Conceptual and Methodological Problems in Cross-Cultural Health Research

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Abstract
The large majority of questions dealing with such topics as ears, eyes, teeth, respiratory system, gastrointestinal system, nervous system, and other physical symptoms were felt to be conceptually understandable, although cultural factors did influence judgments pertaining to degree of impairment. The degree of conceptual equivalence was greatly aided by the Eskimos'' steadily increasing awareness and endorsement of the concepts of health and disease as practiced by modern North American physicians and nurses. In the predominantly psychiatric section of the questionnaire, Eskimo cultural attidues directly influenced responses to questions dealing with anxiety symptoms and the decision-making process. In each of these 3 areas the revision of the questionnaire failed to take into account the original bias of the questionnaire items toward the culture of origin, and the cultural interpretation of the items by the subjects to which the questionnaire was adapted. In other words, Eskimo attitudes pertaining to physical impairment, expression of anxiety, and the decision-making process among women were sufficiently distinct from North American cultural attitudes on the same topics to invalidate any possible correlation between the 2 groups. While the high degree of conceptual equivalence in most areas of the questionnaire warranted a continuation of the investigation, the preliminary study clearly illustrated the fact that before a foreign health survey instrument can be used comparatively, one must first have a detailed understanding of the attitudes of the group in question and the cultural matrix to which these attitudes relate; and 2d, one must provide appropriate translation not only of the instrument''s terminology, but its conceptual underpinning as well. Unless these 2 cautions are kept clearly in mind, tne validity of any cross-cultural study of health and disease may be strongly questioned.

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