International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 7(19), October, 2015

Pages: 43-46

Date of Publication: 10-Oct-2015


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CULTURAL CAPITAL IN HEALTHCARE DELIVERY: FROM PATIENT-PROVIDER PERSPECTIVE IN NIGERIA

Author: Nduka Uzoma C.

Category: Healthcare

Abstract:Healthcare delivery system in Nigeria has been replete with decadence and decay. Overwhelmed persistently by several social inequalities and inequities, the system continues to receive backlashes in spite of spirited efforts by concerned professional groups to revamp it. Healthcare delivery in Nigeria still remains a labor-intensive industry rather than the less complicated, technologically-enhanced one (Obansa, 2013). In addition, healthcare delivery in Nigeria is supplied through a weak conduit
(National Strategic Health Development Plan, 2009). Government has been accused of not being sincere in injecting health into the healthcare system. Thus, the growing perception by the public of some concerted efforts at some quarters to create unequal care in the society (Shim, 2010). But a variable that needs to be factored in into this schism could be the influence of cultural capital in patient-provider interaction. This article will essay to explore the multifaceted nature of patient-provider involvement and its ramifications within the context of Bourdieu's conceptual model of cultural capital.

Keywords: Society’s symbolic, Cultural capital theory, Cultural capital in healthcare

Full Text:

WHAT IS CULTURAL CAPITAL?

Coined by Pierre Bourdieu, a French sociologist, cultural capital connotes an avalanche of artistic, aesthetic, and innate knowledge held by individuals in a community (Dunt, Hage, and Kelaher, 2010; Khawaja and Mowafi, 2007; Smith-Morris and Epstein, 2014). The concept of cultural capital has also been described and defined as interpersonal competence and shibboleth received via interactions with the society and being able to make and show treasured normative behaviors and knowledge (Vorhies, Davis, Frounfelker, and Kaiser, 2012). Bourdieu’s idea of cultural capital show that social stratification contributes to social inequities (Ergin, n.d.) and that cultural competence consists of linguistic and cultural elements (Dumais, 2002). As a cultural signal, including such things as attitudes, preferences, formal knowledge, behaviors, goods, and credentials, cultural capital has been used to examine relationships between so many social and health outcomes (Byun, Schofer, and Kim, 2012; Hernandez and Grineski, 2012; McCrone, 2005). Finally, cultural capital, according to (Fismen, Samdal, and Torsheim, 2012) is an embodiment or repertoire of society’s symbolic and informational resources that could have an impact on health behaviors.

CULTURAL CAPITAL THEORY

The theory of cultural capital presages that success or failure are both tied to either the possession or lack of cultural capital. For instance, success in education equals possession of cultural capital while failure in education exemplifies absence of such capital (Sullivan, 2002). In addition to the bifocal presentation of cultural capital is the issue of social class. Two fundamental fulcrum of Bourdieu’s cultural capital theory are the “field” or the environment and the “habitus” or how the individual perceives the world (Dumais, 2002; Ringenberg, McElwee, and Isreal, 2009). These two factors shape or determine the degree of cultural capital. It is crucial to consider the function of the environment in which the individual resides and how this social ambiance shapes the individual’s worldview when analyzing the patient-provider paradigm (the social action) in healthcare delivery system.

As Fig. 1 above illustrates, the field or environment, in relation to this discussion, could be explained as the community, city, village, town, state one lives in. On the other hand, the habitus could be described as one’s decision to interact, reveal, and explain every details of one’s health condition with the healthcare provider (nurse, physician, dietician, pharmacist, dentist, etc) for the recipient and giver to make informed healthcare decisions. This decision to interact fluently and openly with the healthcare professional could be guided by the field or environment in which one comes from. Transmitted tradition and received culture could bar an individual, especially those who live in the village or suburbs, not to tell his or her healthcare provider every detail of her health issue. This could result into wrong diagnosis and treatment. But with exposure to city life and interaction with technology and people, there are chances that someone who lives in the city could be more open with the healthcare provider than someone from the village. Thus, the likelihood for good prognosis and treatment. Cultural capital theory has three core elements or attributes. These three states of cultural capital, as shown in Fig. 2 below, are institutionalized, objectivized, and incorporated (Abel and Frohlich, 2012; Abel, n.d.).

Incorporated cultural capital is invisible, personally acquired or learned, and associated with the innate biological traits of the individual. In other words, incorporated cultural capital comprises all the stored skills and knowledge of the individual that can be acquired through the culture. The other subcategories, objectivized and institutionalized are equally linked to the incorporated cultural capital. By objectivized cultural capital we mean things that represent knowledge and has been accumulated over time in a culture or society such as a book. Finally, institutionalized cultural capital simply means the formal recognition or acknowledgement of the cognitive skills and pragmatic competence exemplified through the acquisition of a college degree. Since Bourdieu, there has been criticisms about the empiricism of Bourdieu’s theory of cultural production (Dumais, 2002; Holt, 1997). All these trilaterally related states of cultural capital could help healthcare and public health practitioners develop clinical and population health programs. DISCUSSION Patient-centered care is all about the patient and the patient’s healthcare needs (Epstein and Street, 2011; Reynolds. 2009). To have a successful outcome while attending to the patient and his needs, there should be an understanding of the patient’s cultural knowledge, skills, needs, values and preferences (Dubbin, Chang and Shim, 2013) and a built trust between the patient and the healthcare professional. This trust enhances openness on the patients’ part and confidentiality and ability to deliver best care on the healthcare professional’s part. This dual-patriate deal reinforces patients’ empowerment. But empowerment cannot occur in a vacuum. An interaction to enable understanding of the patients’ perspectives and the environment that shapes the patient’s worldview must occur. Full exchange of information and understanding of the information being exchanged determines the individual’s health outcome (Shim, 2010). In other words, during clinical encounters, both the patient and the clinicians are expected to possess this package called cultural health capital. Healthcare literacy, knowledge and understanding of medical resources could enhance health outcomes and increase patient-provider interaction. Given the dictates of cultural capital, individuals who are less educated could be prone to subjugation by the dominant culture and may have a lowlevel medical assistance or care (Vikram, Vanneman, and Desai, 2012). The educated population have greater propensity to navigate the ever changing healthcare system, especially in the developed worlds. Understanding of several cultural products such as eating habits, educational levels, verbal skills, acts as forms of capital to patient-practitioner conversation (Dubbin, Chang and Shim, 2013). Furthermore, building this bridge of understanding may involve living between two tracks from the patient perspective. For example, one may be trapped between choosing a lived experience embodied in what has been transmitted or passed on from parental knowledge and skills and the culture of the healthcare system as explained by the nurses, pharmacists, physician, and other healthcare professionals (Smith-Morris and Epstein, 2014). In Nigeria, for instance, physicians have been perceived to have the notion that they know what is best for the patient and, therefore, limiting the patient’s input in his or her care (Udonwa and Ogbonna, 2012). The above notion could foreclose seamless interaction between the physician and the patient and may not provide room for understanding of the cultural capital. Moreover, 95% of patient’s treatment are decided by the physician with less patient involvement (Onotai and Ibekwe, 2012). Healthcare literacy should be broadened to include understanding of the patient’s field and habitus by healthcare professionals. Acquiring this knowledge-based competency by nurses, doctors, dentists, pharmacists, and other allied healthcare workers may enhance health promoting behaviors among patients (Abel, n.d.). Health literacy may be approached as a dual mechanism that might result into health gain. In this sense, the patient and the provider works towards understanding each other’s environment and worldview. Healthcare workers, especially in a diverse culture like Nigeria, may begin to decipher whether handing out brochures, leaflets, promotional pamphlets, using the internet suits the patient’s learned environment and habitus. As herculean and utopian as this may be, the goal may be working towards a net gain for all players. Presently, the healthcare delivery system in Nigeria is doctor-centered. In other words, the physician makes the diagnosis and treatment with little or no patient involvement. So, the doctors bring into the medical practice their cultural capital via their field and habitus. Abiola, Udofia, and Abdullahi (2014) has described this as paternalistic or asymmetric relationship between doctors and patients. This physician paternalism has been replicated in Brazil, a developing country like Nigeria, where the focus of medical students is not on the interactional skills or humanistic attitudes rather on biomedical subjects (Ribeiro, Krupat, and Amaral, 2007). The paternalistic physician behavior has been described as being beneficial to the patient because the doctor pays attention to holistic medicine (Israel, 2014). Doctor-patient relationship in some Nigerian hospitals have been described as dialogical and transactional with a mention of understanding the field and habitus of the patient (Adegbite and Odebunmi, 2006).

CONCLUSION

This article builds on existing literature to buttress the importance of cultural capital in healthcare promotion and patientprovider interaction in Nigeria. Given the backdrop of events in the healthcare system in Nigeria, time is of the essence to finding practical panaceas to the ailing industry. One of such solutions may be using cultural capital in fostering better partnership between patients and healthcare professionals. The debate in relation to cultural capital in health promotion may portray two divergent perspectives of the impact of this variable on health outcomes. Future research may establish whether promoting cultural capital could improve health for all and strengthen patient-provider partnership in the Nigerian healthcare landscape.

ACKNOWLEDGEMENT

Author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The author is also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Source of Funding This work received no funding from any organization, agency, or body.

Conflict of Interest No conflict of interest

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Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

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‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

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A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
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A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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