Contextualization of Health Interventions: Community-Based Health Care in Papua New Guinea

Purpose: Contextualization of health interventions requires a paradigm shift from the curative, biomedical model to a health promotion focus that emphasizes community empowerment.  Successful community health interventions involve engagement of the community as an entity in addressing health disparities.  The development of local level resources that lead to improved health indices requires an awareness of both the cultural context and the relational components of social capital that link people within the community. Social capital has been defined as resources that are an inherent part of a social group and the elements of social organization such as trust, networks, and norms of reciprocity that facilitate mutual cooperation  The purpose of this study was to determine the influence of cultural health beliefs on the implementation of health promotion practices in rural villages in Papua New Guinea (PNG).  Components of social capital were studied to determine their effect on community participation in the Community Based Health Care program.

Methods:  Using a descriptive, ethnographic approach, this study explored the influence of cultural health beliefs and social capital on the adoption of the Community Based Health Care (CBHC) program by rural villages in PNG. The data collection process consisted of participant observation in the field with detailed descriptions of social interactions, transcribed individual and group interviews, and drawing inferences from the data. Between May and June of 2013, twenty three participants were interviewed using open-ended questions related to their perspectives of health, illness, and adoption of health promotion innovations.  

Results: The qualitative data obtained from these interviews were analyzed and themes identified that afforded a more comprehensive understanding of participant’s awareness of health, why communities adopt health promotion innovations, and the perceived effectiveness of the CBHC program. Using a thematic analysis process, the following themes were identifed: Health was defined as 'being well' or living in good relationships socially, environmently, and spiritually. Although decisions in the community are made collectively, women continue to be disenfranchized.  Traditional health beliefs are being influenced by cultural changes and exposure to health promotion innovations. The community-based health care program was seen as having a positive effect on community empowerment and health status, but many felt that additional economic development was a necessary next step for the project.

Conclusion: Health determinants in developing countries reflect a growing trend of health inequities caused by a variety of infrastructure, public service, and health care resource issues.  The development of local level resources that lead to improved health indices requires an awareness of both the cultural context and the relational components of social capital that link people within the community. The configuration of social capital in a group can potentially be operationalized to support the capacity of the community to create health promoting change. This study explored the complexities of social capital, as well as the socio-cultural and contextual influences on the adoption of health innovations in rural communities in PNG. It is hoped that additional knowledge about the influence of cultural health beliefs and social capital on health-related behaviors will contribute to the expansion of effective and sustainable community health programs.