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2 Designing Projects with Culture in Mind
Pages 7-14

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From page 7... ... 2 Designing Projects with Culture in Mind When developing the agenda for this session, the Planning Committee had two questions in mind:  How might one design international research projects while being cog‐ nizant of cultural distinctions, mannerisms and sensitivities?  What cultural and ethical issues should be taken into consideration when first setting out to design a research project that involves interna‐ tional participants? Read the entire page →
From page 8... ... 8 Culture Matters: International Research Collaboration in a Changing World community functions as a culture that can be studied from a psychological per‐ spective. He emphasized the importance in such studies of being aware of the problem of ethnocentrism -- the natural tendency of using one's own culture as a standard for evaluating others -- and to consider the advantages and disad‐ vantages of the universalist and culture‐specific approaches to research. Leong then noted that while the American Psychological Association (APA) has a code of ethics that contains guidelines regarding research, these guide‐ lines do not specifically address international and cross‐cultural research. For example, the APA code of ethics has specific standards and guidelines regard‐ ing informed consent, but the guidelines say nothing about what to do when there are cross‐cultural encounters with people who have different communi‐ cation styles and expectations. Leong made the point that "there are limita‐ tions to our ethical codes. The behavioral specificity of these ethical codes ig‐ nores a range of ethical challenges when cross‐cultural international research is conducted by American psychologists in other countries." He commented, too, that ethical codes are not created in vacuums but are contextualized and reflect the culture of the country in which these codes are developed. "We know very little about the cultural conflicts and ethical dilem‐ mas that occur when culture‐specific ethical codes are transported across cul‐ tures in international psychological research," said Leong. "More likely than not, these codes lack the flexibility to deal with the complexities of the differ‐ ent cultural contexts. A behaviorally‐based ethical system is not likely to be responsive to these cross‐cultural conflicts that are often subtle and invisible to many American psychologists," he added. Leong then listed some of the ethical challenges in international research (Leong, 2011) Read the entire page →
From page 9... ... One such solution is the International Competencies for Scientists and Practitioners, which derives from the APA's Resolution and defines and measures international competencies as an extension of the multicultural competencies movement in minority mental health services. This movement was launched over three decades ago by the APA's counseling division when it developed a position paper on the topic of cross-cultural competencies as they relate to more culturally competent diagnostic services for minorities (Sue, 1982) Read the entire page →
From page 10... ... 10 Culture Matters: International Research Collaboration in a Changing World and problems that arise from the client's different cultural background; knowledge about other cultures; and skills that a counselor can acquire to work effectively with culturally different clients. From this model for cross‐cultural competencies, Leong and his colleagues created a model for developing international competencies in psychology that he believes can provide a conceptual framework for guiding the increasing in‐ ternationalization of psychology. Leong's model proposes that the develop‐ ment of international or cross‐cultural competencies in psychology should begin with a multicultural mindset that includes a deep understanding of the contextual basis of human behavior and that requires a cross‐cultural and comparative perspective (Leong, 2000) . The opposite stance, explained Leong, is ethnocentrism, "where we assume that our culture's way of thinking, feeling, and behaving is the best and correct one regardless of context." He added that ethnocentrism is a common and natural human tendency and therefore re‐ quires mindful efforts to overcome. One aspect of this model is that the psychologist uses cross‐cultural knowledge, skills, and abilities related to differential contexts in order to ac‐ commodate the significant differences that would otherwise limit or hinder the relevance and effectiveness of his or her international activities. In the devel‐ opment of international competencies for research and practice, an evidence‐ based approach that uses empirically‐based cross‐cultural theoretical models is important. Leong briefly reviewed a few such studies to illustrate the im‐ portance of acquiring knowledge regarding cultural values to guide ethical re‐ search practices. The utility of these models is in explaining how conflicting values can create ethical problems when conducting cross‐cultural research. In his book The Interpretation of Cultures, anthropologist Clifford Geertz made an important distinction between thick versus thin descriptions of cul‐ tures (Geertz, 1977) Read the entire page →
From page 11... ... Designing Projects with Culture in Mind 11 2.2 WHY CULTURE MATTERS IN CANCER RESEARCH Presenter: Edward Trimble, Director of the Center for Global Health at the National Cancer Institute (NCI) Edward Trimble indicated that he had recently counted 15 bilateral inter‐ national research agreements that he is working on or developing to tackle the growing incidence of cancer outside of the United States. He noted that more than 60 percent of the world's cancers occur in the developing world, with that percentage slated to rise to upwards of 70 percent over the next two decades. As a result of the pressing need that arises from the preponderance of cancer occurring in those nations least able to afford the burden of treating and caring for their citizens who develop cancer, Trimble said, "we need to understand the differences in how cancer arises and the response to treatment across different countries and different patient populations. We need to share expertise, we need to build capacity for research, and we need to develop new ways to pre‐ vent, to diagnose, to treat, and to palliate cancer as soon as possible. So we need to overcome any differences related to red tape or culture as quickly as possible to get this done." And while there has been tremendous awareness of the prevalence of infectious diseases in the less developed world, that same awareness has not been the case concerning non‐communicable diseases such as cancer. Trimble said one important aspect of culture related to cancer is its influ‐ ence at the personal, family, and community levels, at the level of local health systems and health care providers, and at the national level as it relates to sup‐ port for research and for engaging in research with investigators from the de‐ veloped world. At the individual, family, and community levels, there needs to be a community understanding of the need for health research and the struc‐ ture of health research, explained Trimble. One advantage that American re‐ searchers have in this realm is that the United States is itself multicultural and the cancer research community has learned how to interact with community leaders. "In many cases, we bring that awareness when we do research in part‐ nership with colleagues outside of the U.S.," said Trimble. One area where improvement is needed, he said, is learning how to ex‐ plain the risks and benefits associated with research to individuals. "It drives me crazy when I have to talk to my own patients and give them a 20‐page, sin‐ gle spaced informed consent form," he said. To him, this represents a failure to bridge the legal culture with the culture of the individual and the health care provider who would "much prefer to have a two‐page document in bold, 16‐ point type." Also needed, said Trimble, is a health care community that puts a premium on research. "Clearly, we need to make sure that doctors and nurses and other members of the healthcare team understand the importance of re‐ Read the entire page →
From page 12... ... 12 Culture Matters: International Research Collaboration in a Changing World search and understand how to do it. This needs to be part of the medical cul‐ ture," he said. It has to start with the institutional leadership's support for re‐ search in a way that engages all of the communities -- each with its own cul‐ ture -- that must be involved for research to have its biggest impact, Trimble explained. In the same way that psychologists have ethical frameworks, so too does the international research community. These frameworks, which can have both national and international scope, are largely in sync with one another. What does vary, said Trimble, is the amount of paperwork needed to satisfy the dif‐ ferent frameworks and the timeliness of the review process. In some cases, he said, the time from submission of a research proposal to its approval by a na‐ tional review board takes so long that the scientific question that was to be addressed by the research is no longer important. This is also a U.S. problem, Trimble admitted, and the National Cancer Institute has revamped its own pro‐ cesses to make sure that it can start trials quickly. He cited France as an exam‐ ple of a country that has refined its processes to speed clinical trial approvals. "France has managed to change the culture to emphasize the importance of timely review. They are not overlooking patient protection but making sure that the science proceeds in a timely way," said Trimble. Trimble noted the potential value of the Bamako Call to Action for Re‐ search in Health, which was issued in 2008 (WHO, 2008) . This document, issued by ministries of health, science and technology, education, foreign affairs, and international cooperation from 53 countries, urged nations to mobilize all rele‐ vant sectors of society to work together to find needed solutions to the world's important health care issues. The Call to Action also recommended that gov‐ ernments and international development agencies allocate specific resources to health research priorities. The culture change needed to realize these goals is still underway, said Trimble. As an example of what happens when the local culture does not support these goals, he cited the clinical trials crisis in India. In 2013, the Indian gov‐ ernment rolled out new clinical trials regulations that were intended to provide greater protection to clinical trial participants. While many of the regulations were reasonable, a few less thoroughly developed regulations caused clinical trials in India to come to a halt: a requirement that compensation be paid to patients who were not fully cured during the trial, a ban on the use of placebos in clinical trials, and a requirement to pay all medical costs for a patient who sustained injury or illness during a clinical trial without regard to whether said injury or illness was related to the clinical trial (Pais, 2013) Read the entire page →
From page 13... ... The NCI has also created a large clinical trials network that, while based primarily in the United States and Canada, also involves investigators and patients in South Africa, Peru, China, Japan, and Korea. Trimble additionally cited the strong culture of partnership that NCI has established in the United States among industry and academia, including the development of model agreements for collaborations across government, industry, and academia. Read the entire page →

From page 7...

... 2 Designing Projects with Culture in Mind When developing the agenda for this session, the Planning Committee had two questions in mind:  How might one design international research projects while being cog‐ nizant of cultural distinctions, mannerisms and sensitivities?  What cultural and ethical issues should be taken into consideration when first setting out to design a research project that involves interna‐ tional participants?

Read the entire page →

From page 8...

... 8 Culture Matters: International Research Collaboration in a Changing World community functions as a culture that can be studied from a psychological per‐ spective. He emphasized the importance in such studies of being aware of the problem of ethnocentrism -- the natural tendency of using one's own culture as a standard for evaluating others -- and to consider the advantages and disad‐ vantages of the universalist and culture‐specific approaches to research. Leong then noted that while the American Psychological Association (APA) has a code of ethics that contains guidelines regarding research, these guide‐ lines do not specifically address international and cross‐cultural research. For example, the APA code of ethics has specific standards and guidelines regard‐ ing informed consent, but the guidelines say nothing about what to do when there are cross‐cultural encounters with people who have different communi‐ cation styles and expectations. Leong made the point that "there are limita‐ tions to our ethical codes. The behavioral specificity of these ethical codes ig‐ nores a range of ethical challenges when cross‐cultural international research is conducted by American psychologists in other countries." He commented, too, that ethical codes are not created in vacuums but are contextualized and reflect the culture of the country in which these codes are developed. "We know very little about the cultural conflicts and ethical dilem‐ mas that occur when culture‐specific ethical codes are transported across cul‐ tures in international psychological research," said Leong. "More likely than not, these codes lack the flexibility to deal with the complexities of the differ‐ ent cultural contexts. A behaviorally‐based ethical system is not likely to be responsive to these cross‐cultural conflicts that are often subtle and invisible to many American psychologists," he added. Leong then listed some of the ethical challenges in international research (Leong, 2011)

Read the entire page →

From page 9...

... One such solution is the International Competencies for Scientists and Practitioners, which derives from the APA's Resolution and defines and measures international competencies as an extension of the multicultural competencies movement in minority mental health services. This movement was launched over three decades ago by the APA's counseling division when it developed a position paper on the topic of cross-cultural competencies as they relate to more culturally competent diagnostic services for minorities (Sue, 1982)

Read the entire page →

From page 10...

... 10 Culture Matters: International Research Collaboration in a Changing World and problems that arise from the client's different cultural background; knowledge about other cultures; and skills that a counselor can acquire to work effectively with culturally different clients. From this model for cross‐cultural competencies, Leong and his colleagues created a model for developing international competencies in psychology that he believes can provide a conceptual framework for guiding the increasing in‐ ternationalization of psychology. Leong's model proposes that the develop‐ ment of international or cross‐cultural competencies in psychology should begin with a multicultural mindset that includes a deep understanding of the contextual basis of human behavior and that requires a cross‐cultural and comparative perspective (Leong, 2000) . The opposite stance, explained Leong, is ethnocentrism, "where we assume that our culture's way of thinking, feeling, and behaving is the best and correct one regardless of context." He added that ethnocentrism is a common and natural human tendency and therefore re‐ quires mindful efforts to overcome. One aspect of this model is that the psychologist uses cross‐cultural knowledge, skills, and abilities related to differential contexts in order to ac‐ commodate the significant differences that would otherwise limit or hinder the relevance and effectiveness of his or her international activities. In the devel‐ opment of international competencies for research and practice, an evidence‐ based approach that uses empirically‐based cross‐cultural theoretical models is important. Leong briefly reviewed a few such studies to illustrate the im‐ portance of acquiring knowledge regarding cultural values to guide ethical re‐ search practices. The utility of these models is in explaining how conflicting values can create ethical problems when conducting cross‐cultural research. In his book The Interpretation of Cultures, anthropologist Clifford Geertz made an important distinction between thick versus thin descriptions of cul‐ tures (Geertz, 1977)

Read the entire page →

From page 11...

... Designing Projects with Culture in Mind 11 2.2 WHY CULTURE MATTERS IN CANCER RESEARCH Presenter: Edward Trimble, Director of the Center for Global Health at the National Cancer Institute (NCI) Edward Trimble indicated that he had recently counted 15 bilateral inter‐ national research agreements that he is working on or developing to tackle the growing incidence of cancer outside of the United States. He noted that more than 60 percent of the world's cancers occur in the developing world, with that percentage slated to rise to upwards of 70 percent over the next two decades. As a result of the pressing need that arises from the preponderance of cancer occurring in those nations least able to afford the burden of treating and caring for their citizens who develop cancer, Trimble said, "we need to understand the differences in how cancer arises and the response to treatment across different countries and different patient populations. We need to share expertise, we need to build capacity for research, and we need to develop new ways to pre‐ vent, to diagnose, to treat, and to palliate cancer as soon as possible. So we need to overcome any differences related to red tape or culture as quickly as possible to get this done." And while there has been tremendous awareness of the prevalence of infectious diseases in the less developed world, that same awareness has not been the case concerning non‐communicable diseases such as cancer. Trimble said one important aspect of culture related to cancer is its influ‐ ence at the personal, family, and community levels, at the level of local health systems and health care providers, and at the national level as it relates to sup‐ port for research and for engaging in research with investigators from the de‐ veloped world. At the individual, family, and community levels, there needs to be a community understanding of the need for health research and the struc‐ ture of health research, explained Trimble. One advantage that American re‐ searchers have in this realm is that the United States is itself multicultural and the cancer research community has learned how to interact with community leaders. "In many cases, we bring that awareness when we do research in part‐ nership with colleagues outside of the U.S.," said Trimble. One area where improvement is needed, he said, is learning how to ex‐ plain the risks and benefits associated with research to individuals. "It drives me crazy when I have to talk to my own patients and give them a 20‐page, sin‐ gle spaced informed consent form," he said. To him, this represents a failure to bridge the legal culture with the culture of the individual and the health care provider who would "much prefer to have a two‐page document in bold, 16‐ point type." Also needed, said Trimble, is a health care community that puts a premium on research. "Clearly, we need to make sure that doctors and nurses and other members of the healthcare team understand the importance of re‐

Read the entire page →

From page 12...

... 12 Culture Matters: International Research Collaboration in a Changing World search and understand how to do it. This needs to be part of the medical cul‐ ture," he said. It has to start with the institutional leadership's support for re‐ search in a way that engages all of the communities -- each with its own cul‐ ture -- that must be involved for research to have its biggest impact, Trimble explained. In the same way that psychologists have ethical frameworks, so too does the international research community. These frameworks, which can have both national and international scope, are largely in sync with one another. What does vary, said Trimble, is the amount of paperwork needed to satisfy the dif‐ ferent frameworks and the timeliness of the review process. In some cases, he said, the time from submission of a research proposal to its approval by a na‐ tional review board takes so long that the scientific question that was to be addressed by the research is no longer important. This is also a U.S. problem, Trimble admitted, and the National Cancer Institute has revamped its own pro‐ cesses to make sure that it can start trials quickly. He cited France as an exam‐ ple of a country that has refined its processes to speed clinical trial approvals. "France has managed to change the culture to emphasize the importance of timely review. They are not overlooking patient protection but making sure that the science proceeds in a timely way," said Trimble. Trimble noted the potential value of the Bamako Call to Action for Re‐ search in Health, which was issued in 2008 (WHO, 2008) . This document, issued by ministries of health, science and technology, education, foreign affairs, and international cooperation from 53 countries, urged nations to mobilize all rele‐ vant sectors of society to work together to find needed solutions to the world's important health care issues. The Call to Action also recommended that gov‐ ernments and international development agencies allocate specific resources to health research priorities. The culture change needed to realize these goals is still underway, said Trimble. As an example of what happens when the local culture does not support these goals, he cited the clinical trials crisis in India. In 2013, the Indian gov‐ ernment rolled out new clinical trials regulations that were intended to provide greater protection to clinical trial participants. While many of the regulations were reasonable, a few less thoroughly developed regulations caused clinical trials in India to come to a halt: a requirement that compensation be paid to patients who were not fully cured during the trial, a ban on the use of placebos in clinical trials, and a requirement to pay all medical costs for a patient who sustained injury or illness during a clinical trial without regard to whether said injury or illness was related to the clinical trial (Pais, 2013)

Read the entire page →

From page 13...

... The NCI has also created a large clinical trials network that, while based primarily in the United States and Canada, also involves investigators and patients in South Africa, Peru, China, Japan, and Korea. Trimble additionally cited the strong culture of partnership that NCI has established in the United States among industry and academia, including the development of model agreements for collaborations across government, industry, and academia.

Read the entire page →

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2 Designing Projects with Culture in Mind Pages 7-14

2 Designing Projects with Culture in Mind
Pages 7-14