Culture is the most basic cause of a person's wants and behavior.

Human behavior is largely

learned. Growing up in a society, a child learns basic values, perceptions, wants and behaviors
from the family and other important institutions.
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*ocial +actors
,hese factors are relatively permanent and ordered divisions in a society whose members share
similar values, interests and behaviors -.rinciples of /areting 0nd edition, pg. 0%%1. 2lmost
every society has some form of social class structure. *ocial classes are society's relatively
permanent and ordered divisions whose members share similar values, interests and behaviors.
*o the consumers behave according to their social class.
.ersonal +actors
2 buyer's decisions are also influenced by personal characteristics such as the buyer's age and
life!cycle stage, occupation, economic situation, lifestyle, and personality and self!concept
-.rinciples of /areting 0nd edition, pg. 0%31.
.eople change the goods and services they buy over their lifetimes. ,astes in food, clothes,
furniture and recreation are often age related. 4uying is also shaped by the family life cycle ! the
stages through which families might pass as they mature over time. 2lso the economic situation
prevailing around the consumer, occupation, also most importantly the personality of the
consumer also affects the buying behavior of the consumer.
.sychological +actors
2 person's buying choices are further influenced by four important psychological factors:
motivation, perception, learning, and beliefs and attitudes -.rinciples of /areting, 0nd edition,
pg. 0&&1.
/otivation ! 5eed becomes a motive when it reaches to a sufficient level of intensity. 2 person
may have many needs at a time, but it is not necessary that all the need becomes a motive. *o
this motivation factor affects the consumer buying behavior. 2braham /aslow devised one of
the most popular theories about motivation. His theory bases human motivation upon a hierarchy
of needs a person faces. Ranging from basic needs such hunger, thirst and se# all the way
through to self!actuali$ation. /aslow sought to e#plain why people are driven by particular
needs at particular times -/areting: 2n 6ntroduction, 7th 8dition, pg. 9:91.
.erception ! ,he process by which people select, organi$e and interpret information to form a
meaningful picture of the world -.rinciples of /areting 0nd edition, pg. 0&;1. 6n mareting,
perceptions are more important than reality, as it is perceptions that will affect the consumer's
actual behavior -/areting /anagement, 90th 8dition, pg. 93(1. 6t is not necessary that two
person having same motivation factors also perceives alie. .eople may act differently because
they perceive the situation differently.
<earning ! ,he change in the behavior also arises with the passage of time. 2s the person learns
and gets more e#perience its behavior becomes different. 6n other words, if a person has good
e#perience with a certain brand/product then there are more chances that he or she will purchase
the same product in the future. 4ad e#periences lead to negative feelings towards the product or
service involved.
4eliefs and 2ttitudes ! ,hrough doing and learning, people ac=uire their beliefs and attitudes.
,hese, in turn, influence their buying behavior. 2 belief is a descriptive thought that a person lies
about something.
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Changing patient demographics and technological advances will lead to higher patient
e#pectations and greater demands for oral health care in the 09st century than they had been
during most of the 0:th century. .atient satisfaction is the ey to any successful dental practice,
and a change in the nature of patients? demands is under way. +ive trends will be described,
along with how each trend is affecting patients? e#pectations and demands for dental care. ,hese
trends are:
@ the change in age and diversity of patient demographicsA
@ the change in patients? oral disease patternsA
@ the increase in the general public awareness regarding oral health careA
@ that patients are becoming more nowledgeable about modern dental servicesA
@ that patients are becoming more aggressive in holding health care providers
accountable for the =uality of care.
Changing demographics in the Bnited *tates demand that new dentists be prepared to treat a
diverse patient population. 6mmigration patterns point to significant increases in racially,
ethnically, culturally, and linguistically diverse populations. 2ccording to the B.*. Census
4ureau, one in every ten persons in the Bnited *tates is foreign!born.
9
Currently, the B.*.
foreign!born population comprises a larger segment than at any time in the past five decades,
and this trend is e#pected to continue. 6n 0:::, 93 percent of the total population aged five
and over, or &; million people, reported they spoe a language other than 8nglish at home.
0
+rom 9))7 to 0:7:, the Bnited *tates will gain 3: million new immigrants and their
descendants, or 07 percent of the total population. .roCections for 0:7: point to 30:,::: net
immigrants a year, comprised of %7:,::: Hispanics, 00(,::: non!Hispanic 2sians, 93(,:::
non!Hispanic whites, and 7;,::: non!Hispanic blacs. ,hus, Hispanics and 2sians will
contribute the most to the influ# of immigrants.
%
,he B.*. surgeon general?s 0::: report on oral health in 2merica
&
reveals profound and
conse=uential oral health disparities along racial and ethnic lines within the population.
2lthough common dental diseases are preventable, social, economic, and cultural factors
affect how health services are delivered and used and how people care for themselves.
Reducing disparities re=uires wide!ranging approaches, including training a worforce that is
responsive to the cultural needs of patients.
2ccording to the 5ational Center for Cultural Competence,
7
critical factors in the provision
of culturally competent health care services include understanding of the following: the
beliefs, values, traditions, and practices of a cultureA culturally defined health!related needs
of individuals, families, and communitiesA culturally based belief systems of the etiology of
illness and disease and those related to health and healingA and attitudes toward seeing help
from health care providers.
Dental schools must strive to prepare their students in these areas. 6deally, the ne#t generation
of dentists would be nowledgeable about the cultures they will treat and silled in using
culturally sensitive health care delivery practices. However, little is nown about students?
own beliefs about treating diverse patients. +or e#ample, educators now little about
students? perceptions of their own strengths and weanesses, whether students perceive
culture as important to the practice of dentistry, and whether there are modifiable predictors
of the perceived importance of culturally sensitive practices. ,he aims of this study are to 91
describe students? self!rated nowledge of their own cultureA 01 describe students? self!rated
nowledge about the cultures they are liely to encounter in dental practiceA %1 describe
students? beliefs about the importance of culturally sensitive practices in dental careA and &1
identify modifiable characteristics of the perceived importance of culturally sensitive
practices.
http://www.Cdentaled.org/content/;0/7/7;9.long
Discussion
Eur main findings are that 91 students report that they barely now about the cultures of patients
they are liely to treatA 01 the maCority of students cannot identify a cultural group whom they
now wellA %1 students believe that it is important to use culturally sensitive practices in dental
careA and &1 nowing at least one cultural group well is related to higher perceived importance of
using culturally sensitive dental practices. ,hese findings are consistent with literature that
suggests that gaining nowledge of specific cultural groups is an important part of improving
provision of culturally sensitive health care. +or e#ample, <ister
3
posits that cultural nowledge
-familiarity with the broad differences, similarities, and ine=ualities in e#perience, beliefs,
values, and practices among various groupings within society1 is an important element of cultural
competence. Hughes and Hood
)
have shown that learning about specific cultural groups of the
local community improves cultural sensitivity in nursing students.
+ewer than one!=uarter of the students in our study could identify a specific cultural group that
they new well. +urthermore, their acnowledgment of barely nowing other cultures speas to
the acute need for a multicultural curriculum. ,he students surveyed were early in their
sophomore year and were Cust beginning their multicultural curriculum, which is designed to
improve both nowledge and perceived importance about culture. ,he outcomes of this
curriculum are being investigated, but are as yet unnown.
Despite the admission of inade=uate nowledge, this group of students believes that cultural
sensitivity in dental practice is important. ,hose who new at least one cultural group well
perceived cultural sensitivity as more important than those who did not now another culture
well. .erhaps those students who have a relationship with someone from another culture can
better appreciate the difficulties of cross!cultural health care and the benefits of health care
providers? cultural sensitivity. ,his suggests that students may benefit from learning about the
characteristics of other cultures and from interacting with people from other cultures. 4enefits
might include nowledge as well as an openness to appreciating and using culturally sensitive
dental care practices. 6ronically, the practice perceived as least important to these students was
participation in cultural competence professional activities. *tudents who do not see the
importance of these activities may be particularly difficult to engage in a multicultural
curriculum. ,his underscores the importance of maintaining a diverse student body and
faculty.
9:
2 diverse dental school can promote both formal learning through curriculum and
informal learning through personal relationships with faculty and students.
*tudents and faculty alie often e#press the concern that it is impossible to now every aspect of
every culture that they may encounter in practice. ,here are three important points to mae in
response to this concern. +irst, there are techni=ues that can be used in virtually all cross!cultural
situations, regardless of the patient?s specific cultural bacground. +or e#ample, the Culture and
Health!4elief 2ssessment ,ool -CH2,1 teaches a core set of =uestions to elicit patients?
culturally specific ideas about health and disease across cultures.
99
2t the BConn *D/, we have
incorporated the CH2, model and give students the opportunity to roleplay using it with
standardi$ed patients.
*econd, while it is unrealistic for dentists to become e#pert in all cultures, it is =uite realistic for
a dentist to learn some basic characteristics of the cultural groups who will be treated in large
numbers in his or her specific setting. .rograms need not be all!inclusive or completely group!
specific to discuss variations in the values and communication styles of various racial and ethnic
groups. However, the recommendation has been made that programs aimed at enhancing the
provision of culturally effective health care should be tailored to the demographics of the
population served.
90,9%
+or e#ample, Hartford serves a large .uerto Rican community. 2 dentist
who is practicing in that area would do well to learn about .uerto RicansFfor e#ample, their
common dietary practices, common home remedies, family roles and decision!maing authority,
patterns of high!ris behaviors such as tobacco, the format for names, and the importance of
values such as sympatia and famalismo, as well as a few phrases in *panish. 2t the BConn *D/,
in a small group seminar setting, students give presentations on the biological and nonbiological
determinants of health and oral health for four of the common cultural groups they are liely to
see in practice in Connecticut. ,hese student presentations are developed with the help of an
appropriate te#tboo
9&
and relevant scientific articles assigned by the faculty.
,hird, cultural competence is a continual learning process. 2 goal of mastering a particular
culture indicates either a limited willingness to integrate new information or an unrealistic goal.
6n either case, an ongoing openness to learning is a more appropriate and beneficial goal. >e
encourage students and faculty to tae a lifelong learning approach to diversity.
,here are several dangers that should be noted when teaching a cross!cultural curriculum. +irst,
focusing on a single given cultural group may not prepare students to interact effectively with a
wide variety of cultural groups. ,his is why, in addition to learning about several core cultural
groups in Connecticut, our curriculum also teaches the CH2, model, which can be used with any
individual from any cultural group.
*econd, stereotypes may be created or reinforced by trying to teach about a given culture.
4ecause individuals are influenced by their own personal e#periences and may or may not
subscribe to group norms, individuals who share the same cultural bacground may thin and act
=uite differently. 2lso, culture is not staticA it changes over time, especially across generations.
2n emphasis on intra cultural diversity and cultural change prevents cultural stereotyping. >e
tae great care in the curriculum to distinguish between stereotypes and generali$ations. 2
stereotype is an uncheced assumption, i.e., the automatic application of information or
misinformation about a group to one of its members. 2 generali$ation, on the other hand,
involves hypothesis testing. 6n maing a generali$ation, one must determine whether the
-mis1information about the group actually applies to a given member of the group. 6n all of our
curriculum activities, we emphasi$e intra group variability and discuss the difficulty of drawing
generali$ations about groups. >ithout asing students to be spoes!people for their own group,
we do invite all students to offer input about the validity of the generali$ations being made. >e
have found that many students are eager to comment, to share personal e#periences, and to dispel
myths about their own cultures. >e believe that creating an opportunity for this type of dialogue,
in a safe environment with silled moderators, is a critical part of dental education. ,his
observation is consistent with findings from other models of health care provider education.
97
,here are several limitations of this study that should be noted. +irst, we relied on student self!
report, and there was no measure of actual nowledge. ,hus, students may over! or
underestimate their own level of nowledge. *econd, we allowed anonymous surveys. ,hus, we
were not able to investigate individual predictors of nowledge or importance. +or e#ample,
perhaps foreign!born students, multiracial or multicultural students, or those from particular
areas of the country may perceive cultural sensitivity as more important than others do. ,hird, we
did not assess variation in students? e#posure to cultural competence training prior to coming to
dental school. +inally, data were collected cross!sectionally. >hile we hypothesi$e that
nowledge of specific groups influences perceived importance of cultural sensitivity, the
converse may be true. 2lternatively, they may be reciprocal, with nowledge influencing
importance, which in turn influences nowledge. 6t might also be true that both nowledge and
importance could be the result of a common bacground characteristic such as the student?s
personality or cultural bacground.
,rinidad was initially a 4ritish Colony. ,he maCor ethnic groups are made up of %).(G 2frican
and &:.%G 8ast 6ndian . ,here has always seems to be a high degree of conflict between the two
maCor ethic groups. 6n ,rinidad before the *econd >orld >ar, a small white elite dominated
politics, in the absence of class mobili$ation, political leaders used race to mobili$e the support
of large supporters. 2s independence from 4ritish colonial seemed to becoming to an end in
,rinidad, the white population was centered on a single party the .olitical .rogress Group -..G1
and still held the power in the land.
8thnic perception among these separate groups has emerged from the divisions of color, religion,
place of residence, and occupation. .roblems started with the white colonists and were further
perpetuated by when they became the early leaders.
6t is perceived that the culture of southerners in ,rinidad still hold a colonial mentality. ,hey
seem to believe in white supremacy and favor the white dentists rather than their local dentists.
,hey neglect the e#perience and credence of local practitioners which affects the productivity
and viability of these local dentist.