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

The DOI matches its Crossref record; 63 of the 64 references it cites were found in a registry or an index; 6 of the 22 sources its claims cite were checked for support.

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

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.

Overview

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.

Verification

Claims the paper makes

22 Own interpretation · 13 No basis given · 11 No full text of the sources · 10 Own result · 5 Supported · 5 Not checked yet · 4 Sources not found · 4 Own method · 1 Supported so far

Show all 29 claims

  • Probably not a substantial claim. 36
  • It may state two separate claims as one. 23
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

Citations

Cites

Show all 64 references

Research works printed but not linked: 8

  1. Airhihenbuwa C. O., 2004, Journal of Social Aspects of HIV/AIDS Research Alliance, 1, 1
  2. Melancon J., 2009, International Electronic Journal of Health Education, 12, 203
  3. 10.2190/IQ.28.3 · DOI
  4. Singhal A., 2003, MICA Communications Review, 1, 21
  5. 10.1155/2012/47806 · DOI
  6. Walker C., 2000, Ethnicity and Disease, 10, 165
  7. White K., 2012, Ethnicity and Disease, 22, 274
  8. Williams M. S., 2012, Ghana Medical Journal, 46, 147

Cited by

Sorted by citations

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Metadata

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.
Venue
Ethnicity & Health
Published
2013-11-22
Volume
19
Issue
1
Pages
20-46
ISSN
  • 1355-7858 (ISSN-L)
  • 1465-3419
OpenAlex
W2090486171
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
Locations
  • Ethnicity and Health (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
Funders
  • National Institutes of Health (5t32da007233-40)
  • National Institute on Drug Abuse (T32DA007233)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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