Causal Attributions of Cleft Lip and Palate across Cultures

Abstract

Objective To describe and compare the causal beliefs associated with cleft lips and/or palates across several different countries. Design Cross-sectional survey. Setting Operation Smile surgery screenings in six developing countries. Participants Two hundred seventy-nine adult patients and parents of children with cleft lips and/or palates in Kenya, Russia, Cambodia, India, Egypt, and Peru. Interventions In person interviews were conducted with interpreters. Main Outcome Measure As part of a larger study, a semistructured questionnaire was created to explore cleft perceptions, belief systems that affect these perceptions, and social reactions to individuals with clefts. Results Causal attributions were grouped by category (environment, self-blame, supernatural, chance, unknown, or other) and type of locus of control (external, internal, or unknown). Results indicate significant difference by country for both causal attribution category ( P < .001) and type ( P < .001). This difference was maintained in multivariate analyses, which controlled for differences by demographic variables between countries. Conclusions This study provides evidence that causal attributions for clefts are influenced by culture. As harmful beliefs about cause may continue to impact affected individuals and their families even after a repair, it is insufficient to provide surgical care alone. Care of the entire person must include attempts to change misinformed cultural beliefs through educating the broader community.