DESCRIPTION: Health care providers are increasingly challenged by cultural differences between themselves and their patients that inhibit effective and/or satisfactory health care (Jecker, Carrese and Pearlman 1995; NCCC 2001). As a result, the concept of cultural difference is becoming more salient in the provision of health care. This is especially true in primary care locations, which tend to be concerned with the management of chronic diseases such as diabetes and high blood pressure, conditions in which lifestyle and diet are crucially important factors. A great body of health-related research has been developing since the mid-1980s addressing cultural differences in health and health care; however, much less has been done to understand what actually constitutes "culturally-appropriate health care" in the primary care setting. The proposed study both builds on this research and carries out recommendations to address the concept of cultural difference as it affects health beliefs and practices. We will use in-depth and open-ended interviews with providers and patients at two community-based health centers in Springfield, MA, and Hartford, CT, to explore these topics and to guide the development of survey instruments for a larger case-control study of the effectiveness of culturally-appropriate health care. The specific aims of the proposed project are the following: 1. To conduct formative research on the intersections between culture and health behavior among four ethnic groups (Vietnamese and Russian immigrants; Hispanics; and African-Americans) to guide the development of survey instruments used to evaluate the effectiveness of culturally appropriate care; 2. To understand what makes health care culturally appropriate from the perspective of patients and providers; 3. To gather qualitative data from health care providers currently engaged in culturally appropriate care to help identify relevant outcomes for measurement in a subsequent chart review, case-control study on the effectiveness of culturally appropriate health care. 4. To gather qualitative data from participants not currently under the care of a physician on health beliefs and practices related to primary health care in Hartford, CT; and 5. To conduct analyses and comparisons among the groups to determine the degree of variation among cultural groups' beliefs related to health and health care.