Rethinking health care cultures in community services: Towards an operational five-criteria framework

Area of Science:

• Health Services Research
• Sociology of Health
• Cultural Studies in Healthcare

Background:

• Cultural change initiatives in health services often lack depth and clarity.
• Existing approaches may treat culture as a background factor or patient attribute.
• There is a need for a more critical and operational understanding of health care cultures.

Purpose of the Study:

• To develop the concept of health care cultures (HCCs) as an analytical category.
• To reframe the analysis of community health and mental health services.
• To propose a framework for analyzing and transforming HCCs to address inequalities.

Main Methods:

• Conceptual development drawing on Gramscian framework, feminist care theory, and structural competency.
• Analysis of three research projects conducted in Brazil and Spain.
• Proposal of a five-criteria framework for analyzing and transforming HCCs.

Main Results:

• Health care cultures (HCCs) are conceptualized as dynamic configurations of power, knowledge, and practice.
• HCCs are sites of tension between hegemonic and subaltern forms of knowledge and practice.
• A five-criteria framework (structural competency, community participation, recognition of experiential knowledge, shared decision-making, safeguarding rights) is proposed.

Conclusions:

• Reframing health care cultures moves analysis beyond background variables to institutional organization.
• The proposed framework offers a method for evaluating and transforming health care institutions.
• Structural competency is foundational for achieving other criteria in transforming HCCs.