Cultural Competency, Imperialism, White Saviorism, and Global Health Ethics:

Improving FISH’s Associate Training and Operational Ethics


Review by: Tessa Fier, Presentation by: Shivangi Goswami, Erika Gonzalez

History of Maclovio Rojas 

  • Why is this important: To be more culturally aware of the origins and current realities of the community we enter to  serve 


Understanding Imperialism

  • Conceptual definition: “ the process whereby the dominant politico-economic interests of one nation expropriate for their own enrichment the land, labor, raw materials, and markets of another people” - Michael Parenti

  • Modern Imperialism - The US and Mexico

    • Maquiladoras as engines of modern imperialism 

    • Recent attempts by the United States Department of State and associated corporate interests to force the Mexican government to reopen maquiladoras despite the coronavirus pandemic


Global Ethics and FISH

  • FISH has integrated global health ethics  training and resources

  • Effort to include the rationale of this training 

  • Examples:

    • Documentaries created for international clinical programs

    • Case study scenarios used to train medical students abroad

  • Despite being more clinically oriented, lessons and perspectives are applicable to FISH


On FISH’s To-Do List...

  • Broadening its curriculum with information on history, imperialism, and global health ethics

  • Create a curriculum for associates that is adapted to the realities of the pandemic

  • Make available a list of vetted and reliable resources relating to these topics for associates in search of more information


Discussion Questions

  • Have to remember the group is the unit of analysis! (not the individuals)

  • Ascertain whether something was a view of one member or a theme for the group

  • Note whether a specific discussion emerged as a result of moderator prompting or spontaneously from the group

  • More text/discussion does not necessarily mean the topic is more important

Health Education Efficacy


  • Questions Faced:

    • What makes people act on the health education they receive?

    • What are common reasons why people do not act on health information they receive? 

    • What is the best way to disseminate information so that the message sticks?


  • Main Idea: Health education is more effective if visual and artistic elements are implemented into the dissemination of the curriculum. 

  • Applications:

    • Use animated videos to explain a certain topic or scenario

    • Use a music and pictures to engage the audience

    • Explain a concept visually through pictographs and flowcharts


  • Main Idea: People motivated to change behavior if that change fits within their perceived identity

  • Applications:

    • Use correct language

    • Include characters & representation that matches target population

    • Include appropriate cultural symbols


  • Main Idea: Health education based on science will be more memorable if messaging is simple, concrete, credible, and relatable. 

  • Applications:

    • Create messages that have influences such as community culture/norms, art, family & friends, etc

    • Keep complex scientific ideas simple and easy to understand

    • Focus on “how” individuals can improve in addition to  “why” person engages in behavior and “what” needs to be targeted to intervene


  • Possible Questions:

  • What are some specific ways that FISH can implement art, culture, and science to increase the effectiveness of its health education?

    • For the cultural component of the SEM, how does one from outside the community use this tactic without appropriating the community’s culture or sounding insensitive?

    • What are some challenges that could arise when trying to implement science and use statistics and evidence-based tactics to explain concepts? 


Transtheoretical model of Behavioral Change

By Daniel Zoleikhaeian


Background: SCT + SEM

  • Social Cognitive Theory (SCT): self-efficacy

    • Achievable goals, track progress, self-reward

  • Social Ecological Model (SEM): 

    • Good environment = good behavior


5 Stages of Behavioral Change

  • 1. Pre-contemplation

    • Individual thinks change is not important or necessary

  • 2. Contemplation​

    • ​Individual realizes the problem but does not implement change

  • 3. Preparation

    • ​Individual makes formal plan for implementing the change

  • 4. Action

    • ​Individual executes their plan for change

  • 5. Maintenance

    • ​Individual has successfully executed plan. Goal is to now maintain the healthy behavior


The Progression towards Maintenance

  • Pre-contemplation

    • Consciousness Raising

    • Environmental Re-evaluation

  • Preparation

    • Self-liberation

    • Counterconditioning

    • Stimulus control

  • Contemplation

    • ​Self-evaluation

  • Action

    • ​Contingency Management

What FISH Can Do: Motivational Interviews

  • Discussion Questions

    • What additional training may be needed to implement motivational interviews during consultations?

    • How would we implement motivational interviewing in our health fairs?


  • Cassidy, C. A. (1999). Using the Transtheoretical Model to Facilitate Behavior Change in Patients with Chronic Illness. Journal of the American Academy of Nurse Practitioners, 11(7), 281–287. doi: 10.1111/j.1745-7599.1999.tb00578.x

  • Franklin, B. A. (1978). Motivating and Educating Adults to Exercise. Journal of Physical Education and Recreation, 49(6), 13-17. doi:10.1080/00971170.1978.10617817

  • Kennedy, A. B., & Blair, S. N. (2014). Motivating People to Exercise. American Journal of Lifestyle Medicine, 8(5), 324–329.

  • Resnick, B., Vogel, A., & Luisi, D. (2006). Motivating minority older adults to exercise. Cultural Diversity and Ethnic Minority Psychology, 12(1), 17-29. doi:10.1037/1099-9809.12.1.17