Abstract

Cultural sensitivity provides one of the foundations for a successful clinical research within tribal communities. Researchers involved in the efforts that cross paths with cultural practices of human subjects must be aware of the potential impact as well as the challenges these will pose to the clinical research process. These were some of the insights gained from the research experience of the biomedical research team from University of Guam (UOGCRC) and the University of Hawai’i (UHCC) after conducting a study in Guam which aimed to describe the betel nut chewing practices of its indigents and identify specific biomarkers that occur in the saliva of humans after betel nut (BN) mastication.
An island in the western Pacific Ocean, Guam is home to a diverse society that reflects the blend of the culture of its original Chamorro inhabitants, and the political, economic and socio-cultural influences from the European, American, Asian, and other Micronesian peoples who have either occupied, visited and immigrated to the island since the 16th century. Betel chewing is an integral part of socializing in Guam and approximately 11% of the population chew betel nut on a regular basis. It is a social activity that imbues the spirit of familial goodwill even to strangers. The indigent people in Guam often offer the hard, mature nut at community celebrations and fellowships such as fiestas. However, the International Agency for Research on Cancer has deemed betel nut chewing (with or without tobacco) carcinogenic to humans. Epidemiological and animal data have suggested strong associations between betel nut consumption and oral mucosal diseases such as leukoplakia, oral and nasopharyngeal cancer, and oral sub-mucous fibrosis.
This paper looked into the cultural realities in Guam, its impact to the conduct of clinical research and the insights gained by the researchers from the process. Knowing the core elements of the culture in Guam was integral in the conduct of the clinical research that revolves around a very culturallyrelated practice which is the betel nut chewing. Seven cultural values were considered dominant and interrelated with the betel nut chewing practices in Guam: the importance of communal relationships; respect for familial and kinship influence especially authority; reciprocity; cultural practices and beliefs such as binge drinking and fluidity of time, language barriers; and the often paralyzing fear of social stigmatization. Researchers were reminded from the experience to be constantly mindful in approaching their work in order to guard against cross-cultural misunderstandings and/or misinterpretations.