Measuring Culture Change as an Evaluation Indicator: Applying Cultural Consensus Analysis to Cultural Models of Lymphatic Filariasis in Haiti

Introduction: This project explores the links between shared cultural beliefs in the illness domain, specific to lymphatic filariasis, and a support group program implemented in three Haitian towns. The purpose is to introduce an innovative approach to evaluation, the cultural model evaluation technique (CM Evaluation), as well as gain an understanding of the shifting cognitive belief structure around the cultural domain of lymphatic filariasis in the Haitian setting as associated with a support group intervention.

Method: The sample population was comprised of 241 women across three sites in Haiti: Archaie, Cabaret, and La Plaine. Data were collected from longitudinal surveys in 2003, baseline, and 2005, outcome. Descriptive statistics and CM Evaluation were utilized to assess the success of the support group program. CM evaluation is a two-pronged approach, comprised of cultural consensus analysis (CCA) and cultural consonance analysis (CC), that differs from standard evaluation tools in that it measures beliefs and behaviors at the shared community level and is culturally contextualized.

Results: At baseline, most participants were not single (59%), Catholic (49%), literate (57%), relatively poor (71%), and engaged in selling at home or the market (46%). In the reduced model longitudinal CM comparisons, intervention and control groups, the intervention group had the highest rate of consensus (ER=4.71), significant changes in the culturally correct answer key (chi-sq=5.1, df=1, p<.02) and cultural competence (t=3.63, p<.0006). Alternately, controls exhibited no significant differences in the culturally correct answer key (Fisher's Exact two-tailed p<1.00) or cultural competence (t=.62, p<.5407) from baseline to outcome.

Conclusion: Evidence suggests that support group participation does significantly impact the shared illness beliefs surrounding lymphatic filariasis, and that this format is appropriate for resource poor settings lacking clinical support. Also, this study suggests that the CM evaluation approach is an appropriate and effective evaluation indicator for assessing changes in shared belief, cultural consensus analysis, resulting from public health interventions while the behavioral piece, cultural consonance, requires further refinement.