Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Defining and Theorizing About Culture: The Evolution of the Cultural Determinants of Help-Seeking, Revised

Arnault, Denise, Saint

doi: 10.1097/NNR.0000000000000264

Background The recent interest in defining and theorizing about social determinants of health has illuminated the importance of culture as a central phenomenon of interest. However, cultural processes appear in multiple places in social determinants of health models, and their specifics are not delineated or operationalized.

Objectives This theory development article describes the complexity of defining cultural variables and uses medical anthropology to show how cultural domains, constructs, and variables can be defined.

Methods Using cultural anthropology theory, empirical work, and a literature synthesis as a starting point, the evolution of the cultural determinants of help-seeking theory is explored and the revision of the theory is highlighted.

Results The expanded theory include structural concepts as control variables, reframes illness as “suffering,” and adds concepts of course, cure, manageability, meaning in life, functioning, social negativity, and perceived need.

Discussion Strategies for and benefits of isolating and operationalizing cultural variables for middle-range theory development and testing are discussed.

Denise Saint Arnault, PhD, RN, FAAN, is Associate Professor, School of Nursing, University of Michigan, Ann Arbor.

Accepted for publication June 27, 2017.

This article was accepted under the editorship of Susan J. Henly.

The author acknowledges that a portion of this research was funded by the NIH Office of Behavioral and Social Sciences, the Office of Women's Health, and the National Institute of Mental Health under Grant number MH071307.

The author has no conflicts of interest to disclose.

Corresponding author: Denise Saint Arnault, PhD, RN, FAAN, School of Nursing, University of Michigan, 400 N. Ingalls, Room 2303, Ann Arbor, MI 48109 (e-mail:

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved