Cited by 21 · see citing works
Definition and classification for adverse events following spinal and peripheral joint manipulation and mobilization: A scoping review
Funabashi, M., Gorrell, L. M., Pohlman, K. A., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0270671 · Cited by 20 · see citing works
Improving Access to Cancer Care in the HIV Population: Qualitative Research to Identify Barriers to Care
Corrigan, K. L., Knettel, B. A., Ho, N., Carr, S., Shah, B. B., Cahill, J., Chino, J., Watt, M. H., & Suneja, G. (2020) · Health Equity · doi:10.1089/heq.2020.0001 · Cited by 20 · see citing works
Public trust in the time of the Coronavirus Disease 2019 (COVID-19): the case of the DR Congo
Whembolua, G.-L., & Tshiswaka, D. I. (2020) · Pan African Medical Journal · doi:10.11604/pamj.supp.2020.35.2.22606 · Cited by 21 · see citing works
“The PEN-3 cultural model has been used as a guide to explore health issues by situating them within their socio-cultural contexts to inform policymakers or interventionists [2].”
Method
An mHealth Framework to Improve Birth Outcomes in Benue State, Nigeria: A Study Protocol
Ezeanolue, E. E., Gbadamosi, S. O., Olawepo, J. O., Iwelunmor, J., Sarpong, D. F., Eze, C., Ogidi, A. G., Patel, D. V., & Onoka, C. A. (2017) · JMIR Research Protocols · doi:10.2196/resprot.7743 · Cited by 19 · see citing works
“The Perceptions, Enablers, and Nurturers (PEN-3) cultural model [35-37] centralizes culture in the design, implementation, and evaluation of any health intervention.”
BackgroundSelf-citation
Barriers and enablers to nutrition and physical activity in Lima, Peru: an application of the Pen-3 cultural model among families living in pueblos jóvenes
Tello, K. T., & Shaw-Ridley, M. (2019) · Ethnicity and Health · doi:10.1080/13557858.2019.1591347 · Cited by 18 · see citing works
Cultural beliefs about breast cancer in Vietnamese women
Kim, J. G., Hong, H. C., Lee, H., Ferrans, C. E., & Kim, E. M. (2019) · BMC Women s Health · doi:10.1186/s12905-019-0777-3 · Cited by 18 · see citing works
“Moreover, previous theories have clearly shown the influence of culture on health behaviors insofar as cultural beliefs triggering or prohibiting certain self-care behaviors in individuals with chronic illnesses [17, 26].”
Background
Utilizing a church-based platform for mental health interventions: exploring the role of the clergy and the treatment preference of women with depression
Iheanacho, T., Nduanya, C. U., Slinkard-Barnum, S., Ogidi, A. G., Patel, D. V., Itanyi, I. U., Naeem, F., Spiegelman, D. L., & Ezeanolue, E. E. (2021) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2021.4 · Cited by 21 · see citing works
“The model consists of three dynamically interconnected and interdependent dimensions that contextualize the role of culture in shaping the understanding of and actions toward health and illness (Airhihenbuwa and Webster, 2004; Iwelunmor et al., 2014).”
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Applying the PEN-3 Cultural Model to Address HIV/AIDS Prevention in Rural Guatemala
Dunleavy, V. O., Chudnovskaya, E. V., Phillips, J., & McFarlane, S. J. (2017) · Journal of Intercultural Communication Research · doi:10.1080/17475759.2017.1398178 · Cited by 18 · see citing works
“Iwelunmor, Newsome, and Airhihenbuwa (2014) reviewed literature utilizing PEN-3 model as a theoretical framework.”
Use of community forums to increase knowledge of HPV and cervical cancer in African American communities
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Social support and cervical cancer screening among sub-Saharan African immigrant (SAI) women
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“The model highlights three interacting domains, Cultural Identity, Relationships and Expectations, and Cultural Empowerment, which guide approaches to understanding health problems and developing interventions [20, 21].”
Background
Using a Cultural Framework to Understand Factors Influencing HIV Testing in Nigeria
Ehiri, J. E., Iwelunmor, J., Iheanacho, T., Blackstone, S. R., Obiefune, M. C., Ogidi, A. G., Ahunanya, F. U., Nnadi, D., Patel, D. V., Hunt, A. T., et al. (2016) · International Quarterly of Community Health Education · doi:10.1177/0272684x16685258 · Cited by 17 · see citing works
“It consists of three domains: (a) cultural identity, (b) relations and expectations, and (c) cultural empowerment.(14,16) Cultural Identity challenges the assumption that all interventions should be focused on the individual, broadening the intervention focus to incorporate immediate and extended family members and co…”
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Cultural factors that influence the treatment of osteosarcoma in Zulu patients: Healthcare professionals’ perspectives and strategies
Brown, O., Goliath, V., van Rooyen, D. R. M., Aldous, C. M., & Marais, L. C. (2018) · Health SA Gesondheid · doi:10.4102/hsag.v23i0.1095 · Cited by 16 · see citing works
Socio-culturally mediated factors and lower level of education are the main influencers of functional cervical cancer literacy among women in Mayuge, Eastern Uganda
Jatho, A., Maniple, E., & Mugisha, N. M. (2020) · ecancermedicalscience · doi:10.3332/ecancer.2020.1004 · Cited by 16 · see citing works
Factors Influencing Pregnancy and Postpartum Weight Management in Women of African and Caribbean Ancestry Living in High Income Countries: Systematic Review and Evidence Synthesis Using a Behavioral Change Theoretical Model
Moore, A., Flynn, A., Adegboye, A., Goff, L., & Rivas, C. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.637800 · Cited by 15 · see citing works
“In fact, Airhihenbuwa, who has contributed considerably toward understanding culturally tailored health promotion to support African Americans (81), explains how important this type of approach is, along-side written or pictorial health communication, because it sits well with the African oral traditions where seeing…”
Background
Intercultural gaps in knowledge, skills and attitudes of public health professionals: a systematic review
Huish, C., Greenhalgh, C., Garrow, A. P., & Verma, A. (2023) · Journal of Public Health · doi:10.1093/pubmed/fdac166 · Cited by 17 · see citing works
A Scoping Study of Cultural Adaptation Frameworks
Leung, J., Sekar, S., Madrigal, L., & Escoffery, C. (2024) · Health Promotion Practice · doi:10.1177/15248399241292317 · Cited by 21 · see citing works
“Incorporation of culture into adaptation process is particularly relevant given the role of cultural characteristics to how people live, work, and play (Iwelunmor et al., 2014).”
Cultural Factors relevant to Korean Americans in Health Research: A Systematic Review
Shin, C., Keller, C. S., & Sim, J. (2017) · Journal of Community Health · doi:10.1007/s10900-017-0418-4 · Cited by 16 · see citing works
Sociocultural factors influencing infant-feeding choices among African immigrant women living with HIV: A synthesis of the literature
Etowa, J. B., MacDonald, S., Hannan, J., Phillips, J. C., Boadu, N. Y., & Babatunde, S. (2018) · Journal of the American Association of Nurse Practitioners · doi:10.1097/jxx.0000000000000014 · Cited by 16 · see citing works
A Qualitative Case Study of Water, Sanitation, and Hygiene Resources after the 2015 Gorkha, Nepal, Earthquake
Uprety, S., Iwelunmor, J., Sadik, N. J., Dangol, B., & Nguyen, T. H. (2017) · Earthquake Spectra · doi:10.1193/112916eqs212m · Cited by 14 · see citing works
“…to address problems associated with HIV, cancer, hypertension, diabetes, malaria, nutrition, smoking, and other issues requiring an understanding not only of behavior but also of related factors that may facilitate or act as barriers to promoting the behavior of interest (Iwelunmor et al. 2014).”
BackgroundMethodSelf-citation
Regular Mammography Screening Among African American (AA) Women: Qualitative Application of the PEN-3 Framework
Adegboyega, A., Aroh, A., Key, K. V., et al. (2018) · Journal of Transcultural Nursing · doi:10.1177/1043659618803146 · Cited by 13 · see citing works
“The coded data were grouped according to the PEN-3 framework domains of perceptions, enablers, and nurturers (Iwelunmor et al., 2014).”
Violence Exposure, Self-Reported Mental Health Concerns and Use of Alcohol and Drugs for Coping among Youth in the Slums of Kampala, Uganda
Perry, E. W., Culbreth, R. E., Self-Brown, S., Gilmore, A. K., Kasirye, R., Musuya, T., Ndetei, D., & Swahn, M. (2022) · International Journal of Mental Health · doi:10.1080/00207411.2022.2073755 · Cited by 13 · see citing works
“…Labor & Social Development, 2020), future research, building on evidence-based strategies and interventions to develop or adapt culturally relevant (Iwelunmor et al., 2014) peer-led interventions for delivery in low-resource settings such as urban slums to address the effects of violence and…”
Background
The American Nations model: An analytical tool for understanding the influence of U.S. regional cultures on health and the social and political determinants of health
Woodard, C., Arena, R. A., & Pronk, N. P. (2025) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2025.03.014 · Cited by 13 · see citing works
Toward an African Community-Based Research (ACBR) Methodology
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Guidebook on Best Practices in Public Health
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Perceptions of Dietary Habits and Risk for Type 2 Diabetes among Congolese Immigrants
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“The PEN-3 domains have proven to be specifically effective in highlighting the role and importance of cultural factors within perceptions of diabetes risk factors [18].”
BackgroundMethodSelf-citation
Sustaining HIV Research in Resource-Limited Settings Using PLAN (People, Learning, Adapting, Nurturing): Evidence from the 4 Youth by Youth Project in Nigeria
Iwelunmor, J., Tucker, J. D., Ezechi, O., Nwaozuru, U., Obiezu‐Umeh, C., Gbaja-Biamila, T. A., Oladele, D. A., Musa, A. Z., & Airhihenbuwa, C. O. (2023) · Current HIV/AIDS Reports · doi:10.1007/s11904-023-00652-2 · Cited by 12 · see citing works
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Opara, U. C., Iheanacho, P., Li, H., & Petrucka, P. M. (2024) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-024-06747-x · Cited by 15 · see citing works
“…perceptions or attitudes concerning health issues, social structures or facilities, such as health services that enhance or limit effective health-seeking practices, and the part played by the family and kin in health-seeking decision related to use of health facilities is explored [39, 40].”
Background
Visible and invisible cultural patterns influencing women’s use of maternal health services among Igala women in Nigeria: a focused ethnographic study
Opara, U. C., Iheanacho, P., & Petrucka, P. M. (2025) · BMC Public Health · doi:10.1186/s12889-025-21275-9 · Cited by 14 · see citing works
“The structural resources, health systems, and family influence are also explored to determine how these factors influence effective health-seeking practices [33].”
How time in the US and race/ethnicity shape food parenting practices and child diet quality
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Qualitative exploration of critical health literacy among Afghan and Congolese refugees resettled in the USA
Im, H., & Swan, L. E. T. (2018) · Health Education Journal · doi:10.1177/0017896918785932 · Cited by 12 · see citing works
“Cultural empowerment implies a process of identifying, exploring and taking pride in positive cultural values and beliefs (Freeman and Cohen, 2001; Iwelunmor et al., 2014).”
Background
Predictive Power of PEN-3 Model Constructs in Breast Cancer Screening Behaviors among Teachers: A Cross- Sectional Study in Central Iran
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Utilizing the PEN-3 model to identify socio-cultural factors affecting intimate partner violence against pregnant women in Suburban Hamadan
Moeini, B., Rezapur‐Shahkolai, F., Jahanfar, S., Naghdi, A., Karami, M., & Rastegar, K. E. (2019) · Health Care For Women International · doi:10.1080/07399332.2019.1578777 · Cited by 12 · see citing works
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Scale validation of Filipino cultural values and its associations with depressive symptoms and substance use in Filipino Americans.
Maglalang, D. D., Woo, B., Katigbak, C., Park, M., Choi, Y., & Takeuchi, D. T. (2024) · Asian American Journal of Psychology · doi:10.1037/aap0000352 · Cited by 11 · see citing works
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“If you respect me, you are respecting my culture”: methods and recommendations for personalizing a TBI transitional care intervention
Oyesanya, T. O., Ibemere, S. O., Loflin, C. D., McReynolds, V., Anaya, B., Huang, M. W., Gonzalez-Guarda, R. M., Strauman, T. J., & Bettger, J. P. (2023) · Brain Injury · doi:10.1080/02699052.2023.2208881 · Cited by 12 · see citing works
Survey on Addressing the Information and Support Needs of Jewish Women at Increased Risk for or Diagnosed with Breast Cancer: The Sharsheret Experience
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“Furthermore, as indicated in the PEN-3 cultural model, cultural identity, relationships and expectations, and cultural empowerment are domains in which to anchor supports and interventions seeking greater community engagement [31].”
Background
Racial Differences in Smoking-related Disease Risk Perceptions Among Adults Completing Lung Cancer Screening: Follow-up Results from the ACRIN/NLST Ancillary Study
Perez, G. K., Gareen, I. F., Sicks, J. D., Lathan, C. S., Carr, A. L., Kumar, P. P., Ponzani, C. J., Hyland, K. A., & Park, E. R. (2019) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-019-00566-z · Cited by 11 · see citing works
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Bea, J. W., de Heer, H., Valdez, L. A., et al. (2018) · American Indian and Alaska Native Mental Health Research · doi:10.5820/aian.2502.2018.54 · Cited by 11 · see citing works
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Olumide, A. O., McGuire, C., Calhoun, L. M., Speizer, I. S., Babawarun, T., & Ojengbede, O. A. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-034482 · Cited by 10 · see citing works
Perceived Determinants of Health-Related Behaviors Among Patients with Coronary Heart Disease After Percutaneous Coronary Intervention: A Longitudinal Qualitative Study
Su, X., Zhang, Y., Zhou, H., Ma, F., Jin, X., Bai, Y., Wei, W., Zhang, X., & Zhou, M. (2024) · Patient Preference and Adherence · doi:10.2147/ppa.s452943 · Cited by 11 · see citing works
“17,18 However, cultural context is seldom addressed in the researches about the determinants of health-related behavior among patients after PCI.”
Background
Interventions Incorporating Therapeutic Alliance to Improve Hemodialysis Treatment Adherence in Black Patients with End-Stage Kidney Disease (ESKD) in the United States: A Systematic Review
Blumrosen, C., Desta, R., Cavanaugh, K. L., Laferriere, H. E., Bruce, M. A., Norris, K. C., Griffith, D. M., & Umeukeje, E. M. (2020) · Patient Preference and Adherence · doi:10.2147/ppa.s260684 · Cited by 13 · see citing works
Comorbid Diabetes and Depression in African Americans: Implications for the Health Care Provider
Chlebowy, D. O., Coty, M., Fu, L., & Hines-Martin, V. P. (2017) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-017-0349-x · Cited by 10 · see citing works
BreatheOut: Development and implementation of a pharmacist-led, culturally tailored smoking cessation program for transgender and gender diverse patients
Miller, S. J., Lahrman, R., Kissel, J., et al. (2023) · Journal of the American Pharmacists Association · doi:10.1016/j.japh.2023.02.017 · Cited by 9 · see citing works
A Factorial Randomized Controlled Trial to Optimize User Engagement With a Chatbot-Led Parenting Intervention: Protocol for the ParentText Optimisation Trial
Ambrosio, M. D. G., Lachman, J. M., Zinzer, P., Sacolo-Gwebu, H., Vyas, S., Vallance, I., Calderón, F., Gardner, F. E. M., Markle, L., Stern, D., et al. (2024) · JMIR Research Protocols · doi:10.2196/52145 · Cited by 11 · see citing works
“…for engaging with ParentText), enablers (ie, structural factors within society motivating parents’ engagement with ParentText, such as access to the internet), and nurturers (ie, the extent to which parents’beliefs and attitudes are influenced and nurtured by their family, friends, and peers) [87].”
An approach to capturing the cultural contexts of health behaviours
Snijders, V., Habersaat, K. B., BOHM, R. M., Fischer, E. F., Thomas, F., Leask, J., Scherzer, M., Mazhnaya, A., & Fietje, N. (2025) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-025-04105-6 · Cited by 9 · see citing works
“While it would beneﬁt from more rigorous evaluations [29], it may supplement widely used behavioural models.”
Self-Care of African Immigrant Adults with Chronic Illness
Osokpo, O. H., Lewis, L. M., Ikeaba, U., Chittams, J. L., Barg, F. K., & Riegel, B. J. (2021) · Clinical Nursing Research · doi:10.1177/10547738211056168 · Cited by 11 · see citing works
Teaching Note—Diversity and Difference Through a Rural Lens
Bice‐Wigington, T., & Morgan, K. M. (2018) · Journal of Social Work Education · doi:10.1080/10437797.2017.1314838 · Cited by 9 · see citing works
“This element of the model emphasizes “the role of the collective (family/community) in defining the health experiences of individuals, and underscores its importance in influencing health-related decisions” (Iwelunmor et al., 2014, p. 38).”
BackgroundMethodInfluential
Socio-Structural Factors Influencing the Prevention of Mother-to-Child Transmission of HIV in the Democratic Republic of the Congo: A Systematic Review
Whembolua, G.-L., Muvuka, B., Tshiswaka, D. I., & Conserve, D. F. (2019) · Maternal and Child Health Journal · doi:10.1007/s10995-018-2688-6 · Cited by 11 · see citing works
Bayo Lapawol (Let Their Voices Be Heard): Haitian Women’s Barriers to and Facilitators of Cervical Cancer Prevention and Control
Moise, R. K., Jonas, E., Campa, E. M., Clisbee, M., Junior, G. L. L., & Kobetz, E. N. (2021) · Health Education & Behavior · doi:10.1177/1090198121990381 · Cited by 9 · see citing works
“Investigators made the final selection of images guided by the PEN-3 model’s tenets of cultural identity, relationships and expectations, and cultural empowerment for optimized interpretation to inform ecological implications (Airhihenbuwa, 1990; Iwelunmor et al., 2014).”
BackgroundMethod
Cervical cancer risk and access: Utilizing three statistical tools to assess Haitian women in South Florida
Moise, R. K., Balise, R. R., Ragin, C. C. R., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0254089 · Cited by 9 · see citing works
“healthcare system due to colonialism, sexism, racism, and xenophobia [32, 60].”
Background
Acceptability and user experiences of a patient-held smart card for antenatal services in Nigeria: a qualitative study
Itanyi, I. U., Iwelunmor, J., Olawepo, J. O., Gbadamosi, S. O., Ezeonu, N. A., Okoli, A., Ogidi, A. G., Conserve, D. F., Powell, B. J., Onoka, C. A., et al. (2023) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-023-05494-9 · Cited by 9 · see citing works
“[39] Particularly, we used the relationships and expectations domain to explore perceptions about the smart card, the societal resources that promote or discourage use of the smart cards, and the influence of family and kin in nurturing decisions about use of the smart cards.”
MethodSelf-citation
Experiences of Family Communication and Cascade Genetic Testing for Hereditary Cancer in Medically Underserved Populations—A Qualitative Study
Bednar, E. M., Rauh‐Hain, J. A., García, J. J. R., de Aguinaga, N., Powell, M. A., Peral, S. L., Nitecki, R., Jorgensen, K. A., Rudy, N. L., Lu, K. H., et al. (2023) · Cancer Prevention Research · doi:10.1158/1940-6207.capr-23-0303 · Cited by 8 · see citing works
“Sex Is a sin”: Afro-Caribbean Parent and Teen Perspectives on Sex Conversations
Gabbidon, K., & Shaw-Ridley, M. (2018) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-018-0695-8 · Cited by 8 · see citing works

Authors: Iwelunmor, J., Newsome, V., & Airhihenbuwa, C. O.
Affiliations: University of Illinois Urbana-Champaign (US)
National Development and Research Institutes (US)
Pennsylvania State University (US)
Corresponding author: Airhihenbuwa, Collins O.
ORCID: Iwelunmor, Juliet
Airhihenbuwa, Collins O.
Venue: Ethnicity & Health
Publisher: Informa UK Limited
Published: 2013-11-22
Volume: 19
Issue: 1
Pages: 20-46
ISSN: 1355-7858 (ISSN-L)
1465-3419
DOI: 10.1080/13557858.2013.857768
PMC: PMC4589260
OpenAlex: W2090486171
Semantic Scholar: 060f9ddb2e0d8b3412ff21c738c490917602a57c
Cited by: 259
References: 64
Citations by year: 2026: 29 · 2025: 36 · 2024: 33 · 2023: 17 · 2022: 20 · 2021: 22 · 2020: 22 · 2019: 26 · 2018: 14 · 2017: 15 · 2016: 9 · 2015: 13 · 2014: 2 · 2013: 1
FWCI: 6.46
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Ethnicity and Health (publishedVersion)
PubMed (publishedVersion)
PubMed Central (submittedVersion)
Funders: National Institutes of Health (5t32da007233-40)
National Institute on Drug Abuse (T32DA007233)
Topics: Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
Social Sciences › Health › Public Health and Social Inequalities
Social Sciences › Health › Indigenous Health, Education, and Rights
Keywords: PEN-3 cultural model, culture and health, health behavior, family systems, culturally sensitive interventions, health disparities, cultural practices, health beliefs, public health interventions
MeSH terms: Cultural Characteristics, Family Relations, Humans, Models, Theoretical, Public Health, Health Behavior, HIV Infections, Databases, Bibliographic, Biomedical Research, Cultural Competency, Social Stigma

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Framing the impact of culture on health: a systematic review of the PEN-3 cultural model and its application in public health research and interventions

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