Cultural and institutional factors in health promotion theory: The case of HIV prevention in Russia

Date of Completion

January 1999


Health Sciences, Public Health|Sociology, Public and Social Welfare




Purpose. This research examines a theoretical model of health promotion, the Multi-Level model, which combines cultural factors with current health promotion models to explain health behavior change in non-Western contexts. ^ Background and significance. Theories and corresponding models of health promotion have primarily been conceived in the West and rarely build in cultural and institutional factors into their explanations of health behavior change. It is unclear if these models can be directly applied to other cultures with different health traditions and cultural beliefs. The Multi-Level model includes individual, interpersonal, and institutional level factors, taking into account the cultural resources and barriers that can promote or deter health behavior change. ^ Methodology. To examine these factors, a current health promotion program to reduce HIV risk in injection drug users in Yaroslavl, Russia was examined. Program effectiveness; attitudes toward health, personal empowerment, and responsibility; and the usefulness of the theoretical model in predicting behavior change were explored through the analysis of four separate datasets: (1) structured interviews with 400 injection drug users in Yaroslavl; (2) more in-depth semi-structured interviews with 50 injection drug users in Yaroslavl; (3) qualitative interviews with 50 health professionals; and (4) a structured general population survey of 100 randomly selected adult residents of Yaroslavl, Russia. ^ Results. Results show that health promotion efforts can be effective in a non-Western cultural context in changing some health behaviors. This research suggests that culture can play a role in influencing factors which traditionally affect behavior change, such as self-efficacy. Self-efficacy, however, does not appear to influence health behavior change in this cultural context as it does in most Western research. In addition, cultural and historical factors appear to influence some health attitudes and beliefs. These and other findings, with limitations and implications for public policy, are discussed. ^