338 Culture’s Impact on Health Risk Appraisal Psychological Well-Being Questions Suzanne Christopher, PhD; John Chambers Christopher, PhD; Tim Dunnagan, EdD Suzanne Christopher, PhD, Assistant Profes- sor, Community Health; John Chambers Christo- pher, PhD, Associate Professor, Counseling Psy- chology; Tim Dunnagan, EdD, Assistant Profes- sor, Health Promotion, Department of Health and Human Development, Montana State University, Bozeman, MT. Address correspondence to Dr. Christopher, Department of Health and Human Development, Montana State University, 104 Hosaeus Com- plex, Bozeman, MT 59717. Email: suzanne@montana.edu Objective : To discuss the im- pact of culture on the develop- ment and utilization of psycho- logical well-being questions em- bedded in Health Risk Appraisals (HRAs). Methods: Using one HRA as a case study, an interpretive- hermeneutic metatheory is em- ployed to situate these questions in cultural and historical context and indicate their underlying in- dividualistic ideology. Results : HRA question development and client feedback are largely shaped by Western concepts of individu- alism, which do not consider the cultural perspective of collectiv- ist societies. Conclusion: Culture determines how we define, think about, and understand health. Therefore, it is essential to be aware of culture’s impact on health research and practice. Am J Health Behav 2000;24(5):338-348 T his paper explores how the under standings of wellness in psychologi- cal, mental, and emotional health components of health risk appraisals (HRAs) are influenced by values and as- sumptions of Western culture. This influ- ence may result in bias against those who complete HRAs and are not from this culture. Extensive work has been done on the psychometric properties of health as- sessments, including issues of scaling, reliability, validity, 1-5 and prediction. 6 The importance of culture has been men- tioned in HRA-related literature. For ex- ample, in their general ethics guidelines, the Society for Prospective Medicine lists cultural and ethnic sensitivity as factors to be examined when selecting a health assessment instrument. 1 However, as we shall make clear, the concept of cul- ture not been given in-depth consider- ation in the construction and use of HRAs. HRAs can comprise strictly a physical and behavioral health needs-assessment or can include other areas, such as spiri- tual, psychological, mental, and emotional health. Sherman 7 noted that almost all HRAs have at least one question related to mental health. Psychological and men- tal health have been incorporated into definitions of health for many years, and it is now commonly accepted that these aspects play an important role in morbid- ity and mortality. The World Health Orga- nization maintains that depressive and anxiety disorders are the leading causes of disability around the globe and are responsible for one quarter of all visits to health care centers. 8 The first White