Cultural competence, mandated by Federal law since 1964, has not been appropriately addressed due to its lack of specifics and the lack of specifics within subsequent mandates. This study was designed to determine specific key elements of cultural and linguistic appropriateness which would "operationalize" cultural competence in the provision of healthcare services. Knowing the elements of cultural and linguistic appropriateness will assist non-Hispanic healthcare providers to remove personal barriers of cultural and linguistic differences for Texas' Hispanic population. The problem of cultural competence gained national focus during the Civil Rights movement of the '60s. Current research revealed that Hispanics continue to have the worst healthcare outcomes of any minority population. Census data reflecting that Hispanics are the fastest growing segment of the population, with Texas having the nation's second largest Hispanic population, make it imperative for healthcare providers to determine methods to improve healthcare for Texas' Hispanic population. A Delphi Technique was used to extract expert opinions from 26 highly qualified, Texas Hispanic healthcare providers regarding the key elements of cultural and linguistic appropriateness for Texas' Hispanic population. The ultimate goal of the research was to determine essential information which would assist non-Hispanic healthcare providers in removing personal barriers of cultural and linguistic appropriateness to the delivery of healthcare services for Texas' Hispanics. Through the approximately 16-month process of the Delphi Technique, the Panel produced 249 distinct elements in 11 groups of cultural appropriateness and 8 groups of linguistic appropriateness. Members of the Panel ranked the groups for importance, indicated the level of agreement/disagreement with each element, and rated each element for its individual importance. This study is important because it is the first time an expert panel of solely Hispanic healthcare providers has spoken collectively about what constitutes cultural and linguistic appropriateness. This research can provide a framework for professional practices, grant providing organizations, or evaluation teams to assess professionals and programs to determine their degree of cultural and linguistic appropriateness. The work can also form the basis for curricula to be used in Texas' healthcare professions preparatory schools or continuing education for practicing healthcare professionals.

The provision of accessible and usable health information is vital for making informed health decisions and embracing active and preventative health behaviours (such as reporting of symptoms, early screening and seeking medical help). Previous research in this area has focused on health-related information seeking behaviour and use of information by citizens of developed countries and within urban geographical locations. The common thread from existing research within the context of developing countries, particularly in Africa, is the need for health information to be provided in a way that considers the diverse cultural perspectives and characteristics of rural communities; regarding both the content and the design of health information services. Considering the cultural aspects is important. However, there is little or no work that has considered the provision of health information that is culturally and locally appropriate. This research aims to investigate the health information behaviour of men in rural Nigeria and explore the local sociocultural aspects that relate to the provision of prostate cancer information. The research extends the theoretical framework of Johnson’s Comprehensive Information Seeking model to include health-related information design heuristics that address aspects of cultural appropriateness within rural contexts and particularly within the setting of developing countries. A qualitative approach was adopted as it was considered appropriate for this research. The research utilised 35 semi-structured interviews and 5 focus group discussions with men (aged 35 or over) residing in rural areas of Nigeria. Participants shared their experiences with health-related information seeking and use, the barriers they encounter and the role that culture and rurality play in that process. Findings show that within rural Nigeria, culture and religion play a vital role in shaping the health information behaviour of men. There is a lack of knowledge about important health issues that affect men, such as prostate cancer. The study documents that internal, interpersonal sources and oral-based communication methods are preferred in rural communities. Based on the findings, a revised model of health information behaviour that extends the existing scholarly perspectives to include cultural context and information use component in rural communities in Nigeria was presented.