Journal of Public Policy & MarketingVol. 32 (Special Issue) .docx

Journal of Public Policy & Marketing
Vol. 32 (Special Issue) 2013, 119–130
© 2013, American Marketing Association
ISSN: 0743-9156 (print), 1547-7207 (electronic) 119
Cultural Diversity in Television Narratives:
Homophilization, Appropriation, and Implications
for Media Advocacy
Cristel Antonia Russell, Hope Jensen Schau, and
David Crockett
This research explores the role of cultural diversity in the
construction of consumer identity, and in
particular, how cultural diversity is appropriated through
television viewing. Data based on depth
interviews and surveys of young adults who created brand
collages centered on a television-based
character reveal that viewers identify and engage with
television narratives through a process of
“homophilization”; that is, they actively envision various
features of television narratives as similar to
themselves and their own lived experiences. The data also show
that homophilizing processes are
enacted primarily by customizing the narrative, or textual
poaching, in which the consumers insert
themselves and their experiences into the narrative, and that
consumption choices serve as primary
mechanisms for poaching. Because media narratives are
important in the formation and maintenance
of consumer identity, the authors strongly recommend vigilance

in the production and dissemination of
socially conscious narratives that allow prosocial and realistic
characters with whom consumers can
actively engage.
Keywords: television influence, consumer culture theory,
cultural diversity, narrative, homophily
Cristel Antonia Russell is Assistant Professor of Marketing,
Depart-
ment of Marketing, Kogod School of Business, American
University
(e-mail: [email protected]). Hope Jensen Schau is Associate
Professor of Marketing, Gary M. Munsinger Chair in
Entrepreneur-
ship and Innovation, Eller College of Management, University
of Ari-
zona (e-mail: [email protected]). David Crockett is Associ-
ate Professor of Marketing, Moore School of Business,
University of
South Carolina (e-mail: [email protected]).
C
ultural diversity is a central trope in contemporary cul-
ture (Kymlicka and Norman 2000). Though almost
universally regarded as ideal and socially desirable,
cultural diversity is a polysemic text with highly contested
meanings (Parekh 2000). Consumers must engage and rec-
oncile these many meanings as they construct and commu-
nicate their own identity. This research explores how con-
sumers engage and reconcile cultural diversity-related
meanings received through television. Television’s central
role in shaping understanding of diversity makes this a
compelling issue for public policy.

The hallmark feature of the cultural diversity trope is an
idealized interpersonal relationship (of varying depth and
intimacy) with a person from a marginalized cultural group
(e.g., Naisbitt 1988). However, despite their idealized status,
culturally diverse relationships are rare in practice. They tend
to dissolve quickly when they occur and are unlikely to
develop after the early school years (McPherson, Smith-
Lovin, and Cook 2001). Media (e.g., television, Internet/
social media, cinema, music) allows many to experience vir-
tually what they do not experience interpersonally. The juxta-
position of what occurs in daily life against what can be
accessed through media raises the central question posed by
this research: How do people appropriate cultural diversity
through media consumption, particularly television?
Media scholars have long investigated related questions,
and the scholarship provides the grounding assumptions that
guide the current research. Prior research has identified a
media culture that socializes and provides materials for con-
structing identity, social reproduction, and change, as a cen-
tral feature of the postmodern condition (Hutcheon 2002;
Kellner 1995). In addition, Friedberg (1994, p. 179) notes
that “electronic media reorganizes social space, breaking
down the boundaries between here and there, lived and
mediated, personal and public.” Media consumption is active
and always negotiated (Mayne 2000). People stake personal
identities inside media narratives, using them to legitimate
identity positions such as gender and ethnicity (Gauntlet
2008; Morley and Robins 1995). As Briley, Shrum, and
Wyer (2013 [in this issue]) detail, media also offers access to
other identity positions (e.g., gender, ethnicity, race, class,
geography). It mitigates and translates experience into the
corporeality of the consumer (Friedberg 1994).
In line with these insights from prior research, we posit

that television is uniquely important for understanding how
cultural diversity is appropriated through media. Television
instantiates reigning cultural logics; viewers observe and
adopt the cultural logics it depicts. Thus, television is a
prime site for acculturation and enculturation. To paraphrase
Raymond Williams’ ([1974] 2003) famous insight, televi-
sion blends narrative, information, and advertising into a vir-
tually ceaseless flow of ideas. Television is also chiefly
responsible for disseminating idealized narratives about cul-
ture that viewers (i.e., consumers) may actively seek out (as
documented in Brumbaugh and Grier 2013 [in this issue])
and appropriate for use in their identity construction (e.g,
Crockett 2008). Little is known about how viewers appropri-
ate these narratives. This research addresses the oversight by
exploring the following questions: How do viewers engage
with cultural diversity experienced through television pro-
grams? What role is played by traditional markers of cultural
diversity, such as gender and race, in connecting viewers
with television narratives? In turn, how are viewers influ-
enced by the consumption lifestyles of culturally diverse
characters and narratives on television?
We treat the intersection of cultural diversity and media
as a matter of social justice and welfare, and thus squarely
within the scope of public policy. In the United States,
issues pertaining to cultural diversity and media have long
been investigated as matters of social justice and welfare,
particularly role status and the depiction frequency of
women and minorities. In 1968, for example, the National
Advisory Commission on Civil Disorders (more com-
monly, the Kerner Commission) admonished media outlets
for their portrayal of blacks (Hrach 2011). Although the
commission stopped short of linking negative media por-

trayals directly to civil unrest, it legitimized treatment of
minority role status and frequency of depiction on televi-
sion as a social justice and welfare matter in public
discourse—a pattern that has held since. In consumer
research, Kassarjian’s (1969) almost simultaneously pub-
lished analysis of blacks in advertising during the 20-year
Baby Boom adopts a similar social justice and welfare
stance, delivering a commentary to both business and civil
rights groups about the state of race relations. Likewise, we
offer our analysis and findings primarily to industry and
advocacy groups rather than lawmakers and regulators.
Literature Review
Theories about how television narratives influence audi-
ences abound in the fields of media communications and
cultural studies, and they are also well represented within
advertising and consumer research. Given the goal of
understanding how viewers use television to understand
diversity, we briefly review this expansive set of literature
with an eye toward foregrounding the relevant constructs
rather than exhaustive coverage.
Television Delivers Narratives
Television is a polysemic text that contains a virtually cease-
less flow of content (i.e., narrative, information, and adver-
tising) within and across programs (Butler 2007). Television
producers build narrative by managing flow and interrup-
tions of content in ways that privilege their preferred mean-
ings. Television narratives center on characters, which are
textual signifiers that communicate essence. Basic demo-
graphic (e.g., age, ethnicity, gender) and/or physical signi-
fiers (e.g., clothing, body type) often indicate essential fea-
120 Cultural Diversity in Television Narratives
tures of a protagonist (antagonist) or secondary story partici-

pant. Aspects of acting performances (e.g., voice, facial fea-
tures, gestures) can further develop important features of the
character in the narrative. In addition, some actors deliver
meaning because they are stars. They have intertextuality;
that is, audiences read their stardom across multiple texts—
as characters in programming, as actors who are targets of
professional criticism, as product endorsers, and as celebri-
ties who are the subjects of intensive public scrutiny about
their personal lives. Thus, the act of viewing is an open-
ended engagement with the text filtered through personal
and social discourses. Although television producers may
have a preferred meaning, communicating it to an audience
is always probabilistic rather than deterministic: viewers
may or may not adapt the position of identification with the
producer’s preferred meaning (Hall 1997; Newcomb 1994).
Television Influences Through Referential
Relationships
Theories have long established that influence stems from
the structural relationship between agent and target. Thus,
influences received from mediated agents in television nar-
ratives are driven by the referential relationship targets
(viewers) develop with characters/sources, even if they are
socially, geographically, or culturally distant (Cocanougher
and Bruce 1971). We describe the basic relationship types.
Upward-Looking Relationships
Upward-looking relationships reflect a hierarchical struc-
ture in which viewers look up to media sources, a prevail-
ing notion in traditional models of media influence. Televi-
sion is often viewed as an aspirational world, especially the
idealized images of advertising (Richins 1991) and televi-
sion series (Hirschman and Thompson 1997). The basic
research tenets of celebrities’ credibility as advertising
endorsers and agents of persuasion are that they ought to be
perceived as attractive, powerful, and trustworthy (Kertz

and Ohanian 1992; Ohanian 1990). These characteristics
assume an upward-looking, mediated relationship to
celebrities; viewers envy, admire, and want to emulate the
consumption constellations and lifestyles displayed in the
television series they watch (Festinger 1954; Hirschman
and Thompson 1997). These hierarchical relationships are
also central to McCracken’s (1989, 1998) meaning transfer
model, wherein celebrities and characters emanating from
popular culture and mediated texts serve as opinion leaders
and inspire the consumer and lifestyle habits of those who
revere them. However, it is important to note that media
audiences generally (and television viewers especially) may
relate to characters and celebrities in additional ways that
have been less commonly highlighted in the literature.
Lateral/Peer Relationships
Lateral/peer relationships reflect a horizontal relationship
structure, in which media consumers are on par with the
mediated characters with whom they interact. Because they
commonly simulate real life, television-based characters
often trigger parasocial relationships. Viewers think of
recurring characters that seemingly evolve on a similar
timescale as being real, even close friends and thus relate to
those characters on the same level (Russell, Norman, and
Heckler 2004). Social media platforms further foster a sem-
blance of interactive relationship and closeness, as audi-
ences can communicate directly (or seemingly so) with
mediated celebrities. Such lateral relationships are prone to
establish trust, a central tenet of credibility models, as well
as perceptions of similarity. Indeed, people often assume
that their television “friends” (interpersonal or mediated)
are like them, sharing similar beliefs and attitudes, even
when this is inaccurate (Huckfedlt and Sprague 1995; Jus-

sim and Osgood 1989).
Such perceptions of similarity with close others are the
underlying principles of homophily. Homophily broadly
refers to the degree to which two or more people who inter-
act are similar on certain attributes, such as beliefs, educa-
tion, social status, and the like. Colloquially stated, “birds
of a feather flock together” (McPherson, Smith-Lovin, and
Cook 2001). In their classic study on the subject, Lazarsfeld
and Merton (1954) distinguish between “status” and “value
homophily” as bases of similarity. Status homophily is
based on membership in status categories (or behaviors
associated with them), in which status may be ordered by
ascribed characteristics (e.g., race, ethnicity, sex, age) or
acquired characteristics (e.g., religion, education, occupa-
tion). Value homophily is based on adherence to values,
attitudes, and beliefs, which are internal states that presum-
ably shape orientation toward future behavior. Because
these internal states are rarely observed directly, they are
often inferred from behavior.
This distinction between status and value homophily
implies multiple broad bases on which viewers might per-
ceive similarity to mediated others. They might perceive a
physical resemblance or a more subjective, elaborated, even
imagined resemblance. Alternatively, they might use
observable behaviors, such as consumption, to infer simi -
larity of values, attitudes, and beliefs. For example, a recent
study of Facebook friendship ties among college students
indicates that ties were more likely to form as a function of
propinquity based on co-residence and similarities on non-
racial categories than on more traditional status homophily
markers such as race (Wimmer and Lewis 2010). In these
relationships, credibility is established through perceived
homophily (Eyal and Rubin 2003; McCroskey, Richmond,
and Daly 1975). Distinct from having close, mediated rela-

tionships with homophilous others, media audiences may
even fully identify and live vicariously through these per-
ceived relationships, in a type of merged relationship.
Merged Relationships
In merged relationships, self and mediated others overlap
entirely. Identification with a mediated character, a central
construct in media (Cohen 2001), can allow the projection
of oneself onto the other, which promotes vicarious experi-
ences. Identification with a television character is a major
contributor to self-identity development because the viewer
experiences the social reality presented therein from the
inside (Erikson 1968). Identification can promote narrative
transportation into a story and vicarious experience of its
events, as well as greater belief in the events and what they
represent (Green and Brock 2000). Identification with
media characters can also trigger adoption of displayed
Journal of Public Policy & Marketing 121
behaviors (Cohen 2001). A study of Elvis impersonators
(Fraser and Brown 2002) provides a compelling, if rather
extreme, illustration. Some fans have adopted Elvis’ per-
ceived attributes, values, and behaviors and have integrated
them into their own, even undergoing surgery to enhance
the physical resemblance.
The literature suggests that homophily undergirds rela-
tionships that viewers form with television characters,
actors, and celebrities that have a lateral/peer or merged
(but not upward-looking) structure. The premise of this
research is that these mediated others convey meanings
about cultural diversity through television narratives. View-
ers then appropriate meaning about cultural diversity
through their relationships (structured as upward-looking,
lateral/peer, or merged) with characters, actors, and celebri-

ties to aid in constructing their own identities. Given the
important role media plays in shaping meanings associated
with cultural diversity and producing images of it, we
investigate the processes by which television narratives
influence viewers’ understanding of cultural diversity.
Methodology
In the spirit of discovery-oriented research (Wells 1993),
we examine how consumers relate to television-based nar-
ratives and the characters therein. We began by theoreti-
cally sampling university students (aged 18–35 years) who
self-identified as television fans. We asked 137 of them to
create a digital brand collage centered on a character in a
television narrative of their choice and to complete an
online semistructured questionnaire about their collage. A
subset of these collage creators (N = 22) also agreed to par-
ticipate in a long interview about their collage. For details
on the informant set, see Table 1.
Collage Task
Instructions for the collage task were (1) to select a charac-
ter from a serial television program they watch and (2) to
create a digital collage of products and services that they
could envision the focal character using in a typical day.
Collages should contain at least five products/services but
could be of any length. Participants could take up to ten
days to prepare and submit their collages electronically (for
examples, see the Appendix). This task is in keeping with
the visual nature of most social communication and, thus,
most consumption expressions (Zaltman 1997). In the inter-
views, the collages served as a compelling projective tech-
nique to elicit product/service-, character-, and self-related
thoughts without explicitly asking for them (Belk, Ger, and
Askegaard 2003). Collages of this nature provide a creative,
unbounded, projective task that bypasses participants’
defense mechanisms, rationalization, and social desirability

biases. This interpretive tool, similar to Zaltman’s (1997)
metaphor elicitation technique, is useful to uncover deep
insights into a specific phenomenon (Belk, Ger, and
Askegaard 2003) or to unearth consumption’s implications
for self-identity (Chaplin and John 2005).
Semistructured Questionnaires
In an online questionnaire (link provided), participants
responded to an open-ended prompt to describe their
process for selecting a television character and creating
their collage. They similarly discussed five products/
services in their collages and explained how the character is
associated with each, how they personally relate to it, and
what the product/service means to them. This semistructured
online format provides an unobtrusive and confidential
forum for the participants to express themselves, and their
short narratives yield valuable insights across a range of
self-character relationships as well as a variety of character–
product and self–product connections.
Long Interviews
The goal of the long interview is methodological empathy
(Singleton, Straits, and Straits 1993). Therefore, we care-
fully crafted an interview protocol flexible enough to reveal
emic insights. A semistructured and open-ended interview
format addresses a baseline set of similar issues across
informants while maintaining sufficient flexibility to allow
unanticipated themes to surface (Spradley 1979). The inter-
views were scheduled shortly after participants submitted
collages and lasted between 38 and 81 minutes. In a manner

analogous to Heisley and Levy’s (1991) autodriving, par-
ticipants walked the researcher through their collages, dis-
cussing the meanings they attributed to the products/
services, the significance of their inclusion and placement
within the collage, and the meaning of the constellation of
consumption objects depicted in the collages. Participants
routinely volunteered details about their feelings toward
characters, what characters meant, and how characters
Table 1. Informants
Ethnicity/ Geographic
Name Sex Age Race Location Show Character Length
Frequency
Yasmina F 21 Persian Southern The OC Summer Roberts 1.5
years 1/week
California
Kai M 28 Latino Southern Curb Your Larry David All episodes
1+/week
California Enthusiasm (+DVD)
Tandy F 22 White Southern Sex and the City Carrie Bradshaw 6
years 1+/week
California
Todd M 22 White Southern The Simpsons Homer Simpson 14
years 1+/week
California
Natalie F 22 White Southern The Simpsons Homer Simpson
Sporadically Not
California regularly
Wendy F 21 White/ Philadelphia Friends Phoebe Buffay 10

years Every day
Jewish or more
Van M 22 Black Philadelphia Bernie Mac Bernie Mac 1 year
1/week
Fred M 22 Black Philadelphia Chappelle’s Show Dave
Chappelle 1 year 1/week
Nandy F 20 Latina Philadelphia King of Queens Carrie
Heffernan 6 years 1+/week
Reshay M 22 Black Philadelphia The Philadelphia Allen Iverson
All life 1/week
76ers in season
Nate M 21 White Philadelphia The Apprentice Donald Trump 2
years
Sam M 20 White/ Philadelphia ER Dr. Pratt 2–3 years 1/week
Jewish
Elliott M 21 White Philadelphia The Apprentice Donald Trump
2 years 1+/week
Vince M 22 Latino Philadelphia Til Death Do Carmen Electra
<1 year Twice total
Us Part
Nelly F 21 White/ Philadelphia Will and Grace Karen Walker 5
years 1+/week
Jewish
Laura F 20 White Philadelphia Family Guy Lois 1 year
2/months

Daeshona F 20 Black Philadelphia The Parkers Nikki Parker 4–
5 years 3–5/week
Tameca F 21 Black Philadelphia The Sopranos Carmella
Soprano 3 years 1+/week
Nashawna F 21 Black Philadelphia My Wife and Kids Jay Kyle
4 years 1+/week
Vashan M 23 Black Philadelphia The Fresh Prince Will Smith
All episodes
of Bel Air
Shakeera F 34 Black Philadelphia The Cosby Heathcliff 17
years 4–5/week
Show Huxtable
Nelson M 22 Black Philadelphia All of Us Robert James <1 year
1/week
related (or do not relate) to their identities. Thus, the inter-
views tap into the three distinct categories of narrative: a
collage narrative, a television narrative and its consumption
images, and each participant’s personal narrative, along
with the relationships among the narrative categories.
Analysis
Data analysis was guided by grounded theory as advocated in
Glaser and Strauss (1967) and elaborated by Strauss and
Corbin (1998); interviews were coded and themes were dis-
tilled using the constant comparative method of analysis
(Spiggle 1994). The initial interviews were analyzed sepa-
rately and then reinterpreted comparatively. Subsequent inter-
views were analyzed in light of previous interviews and per-

formed in an iterative style, or hermeneutic circle of
understanding (Schwandt 1997). Because the interviews were
guided by participant-created collages, participants could pro-
duce their own interpretations of their collages and influence
researcher interpretations. This method brings the researcher a
step closer to perceiving the signs consumers offer in the man-
ner in which the consumers themselves do (Grayson 1998).
Findings
Our data reveal that consumers identify and engage with
television narratives through a process of “homophiliza-
tion”; that is, they actively envision various features of tele-
vision narratives (e.g., settings, characters, actors) as simi-
lar to themselves or to their lived experience. The data also
show that viewers enact homophilizing processes by first
evaluating available narratives and then customizing them.
In customizing narratives, often referred to as “textual
poaching” (Jenkins 1992), viewers insert themselves and
their experiences into the narrative. Consumption choices
serve as primary mechanisms for poaching. We elaborate
on homophilization and discuss its implications for cultural
diversity from a social justice and welfare perspective.
Viewers Evaluate Available Narratives
A prominent pattern across informants is how readily and
directly they describe and comment on the array of narra-
tives available in the mediascape. This unprompted but
explicit discussion of available narratives is a robust find-
ing, reflective of the television audience as “active produc-
ers of perceived meaning” (Hirschman and Thompson
1997, p. 45). Shakeera describes what she views as a void
in the mediascape and explains her choice of a classic tele-
vision program, The Cosby Show, starring Bill Cosby as Dr.
Cliff Huxtable:
I love the premise: a strong black upper middle class family

talking about morals and ethics and music. I really like that
blend. Bill Cosby as a man is quite impressive. The show is a
legacy for the people to follow. We’re not all thugs and hos
[sic]. We’re real people with real, normal problems. I’d say
we’re more like Bill Cosby’s family than the felons we usually
see on TV. It is an important show; one that really broke color
barriers and one that made black people look good—like people
anyone might meet or know. We’re not just hired help. We’re
doctors and lawyers and accountants.
Shakeera uses what she considers prominent depictions of
black criminality (“thugs,” “hos,” and “felons”)—a percep-
tion that no doubt includes both news and entertainment
programming—as a rhetorical foil to highlight what makes
The Cosby Show an exceptional narrative. She articulates a
story that actively foregrounds the importance of compara-
tively rare depictions of middle-class black families in
high-status occupations on television. The Cosby Show’s
matter-of-fact depiction of black middle-class family life
actively counterbalances prevailing stereotypes in a way
that had not been previously done (Downing 1988).
Notably, because The Cosby Show is by definition excep-
tional, it need not mirror Shakeera’s life to be compelling
and useful for shaping her understanding of diversity.
Am I like [Bill Cosby]? Well, no. I’m a woman; a black
woman; a 34-year-old black woman.... I’ll never be a doctor
like he was on the show, or a lawyer like Clair, his wife on the
show. I’ll just never be. My family was not middle-class. We
lived paycheck to paycheck. We still do. It is what the show
means to black people that makes it cool. It is the possibility
that we can be doctors and lawyers; that some of us have made
it and that we can too. When you see thugs and hos you think

that’s all there is, but the show was something else to do, some-
thing else to be. It kept me in school.
Shakeera notes her gender difference from Bill Cosby and
the wide social class gap between her family and the fic-
tional Huxtables. Nevertheless, she values The Cosby Show
as an exceptional narrative about diversity because it articu-
lates the possible. She credits the show’s morality-laden
emphasis on education with inspiring her to remain in col-
lege, even if only part-time.
Informants made regular note of their perceptions about
the availability of television narratives that address multiple
dimensions of social identity, particularly gender, social
class, and our focus, ethno-racial identity. Their accounts
are structured similarly to Shakeera’s: a perpetually limited
or narrow range of available narratives in the mediascape
limits their identity projects, but a subset of exceptional nar-
ratives counterbalance the common by articulating or
inspiring prosocial possibilities. Regardless of their empiri-
cal accuracy, evaluations of available narratives function to
mark some as exceptional so that viewers can incorporate
them into identity projects. Next, we turn to the way con-
sumers incorporate exceptional television narratives about
diversity into their identity projects.
Homophily and the Narrative–Self Connection
The most common way informants mark narratives as
exceptional is to seek out aspects that are similar to their
lives, a process researchers refer to as “homophily”
(Lazarsfeld and Merton 1954). We ask informants directly
about their connection to television narratives to highlight
how they actively create similarity rather than simply notice
it. Informants appropriate diversity through television view-
ing by flocking together with like celebrities in an imagined
social network based on the time they spend within the nar-

rative. We note that homophily often occurs in relationships
that are lateral/peer or merged and far less in upward-
looking relationships. Drawing on McPherson, Smith-
Lovin, and Cook (2001), we differentiate between status
and value homophily and their roles in identity projects and
understandings of cultural diversity.
Status Homophily
In status homophily, similarity is based on ascribed or
achieved social status. Status homophily is composed of
two main types: (1) perceived and acknowledged pheno-
type (phenotype status homophily) and (2) perceived and
acknowledged behavioral attributes (behavioral status
homophily). Phenotype status homophily inherently
involves subjectively noting resemblance to actors’ ascribed
traits and is fairly pervasive. For example, Yasmina, a
second-generation Persian immigrant, marked similarities
between her own physical attributes and Summer, a charac-
ter on the Fox drama, The OC. Phenotypically dissimilar to
Summer in most respects, Yasmina latched on to hair color
(not texture) and height to base resemblance claims.
Behavioral status homophily is more complex because it
prevails on viewers’ ability to navigate the intertextuality
that commonly accompanies actors in television narratives.
In this excerpt, Van established behavioral status homo -
phily with the late Bernie Mac from the Fox sitcom The
Bernie Mac Show:
Van: [Laughs.] OK. Everybody in the community knew [about
the show’s premiere], and was excited about the show.… We
all knew it was coming.
Interviewer: What do you mean “in the community”? People on

campus? In your neighborhood?
Van: Oh, I mean black people. The black community. We knew
he was coming on the TV and we talked about it. It was in Vibe
[magazine]. [Bernie Mac] is a well-known comedian in the
community. We were hoping the show [would] be like an
updated Cosby Show; some good examples of black folks not in
jail or pimping. Something real.
In this instance, “something real” refers to the character’s
and the show’s decidedly middle-class aesthetic and sensi-
bility. In some crucial respects Bernie Mac, a renowned
stand-up comedian who plays himself as a full-time parent
on the show, updates Bill Cosby as the embodiment of black
middle-class comportment. He is a self-employed profes-
sional with a professional spouse, a family man who lives
comfortably though not lavishly. Mac’s character comports
with what Van presumes to be the black community’s ideal.
“We,” which is to say the black community, hoped for an
updated Cosby Show to counter that which is not real; inac-
curate stereotypes of black masculinity thought to be abun-
dant in television as noted by Van and by other informants.
Van’s comments also echo those in contemporary consumer
culture theory research (see Thomas 2013 [in this issue]), in
which African American male informants note that their
consumption practices are constrained by long-standing
stereotypes. When asked about his specific connection to
Bernie Mac, however, Van articulates a less direct connec-
tion than did Shakeera to Bill Cosby:
Interviewer: Why exactly did you choose Bernie Mac?
Van: He’s not trying to be white; not selling out to go main-
stream. He’s a black man.
Interviewer: So, you think there are a lot of people selling out?

Van: Most black people on TV or in the movies are definitely
selling out. They are black people; B-I-S-O.
Interviewer: What does B-I-S-O mean?
Van: Black-in-Skin-Only. They aren’t black any more cultur-
ally. I guess you could say they pass.
Interviewer: And you think a lot of black people pass?
Van: Oh yeah. Oh yeah.
Interviewer: OK, so what makes Bernie Mac… real?
Van: He’s black. He talks black. He looks very black. He never
pretends he’s white or that he’s same as white.
Interviewer: OK. So it is the way he talks—?
Van: And the way he looks. He dresses black. He has bold col-
ored clothes and he’s—ah—trendy. He knows what’s stylin’
now and he wears it.
Interviewer: And you like that about him?… Cool. I noticed
you don’t have clothing items in your collage.
Van: Well, he’s not really that stylin’, but I mean you wouldn’t
see a white dad on TV dress like that.… He’s like me in a lot of
ways. Fame and money didn’t get to him yet.
Unlike Shakeera, for whom The Cosby Show counterbal-
ances prevailing stereotypes and articulates the possible, we
note that Van’s connection to the Bernie Mac character and

actor is woven together from essentialized notions of cul-
tural and masculine identity. “Essentializing” involves
drawing boundaries (typically narrow and fixed boundaries)
around a category of representation, such as race or gender,
and making hard distinctions between the authentic and
inauthentic, in-groups and out-groups (Hall 1997). For Van,
ways of being or acting (behaving) black (which include
speech, general appearance, and dress) are clearly distinct
from ways of being white, and they mark membership in
black (masculine) culture. Van accuses some of “passing,”
spurning membership in a presumably low-status group to
pursue mainstream success. Bernie Mac’s fealty to pre -
sumably black cultural conventions, despite his popularity
with white audiences, marks him as simultaneously an aspi-
rant figure and a peer for Van. That is, Van rejects a sim-
plistic phenotype homophily, built on uncritical ethno-
racial solidarity, in favor of behavioral homophily built on
adherence to cultural convention. He places Bernie Mac—
both the character and the actor—in a particular milieu
comprised of particular cultural and gendered practices, to
which he also adheres. To clarify, Van does not mimic
Bernie Mac’s behavior. Mimicry is a hallmark of upward-
looking relationships. Van sees Mac as a peer, even being
mildly critical of his dress while noting its distinction from
white television dads. Van creates behavioral status
homophily by perceiving that he and Mac opt into the same
milieu based on adherence to a set of distinguishing prac-
tices. Their practices are not identical. As such, this excerpt
challenges the conventional wisdom that viewers only (or
mostly) mimic celebrities such as Bernie Mac to establish
behavioral status homophily (cf. Schor 1998).
Value Homophily
In value homophily, similarity is based on attitudinal and
belief systems that are revealed only upon reflection
(McPherson, Smith-Lovin, and Cook 2001). Having estab-

lished certain points of status homophily, informants con-
sider their connection to characters, actors, and narratives
through values and beliefs. Van connects personally to
Bernie Mac’s ability to keep money and fame from “getting
to him.” Similarly, Tandy connects initially to the charac-
ters in Sex and the City but expands to other features of the
narrative:
I’m in love with fashion, and that is what I want to do. I want to
go to an art school for fashion design and stuff, so seeing the
clothes and costume designs in Sex and the City is like the most
unbelievable thing to me. I really enjoy looking at all the
fashion.
Tandy articulates a connection to the fashions, a narrative
feature for which the show gained notoriety. Value homo -
phily often results from elaboration on the similarities
between self and narrative that begin with status homophily
but then extend to values, attitudes, and beliefs. In this
instance, Nashawna relates to the character Janet (Jay), the
matriarch in the situation comedy My Wife and Kids:
[T]hey don’t act like they’re perfect. In fact, the oldest son and
his girlfriend are having a baby this season. So Michael and Jay
are going to be grandparents! Very young ones. They didn’t
plan on that, and that is what I mean. They aren’t perfect peo-
ple, but they’re good people trying to make good choices.
Nashawna revealed that she was born to an unwed teenage
mother and that, like Jay, she became a grandparent in her
thirties. Nashawna’s experiences parallel the show’s narra-
tive plot, but importantly, she connects to the characters’
efforts to do what she considers the right thing. Using the

program as a guide, she navigates complicated family
relationships.
Because value homophily is often based on unarticulated
attitudes and beliefs, it is often established superficially
through inferences about consumption that require an elab-
orate filling in of prodigious knowledge gaps. In this
excerpt, Nandy elaborates on Pantene shampoo in her col-
lage of Carrie Heffernan, the female lead on the sitcom
King of Queens:
I thought Pantene because it’s one of the best you can buy at the
grocery, though maybe she’d buy it at the salon, like Sebastian.
I don’t know. I just think she’s a Pantene girl. She wants great
hair, but she’ll save brand names for when it matters—when
other people can see. No one knows what hair products you use,
but your clothes—they need to be good brands, especially your
shoes.
Consistent with prior research, a great deal of value
homophily is inferred after status homophily is established
(McPherson, Smith-Lovin, and Cook 2001). Nandy
assumes her tastes constitute dimensions of similarity with
the character. She thinks that Carrie is like her and will
make similar trade-offs.
Homophilization Processes
Our data demonstrate that informants contrive similarity to
television narratives through a process we term “homo -
philization.” Informants actively weave similarity together
from traits associated with actors, characters, and various
features of narratives. Building on Schau and Gilly’s (2003)
findings that brands are vehicles of self-definition and com-
munication, our study shows that informants use them to
establish connections to television narratives. We highlight

three specific practices by which informants contrive simi-
larity to available television narratives: aspiration and imi-
tation, legitimation, and opposition.
Aspiration and Imitation
Aspiration and imitation are the most consistent with com-
mon conceptions of homophily and views of mediated rela-
tionships as upward-looking. We characterize aspiration
and imitation as practices that may exist (even prevail) in
any mediated relationship. However, lateral/peer and
merged relationships more often provide a basis for homo -
philization. Informants desire a consumption object, prac-
tice, or lifestyle highlighted in a television narrative, as
Tandy explicitly states: “[Sarah Jessica Parker, the female
lead in Sex and the City] is who I want to be when I finish
school and move to New York City.” Informants project
themselves into television narratives and actively imitate
some aspects (e.g., lifestyle, skills, phenotype, personality).
Because the narratives and their intertextual connections are
so rich in consumption images, consumption references
abound and we find that brands are the most readily appro-
priable features of the mediated world. Many informants
are highly receptive to product placements and official
celebrity endorsements, at times embracing them uncondi-
tionally. In this way, at times, our informants embody the
materialism-fueled over-consumers highlighted by numer-
ous critics of media (Postman 1985; Schor 1998; Shrum,
Burroughs, and Rindfleisch 2005).
Legitimation
Informants also adopt media narratives that provide post
hoc justifications for behavior. This is especially prevalent
in establishing value homophily. For example, one inter-
view respondent states, “Sure the fashion on Sex and the

City is over the top, but that’s OK. It sure makes my fashion
addiction at [trendy clothing retailer] Forever 21 more
acceptable.” She favorably compares her “fashion addic-
tion” to a discount retailer to the characters’ fundamentally
similar attitude toward shopping. Her similar attitude is
nevertheless morally superior because she is not acquiring
expensive luxury brands at high-end retailers. Informants
find congruence between media narratives that substantiate
(even excuse) their lived experience. Even cartoon charac-
ters like Homer Simpson serve as benchmarks for justifying
consumption practices such as Todd’s “Homering on the
couch,” which involves drinking beer and eating pizza or
donuts while watching television and which many timidly
admit is a guilty pleasure. The related assumption that
everyone who watches the Simpsons does this legitimates
the behavior. This legitimation process has troublesome
implications for public health, given the abundance of illicit
substances, portrayals of underage drinking, and generally
unhealthy lifestyles depicted on television (Avery et al.
1997; Russell, Russell and Grube 2013; Story and Faulkner
1990).
Opposition
Perhaps less obvious is that informants sometimes disap-
prove of consumption objects and practices that characters
perform or endorse. Informants distance themselves from
particular media narratives, in some instances outright
defining their identity against them. This process is espe-
cially prevalent for informants contriving status homophily.
Sometimes opposition involves active resistance, in
which the informants reject something they do not like.
“Ke$ha is a total ho [sic] but that is why I watch her. She’s

not me. She’s nothing like me.” Note that rejection involves
only a refusal to establish status or value homophily. It does
not preclude watching or utilizing the narrative. As Calvin
notes, “[Characters] say s— you could never say in pub-
lic.… It’s like they say it for me so I don’t have to. I can
relive their rude behavior while being civilized.” For some
informants, rejected narratives remain useful objects of
catharsis or displacement. Informants can relish a character
or narrative they do not intend to mimic.
Opposition also includes more traditional notions of
rejection. One young adult informant, Natalie, expressed
strong negative views about media narratives that had
“severely” affected her identity during adolescence and
from which she had recently escaped:
The only time I ever watched TV was in my youth and I can see
how severely it affected my life because I kind of took those
images…. Growing up in Orange County, you have that infil-
tration from LA. It affected my youth a lot and I have a lot of
animosity towards some of the shows that were projected
towards me. Like [Beverly Hills] 90210. Girls look at that and
think that is really how it is supposed to be. Then they see those
images and mimic them, which I don’t think is portraying the
right age group to the right people.
Natalie eventually concluded that watching television made
her “very insecure” and opted to turn it off. A conscious
distancing and separation from television is readily visible
in her collage: it includes only fictional brands within the
Simpsons’ world, because she considers it all fiction.
Building Diversity Narratives Through
Appropriation
Informants relate to television narratives through an active
process of homophilization. They appropriate what they see

and build their own narratives, or stories, about diversity.
Stories are the primary mechanism by which people share
and attach meaning to experiences and objects (Labov
1972). They become part of communal mythology
(Durkheim [1912] 1965). They situate the person’s identity
within the broader context of community identity (Creed
and Scully 2000) and allow people to grapple with identity
issues. Open text stories leave room for fans to write them-
selves into them and locate resonant themes (Derecho
2006). These informants craft stories about available televi-
sion narratives, mark some as exceptional, and establish
upward-looking, lateral/peer, or merged relationships to
actors and characters. They then appropriate key pieces of
exceptional narratives through aspiration and imitation,
legitimation, and opposition. They contrive homophily by
revising exceptional narratives, interweaving their identities
throughout.
Informants intertwine television narrative and characters
with their own stories through what Jenkins (1992) calls
“textual poaching.” It is a form of customization in which
media consumers use elements of the primary text and their
imagination to augment, modify, and reconstitute the text to
fit their specific needs. Media consumers fill in knowledge
gaps, fix problems, and extend the text’s meaning. Some
narratives, such as The Simpsons, a prevalent source of col-
lages in this data set, constitute easy texts for poaching
given their slate of oddly colored characters and fictional
brands. However, homophilization practices allow viewers
to contrive similarity, even when none is apparent. There-
fore, any television narrative can be poached.
Discussion

Our findings are consistent with the widely held notion that
television plays a critical role in the transmission of culture.
Beyond this insight, we offer a more complete account of
media consumers’ relationship to culture as instantiated in
television than has been typical in consumer research.
Because consumption markers (e.g., product placements,
imagined consumption constellations) are especially useful
to media consumers for ascertaining homophily, this
research has implications for standard programming and for
advertising practices embedded in television shows (Cain
2011). As such, this research contributes to discourse about
the media and social justice/welfare that can inform public
policy beyond regulation and censorship.
Our investigation highlights the myriad ways television
narratives, homophily, and textual poaching operate to
transmit culture and influence enculturation processes. If
we consider McCracken’s (1998) insights about the move-
ment of cultural meaning, metaphorically speaking, this
research expounds on the “arrows” that connect cultural
producers to individual consumers in the model. The find-
ings generate nuanced (and we believe more useful)
insights into such phenomena and their implications.
Viewers have limited ability to directly influence the pro-
duction of television narratives. In general, they can bestow
(or withhold) legitimacy and/or loyalty on programming
that is already network approved, filmed, and aired. Net-
work executives and advertisers retain primary (if no longer
exclusive) control over television narratives, including nar-
ratives about diversity. They wield effective veto power
throughout the process of ideation, filming, and airing.
Thus, television transmits culture through a fundamentally
hegemonic relationship between network executives and
advertisers, writers and producers, and viewers. An under-
girding logic and language of business imperative natural-

izes the relationship.
Despite their comparatively limited power, viewer
agency remains evident in our data. They mark available
television narratives—or parts of them—as exceptional and
appropriate aspects of them through textual poaching to
construct their own meaningful narratives about cultural
diversity. Despite their agency, viewers are shackled to the
hegemonic logic and language of business imperative that
networks prefer. According to this logic, viewers are con-
sumers whose choices are limited to the products (narra-
tives) networks make available. It affords viewers little
practical input into the production of television narratives
about diversity (or any topic).1
1We readily acknowledge that networks are increasingly
responsive to
viewers, even to the point of cocreation efforts, and that
viewers are
increasingly creating their own content.
At times however, issue-oriented advocates have adopted
a competing logic of social justice and welfare to exert direct
influence on the production of narratives, particularly those
related to cultural diversity. As we noted previously, the
Kerner Commission legitimized this competing logic. Since
then, advocacy organizations such as the National Associa-
tion for the Advancement of Colored People and Fairness
and Accuracy in Reporting have incentivized and pressured
producers to increase cultural diversity narratives in both
entertainment and news media. The logic and language of
social justice and welfare render the production of television
narratives about cultural diversity a matter of public rather
than exclusively private interest. Television’s widely

acknowledged role in transmitting cultural meaning drives
such logic. Even so, narratives have typically remained part
of an ongoing conversation between advocates, industry, and
viewers rather than a matter for formal legislation or censor-
ship (Levin 1980; O’Malley 2004)—with the notable excep-
tion of child-focused programming and indecency/obscenity.
As such, the policy implications of this research are primarily
for advocates, industry, and the public rather than regulators.
In the broadest sense, this research suggests that public
discourse on television and culture should move beyond its
simplistic “aspire and imitate” assumptions about viewers.
Instead, public discourse is sorely in need of updating to
reflect a nuanced understanding of how viewers actually
build narratives about cultural diversity out of available nar-
ratives. Clearly, viewers at times aspire to what they see on
television and imitate it, but they do not swallow network-
generated narratives whole. Rather, they mark some as
exceptional and find ways to make features of exceptional
narratives similar to themselves (while holding obvious dis-
similarities at arm’s length, at times self-consciously so).
We direct our remaining discussion specifically to media
advocacy, which includes research-focused organizations
(e.g., Pew Center for Excellence in Journalism) as well as
traditional advocacy ones (e.g., Berkeley Media Studies
Group). Our findings suggest that organizations aiming to
engage networks about cultural diversity narratives must
first recognize the fundamental hegemony characterizing
the relationship. Advocates seeking change must craft mes-
sages for the array of network executives and advertisers
who hold veto power at multiple points in the narrative pro-
duction process. For example, despite an array of successful
examples, some network executives and advertisers still
consider narratives that foreground cultural diversity to be
too risky for general audiences. Not surprisingly, such nar-

ratives have historically faced significant barriers in the
approval process, as The Cosby Show’s initial rejection at
ABC illustrates (Downing 1988). Even when approved, net-
works can remain hesitant to incorporate diversity into cast-
ing, relying instead on episodic minority characters to sup-
ply diversity. For example, a three-year study of the Los
Angeles viewing market, which is nearly half Latino/
Latina, reports a high percentage of episodic characters in
local network television, which includes many syndicated
shows (Chicano Studies Research Center 2004).
Sophisticated advocates seeking to influence the narrative
production process must craft messages that address the
interests of network executives and advertisers, who wield
considerable power. We suggest that, in addition to docu-
menting the paucity of diversity narratives on television,
media advocates also devote greater energy and resources to
understanding how viewers create diversity narratives. We
demonstrate that cultural diversity is important enough to
some viewers that they use self-relevant narrative elements
from all manners of programming, and make them similar,
to appropriate it. Understanding viewers in this way pro-
vides a basis for crafting compelling messages to network
executives and advertisers about their engagement with
diversity, which is a perpetual network challenge. Our infor-
mants revealed connections to characters, storylines, actors,
and consumption portrayals that go well beyond “aspire and
imitate.” They searched extensively for exceptional narra-
tives and sought to engage them in deep, enduring, and
complex ways. Advocates might also include insights on
viewer engagement with existing diversity narratives to
devise more compelling messages that build in space for
episodic characters to recur or even spin off.

To be clear, we are in no way suggesting that advocacy
organizations substitute the logic and language of business
imperative for that of social justice and welfare—quite the
opposite. Such a substitution would be self-defeating for
advocates whose own public legitimacy is tied to the latter.
Rather, we suggest that media advocacy sits at the intersec-
tion of the two. As such, it is uniquely well positioned to
interject the logic of social justice and welfare into the nar-
rative production process by crafting messages that can
speak to the needs of networks and advertisers as well as to
the interests of viewers.
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F e a t u r e
Cultural safety, diversity and the
servicer user and carer movement in
mental health research
Leonie G. Coxa and Alan Simpsonb
aQueensland University of Technology, Brisbane, Qld,
Australia, bCity University London, London, UK
Accepted for publication 31 January 2015
DOI: 10.1111/nin.12096
COX LG and SIMPSON A. Nursing Inquiry 2015; 22: 306–316

Cultural safety, diversity and the servicer user and carer
movement in mental health research
This study will be of interest to anyone concerned with a
critical appraisal of mental health service users’ and carers’
participa-
tion in research collaboration and with the potential of the
postcolonial paradigm of cultural safety to contribute to the
service
user research (SUR) movement. The history and nature of the
mental health field and its relationship to colonial processes
pro-
vokes a consideration of whether cultural safety could focus
attention on diversity, power imbalance, cultural dominance and
structural inequality, identified as barriers and tensions in SUR.
We consider these issues in the context of state-driven
approaches towards SUR in planning and evaluation and the
concurrent rise of the SUR movement in the UK and Australia,
societies with an intimate involvement in processes of
colonisation. We consider the principles and motivations
underlying cul-
tural safety and SUR in the context of the policy agenda
informing SUR. We conclude that while both cultural safety and
SUR
are underpinned by social constructionism constituting
similarities in principles and intent, cultural safety has
additional dimen-

sions. Hence, we call on researchers to use the explicitly
political and self-reflective process of cultural safety to think
about and
address issues of diversity, power and social justice in research
collaboration.
Key words: carers, cultural safety, diversity, mental health,
power, research, service users/consumers.
The study offers a critical appraisal of the participation of
mental health service users in research collaboration and the
potential of cultural safety to concentrate researchers’ atten-
tion on power imbalance,1 cultural dominance and struc-
tural inequality2 informing research practices and mental
health service users’ experience. According to Kara, the liter-
ature on mental health service user3 research involvement
‘suggests that power imbalances and identity issues are at the
root of most difficulties and gaps’ (Kara 2013, 122). Kara
suggests that these matters relate to the diversity4 of players
in mental health research, which, along with service user
involvement, is central to policy in both the UK and Australia
(Australian Health Ministers 2010; HM Government 2011a,

b). Diversity concerns are evident in the work of the UK’s
Mental Health Research Network (NHS National Institute
Correspondence: Dr Leonie G. Cox, PhD, BA (Hons); RN
Senior Lecturer; School
of Nursing, Queensland University of Technology, L3 N Block,
Kelvin Grove Cam-
pus, Victoria Park Road, Kelvin Grove, Brisbane, Qld 4059,
Australia.
E-mail: <[email protected]>
1 Power is a contested concept in deep, ongoing philosophical
debates. We are
indebted to Berger and Luckmann’s (1966) social
constructionism that overcame
the agency (Weber) and structure (Marx) debate in arriving at a
concept of
power that recognised it as an aspect of social relationships
occurring in the
dialectic between individuals and structures.
2 By structural inequality, we mean systematic unequal rewards,
access to
resources and their control and opportunities in education,
health and so on that
are a consequence of social processes and relationships

experienced by groups
such as mental health service users.
3 We use the term service user to refer to mental health service
consumers and
carers. Various other terms are used in the UK and Australia,
for example people
with lived experience, consumer, carer and survivor. We use the
term service user
research (SUR) to denote the movement advocating their
involvement in
research.
4 Our use of the term diversity refers to social experience
related to ethnicity,
gender, gender identity, sexual orientation, physical and
intellectual dis/ability, age
and socioeconomic status.
Nursing Inquiry 2015; 22(4): 306–316
© 2015 John Wiley & Sons Ltd
for Health Research 2013) and of a proposed Australian
National Mental Health Consumer Organisation (Craze

2010; also see http://mhconsumer.org.au/).
These similarities between the UK and Australia reflect
their close sociopolitical relationship and shared history in
colonial projects and so they were chosen as the context for
our discussion. Today both societies grapple with control of
bodies, minds and discourse in increasingly complex socie-
ties created through globalisation and colonial diasporas. As
Bell et al. note: ‘As Europeans expanded their borders, the
cultures, peoples and diseases they embraced began diffus-
ing through permeable membranes back towards their impe-
rial cell bodies’ (Bell, Brown and Faire 2006, 589).
The resultant health inequity, poverty, stigma and racism
(WHO 2010) are of concern in Australia and the UK. Unsur-
prisingly, these processes impacts on mental health and
problems are compounded as service users experience dis-
crimination and victimisation, poorer health outcomes and
barriers to work, education, the practice of their civil rights
and wealth creation (WHO 2014). These structural inequali-

ties reflect and entrench the unequal power relations experi-
enced and constitute the cycle of disadvantage that the
mental health SUR movement sought to overcome.
We reasoned that cultural safety, a philosophy and
approach to clinical nursing, nurse education and research
that focuses on these concerns should be central to this con-
versation. Further as a specifically ‘postcolonial paradigm of
inquiry’5 (Racine 2009, 183) it is directly relevant to the men-
tal health and social problems arising from colonial activity,
related to what Joseph aptly calls the ‘. . . colonial ancestry of
psychiatric violence’ (2014, 275). Therefore, we suggest that
cultural safety with its focus on social justice and its challenge
to mainstream cultural dominance in research practice and
ways of knowing should be integral to mental health service
provision, evaluation and research and conclude that it is a
useful model to support SUR.
To ground the discussion, we start with an introduction
to cultural safety and its definition of culture that inverts

diversity concerns by challenging where the locus of diversity
problems should be. We then move on to an overview of
SUR in its historical context, as state-driven policy
approaches to service user inclusion in the UK and Australia,
developed concurrently with it. We consider debates about
the value and outcomes of such research processes in terms
of power sharing and control of research practices in both
contexts.
We then turn to a discussion of calls for cultural change
in SUR and the potential of cultural safety to bring it about.
We consider the role of cultural safety to confront power
imbalances as the SUR movement struggles to achieve its
aspirations within predominantly state-funded mental health
research. Importantly, the context of this struggle is policy
focussed on individualism and the reduction of human ser-
vices to market forces, a form of cultural dominance
obscured by government policy and rhetoric of inclusion
and participation.

CULTURAL SAFETY: INTRODUCTION TO THE
CONCEPT
Cultural safety was developed with the Maori community by
Maori nurse scholar Irahapeti Ramsden in the 1990s, in the
neocolonial context of New Zealand (1991; 2002). It aimed
for cultural change by exposing and addressing power imbal-
ances to decrease the impact of cultural dominance and rac-
ism in health care, education and research (McCleland
2011). Ramsden was motivated by nursing curricula devoid
of structural issues and designed by and for those who did
not share her cultural position or experience of colonisation.
She wanted to challenge this form of cultural dominance
and the way it shaped policy and developed nurses as mere
biomedical technicians rather than agents of social change
(Ramsden 2002).
Ramsden saw cultural safety as a way for nurses to con-
sider how their socialisation and cultural position impacted
on their work. She emphasised the links between ill-health

and dispossession, economic status and political agendas, as
against individualist biomedical notions that illnesses merely
occur within bodies. Further, she argued that transcultural
approaches focussed on the ‘cultural’ activities of patients,
based on the idea that culture simply means ethnicity and
that culture is, therefore, unchanging. As a consequence,
transculturalism promotes stereotypical views of culture and
limits nurses’ responses to diverse social experiences and
positions (Ramsden 2002, 112).
In contrast, cultural safety is underpinned by social con-
structionism so proponents accept that people create society
and in turn society influences human activities too. In cul-
tural safety, culture is conceptualised as changeable, learned,
strategic and sociopolitical and ‘. . .is used in its broadest
sense to apply to any person or group of people who may dif-
fer from the nurse/midwife because of socioeconomic sta-
tus, age, gender, sexual orientation, ethnic origin, migrant/
refugee status, religious belief or disability’ (Ramsden 2002,

114). In cultural safety, these differences are accepted and
respected as legitimate not as deficits to dominant norms.
5 Note that Ramsden used the term neo-colonial in preference to
postcolonial as
she saw these power relations as continuous, so postcolonialism
had not been
achieved (2002, 1).
Cultural safety in mental health research
© 2015 John Wiley & Sons Ltd 307
http://mhconsumer.org.au/
Although these issues and aspects of cultural identity are
the dimensions of diversity that policy in the UK and Austra-
lia seeks to address in the mental health field (cf. Australian
Health Ministers 2010; HM Government 2011a) cultural
safety challenges the dominant conceptualisation of diver-
sity’s significance in two respects. First, under cultural safety’s
definition of culture, diversity does not belong to people of
colour or those who differ in some way or other from main-
stream culture. Dyck and Kearns (1995) discuss one of its

key concepts, bi-culturalism, which, although subject to some
criticism (Reimer-Kirkham et al. 2002; Harrowing et al.
2010) signals that everyone has culture.
This point is important as discussions about health
inequality are often dominated by a ‘white’ cultural position
where culture and ethnicity are seen as only belonging to so-
called culturally and linguistically diverse (CALD)6 ‘others’
(Tolich 2002; Cox and Taua 2013), positioning the source of
social inequity firmly outside white mainstream domains.
Cultural safety, however, requires that health-care profession-
als and researchers accept that they are bearers of culture;
that they are socially powerful, privileged and positioned;
that their status is related to historical and political pro-
cesses; and that it is their own values, beliefs and assumptions
that require examination to shift power relations and struc-
tural inequalities.
Secondly then, the significance of culture and diversity is
not differences in ethnicity, in art, ritual or ceremony, but in

how people are treated differently in everyday life as they
deal with social institutions such as health/welfare, busi-
nesses, media and educational institutions. In this respect,
cultural safety resembles mental health service users’ per-
spectives that health professionals should ask them ‘what
happened to you’ not ‘what is wrong with you’ (British Psy-
chological Society 2013).
Being grounded in critical social theory, cultural safety
recognises that health service delivery, education and
research are not value neutral activities but reflect the values,
assumptions and priorities of those involved and historical
and sociopolitical contexts (Ramsden 2002; Reimer-Kirkham
et al. 2002, 2009; Anderson et al. 2003; Browne et al. 2009;
Racine 2009). Unless practitioners undertake processes of
self-reflection, as required in cultural safety, unexamined
relations of power can be perpetuated. Cultural safety pro-
vokes us to ask who holds the power to define what counts as
knowledge, as health, as recovery or as evidence; challenging

us to bring to mind cultural assumptions that ‘culture’ and
‘race’ determine outcomes and blaming people for their
social situation (Browne et al. 2009; Racine 2009; McCleland
2011; McGibbon et al. 2013).
Just as proponents of cultural safety say that it is sys-
tems that need to change rather than users of such sys-
tems, so Frankham (2009), writing about service user
involvement in research, proposes that mainstream society
is the appropriate locus for efforts at change. This posi-
tion, which underpins the emergence of SUR to which we
now turn, is in stark contrast to the neoliberal view that it
is individuals who must engage in ever expanding pro-
cesses of self-improvement.
THE EMERGENCE OF MENTAL HEALTH SUR
The 1990s saw a profound mental health reform agenda in
Australia expressed in the First National Mental Health Pol-
icy in 1992. Its evaluation and the development of National
Standards for Mental Health Services in 1997 emphasised

the requirement for service user involvement at all levels of
mental health services (Goodwin and Happell 2006). Con-
currently in the UK, there was a drive to include service users
in the commissioning, design, delivery and evaluation of
health and social care services (Department of Health 1999a,
b, 2000, 2005). Thus as Barber et al. (2011) establish, mental
health service user involvement, specifically in research,
became expected in both contexts.
Beresford (2002) explains that these initiatives were
partly in response to the growing demands of a mental
health SUR movement to lead and control research that was
about them and the issues that impacted on their lives, a pro-
cess he calls the democratic approach to SUR. However, he
reminds us that the New Right and the service users’ move-
ment did not see participation and user involvement in the
same way and, as Frankham argues, the impetus for the SUR
movement was the desire to explore the disabling assump-
tions arising from individualism and the institutionalised dis-

abling practices of society (Frankham 2009, 2).
In a similar vein to cultural safety’s focus on how people
are treated in society, Frankham’s point is that it is not diver-
sity (e.g. gender, ethnicity, disability or age) per se which
dominates people’s experience but how society impacts and
respond to them. She discusses the social creation of deficit
discourses that circumscribe people’s identity and social
experience more than the disability itself. Thus, the SUR
movement sought to create knowledge that could explain
the economic, political, cultural and environmental struc-
tural drivers of these experiences and deprivations (Frank-
ham 2009).
6 In the UK, the acronym BME (Black and Minority Ethnic) or
BAME (Black,
Asian, Minority Ethnic) is used. Australia employs CALD and
other terms such as
non-English speaking background (NESB) or English as a
Second Language
(ESL).

L G Cox and A Simpson
© 2015 John Wiley & Sons Ltd308
Such concerns stand in contrast to another facet of these
developments; namely a consumerist approach. Far from
ceding any power or control over research agendas or prac-
tices to mental health service users, it is argued that ‘. . .
mainstream interest in user involvement in research and
evaluation highlights feeding user knowledge and experi-
ence into existing research arrangements and paradigms . . .
‘(Beresford 2002, 101). Further, the complex dynamics of
these power relations are often suppressed by discussions of
inclusivity and community, overcoming any concerted effort
to acknowledge and actually deal with diversity in people’s
experience, interests and needs and with the complexity of
knowledge production in such circumstances (Frankham
2009, 19).
While there are clearly worthwhile and robust benefits to

researchers and service users of inclusive approaches (Simp-
son et al. 2014), these studies highlight the broader social-
political influences at play. According to Beresford, main-
stream state institutions include service users in processes
presented as inclusive, but which are motivated by the need
to subvert and contain threats to the legitimacy of state con-
trol over mental health policy, planning and research pro-
cesses that the SUR movement signified. While the
perspectives of service users can legitimate governments and
their agencies and provide evidence of inclusivity, they can
also be aimed at ‘efficiency, economy and effectiveness’ and,
in this process, service users become available as scapegoats
should such policies fail or become unpopular (Beresford
2002, 97).
SERVICE USER RESEARCH: THE STATE OF
PLAY
In the decade or more since Beresford’s study (2002), con-
certed efforts to include mental health service users in

research and service evaluation are evident both in the UK
(Rose 2003; Hodges 2005; Stickley and Shaw 2006; Wilson,
Fothergill and Rees 2010; Repper, Simpson and Grimshaw
2011; Hancock et al. 2012; Simpson 2012; Staley 2012;
Hutchinson and Lovell 2013; Simpson et al. 2014) and Aus-
tralia (Lammers and Happell 2004; Craze 2010; Callander
et al. 2011; Hancock et al. 2012). But the level and nature of
that involvement most often remains disappointing. Staley
(2012) overviews SUR in the UK’s Mental Health Research
Network concluding that 40% of projects involved service
users on steering groups with variable success and impact;
20% at the design stage with variable impacts and about 20%
involved SURs through the whole project with strong influ-
ence on the projects.
Staley’s analysis is a far cry from the original intention of
the SUR movement that service users should be involved in
the whole process (Beresford 2002; Phillips 2006). Hutchin-
son and Lovell (2013, 642) observe that, despite the appar-

ently well-established nature of SUR involvement in the UK,
there is not much evidence that their involvement in
research is ‘. . . truly an integral embedded part of statutory
mental health services’. In Australia too, Lammers and
Happell (2004) argued that mental health consumer partici-
pation in research was tokenistic while some eight years later
‘. . . genuine inclusion of consumers as members of the
research team remains rare’ (Hancock et al. 2012, 218.)
These commentators along with Kara (2013) point to
the need for a much stronger focus on SUR participa-
tion from inception to dissemination of research, to be
in line with the philosophy of the SUR-led movement in
both the UK and Australia and with mental health policy
and expected standards in both contexts. It is for these
reasons that there have been calls for a cultural change
in SUR involvement.
SERVICE USER INVOLVEMENT: TENSIONS
AND DEBATES

Appeals for cultural change in SUR involvement reflect
its politicised nature and speak to the problem of power
imbalance. In 2006, Phillips suggested that service users
had gained some power and could advance their cause
by lobbying, advocacy and positions of authority in
health organisations. However, Frankham (2009) pro-
poses that the central claim by proponents that research
partnership processes are ‘empowering’ relies on a con-
cept that is rarely defined much less theorised. She calls
for debate on the advantages claimed for partnership
approaches and proposes that the political nature of
SUR creates a kind of closed shop preventing analysis of
its actual merit. Frankham (2009) argues that the combi-
nation of government policy, funding body requirements
and the unarguable moral rightness of including service
users, militate against sound analysis of the practice. Nev-
ertheless, some analysis does exist which clearly shows
that power relations are an enduring problem.

Frankham (2009, 13) echoed earlier commentators in
calls for a ‘cultural shift’ to address the fact that control
still sits with academics. While it is reasonable to note
that academic researchers spent decades gaining the
qualifications and skills to lead research, it is still the
case that major power differentials exist between the
parties. A number of commentators point to power
imbalances that work in favour of funding bodies and
the academy such as devaluing service users’ knowledge
(Phillips 2006); service users being outnumbered by aca-
demics and not leading projects (Wilson et al. 2010);
funders restricting applications to academics (Fothergill
et al. 2013) and academics using exclusionary scientific
paradigms and language (Phillips 2006; Barber et al.
2011). Kara (2013) provides the evidence of service

users’ being silenced; of academic researchers being able
to keep private their experiences as service users or ca-
rers and of the challenges of partnership research being
laid solely at the door of service users.
Nevertheless, Wykes argues that over the past decade
sound progress has been made in the mental health field in
terms of the ladder of participation, from consultation to col-
laboration and then to service user led research paradigms
‘where the power in the relationship is reversed’ (Wykes
2014, 25), although she acknowledges that evidence to sup-
port this remains a ‘scarce resource’ (Wykes 2014, 24). Stud-
ies led by SUR Diana Rose (Rose et al. 2003; Evans et al.
2012) provide support for the emergence of SUR-led
research, while standing out for their rarity.
Further insights can be drawn from Patterson, Trite
and Weaver (2014) widespread study of SUR. It somewhat
contradicts Wykes’ conclusions in reporting that while
most respondents had positive experiences the potential of

SUR involvement is constrained by experiences of stigma,
discrimination and tokenism. Patterson et al. (2014, 7)
described a need for ‘. . . continued attention to deep-level
cultural change and development of robust mechanisms to
ensure timely and meaningful engagement’ and a ‘. . .
critical examination of power hierarchies within psychiatry’.
It is with respect to challenging such power hierarchies to
produce cultural change that cultural safety has much to
offer.
Anderson et al. (2003) draw on critical theorists to argue
that cultural safety directs our attention to imbalanced
power relations that favour biomedical and professional dis-
courses and silence other voices in research. The need for
such attention is reinforced by Kara (2012, 131) in her
review of SUR which showed:
. . . that power imbalances are situated between con-
structed group identities: psychiatrists and patients,
researchers and researched, and so on; perhaps even
between subgroups of MHSUs (mental health service
users), such as those who have been psychiatric inpatients
and those who have not.

We turn now to a brief account of the commonalities
between SUR and cultural safety before teasing out the con-
tribution cultural safety can make to SUR.
ON COMMON GROUND: CULTURAL SAFETY
AND SUR
It is clear that the SUR movement and cultural safety arose
for similar reasons and both drew inspiration from feminist,
civil rights, emancipatory movements and critical theory
(Beresford 2002; Ramsden 2002; Phillips 2006; Frankham
2009; Barber et al. 2011; Hancock et al. 2012; Hutchinson
and Lovell 2013; Kara 2013). They were motivated by the
desire to bring about social change by addressing the social
and emotional consequences of ‘special’ legislative provi-
sions applied to Indigenous people and the Mental Health
Acts applied to those with mental illness and the fact that
their voices and experiences were either absent or devalued
in research, as in their everyday life. To borrow Goffman’s
(1963) term, both movements sought to lessen the impacts

of a ‘spoiled social identity’ related to a loss of power, status
and rights; in terms of racism on the one hand and stigma
on the other.7
The thrust of methodological implications of culturally
safe research is its strong focus on challenging power imbal-
ances so that alternative knowledges, values and ways of
understanding are on an equal footing to western scientific
models and such concerns are evident in some accounts of
SUR (Phillips 2006; Stickley 2006; Barber et al. 2011; Hutch-
inson and Lovell 2013; Kara 2013). Likewise, culturally safe
research applied to SUR would support the latter’s ideal to
engage service users in the whole research process in an
equal research partnership (Wilson et al. 2010; Wykes 2014).
However, although other participatory models share many
principles of cultural safety, the approaches are not the same
as one could use a participatory model that was not culturally
safe (Wilson and Neville 2009; Cameron et al. 2010).
WHAT ARE THE IMPLICATIONS FOR

CULTURAL SAFETY TO TRANSFORM SUR
All research involves basic assumptions about the reasons
for individual behaviours, what is an acceptable research
approach, where it is appropriate to publish results, and so
on. While these assumptions are often unstated and taken
for granted, they strongly influence what is actually studied
and the way research is conducted. There is therefore a
need for culturally safe research. . .
(Ramsden 2002, 105)
7 There are complex cumulative impacts for those experiencing
a mental illness
and who are Indigenous or who are the target of racism or other
isms (cf. Happell
et al. 2013) chapter 8 for a full consideration of these factors.
L G Cox and A Simpson
© 2015 John Wiley & Sons Ltd310
Although cultural safety is recognised as an Indigenous
and decolonising research methodology (Smith 1999;
McCleland 2011), it is applied more broadly to research
practice (Reimer-Kirkham et al. 2002, 2009; Tolich 2002;
Anderson et al. 2003; Racine 2009; Harrowing et al. 2010;

Seaton 2010; McCleland 2011) and has methodological
implications for the conduct of research. These implications
centre around the fact that research encounters reflect the
diverse and shifting sociocultural positions of those involved;
they are ‘power-laden’ (Dyck and Kearns 1995, 142). From
the perspective of cultural safety then, what matters most is
the social experience and social positioning of those
involved as these influence research problems, questions,
design, methods, analysis, ethics and outcomes (Tolich
2002).
The crux of cultural safety is that researchers undertake
a process of critical reflection to bring their cultural values,
priorities, assumptions and social experience to mind to first
acknowledge and then address imbalanced relations of
power and the dominance of certain forms of knowledge.
Although undertaken by individuals, these processes are not
individualistic as they require reflection on structural posi-
tion, power and privilege. Therefore, they could help to

address structural inequality by challenging government pol-
icy and priorities and their influence on topics and methods
and the very conceptualisation and focus of research pro-
jects. Such processes provoke a crucial change of emphasis
from locating the source of issues in the diversity of people
to how society responds to diversity; a change in focus from
individualistic to systemic concerns.
A critical research practice based on cultural safety would
go far beyond the transcultural approach of including
‘diverse’ groups in recruitment and translating established
research instruments and information into various lan-
guages. For example, cultural safety would provoke reflec-
tion on which groups and languages are included/excluded
and why and what such decisions say about researchers and
the political and economic context of their research prac-
tice. In this vein, Kalathil (2008) notes that in research black
and minority ethnic (BME) people are often stereotyped as
being hard to reach, experience racism and are included

minimally to show policy adherence.
Kalathil (2008) makes the observation that three decades
of service user involvement has seen little change in mental
health services, citing these circumstances as a major barrier
to their being involved in service user activities. Kalathil
(2008, 10) writes ‘. . .service user involvement will become a
meaningful reality only if the damage done to individuals
within mental health systems is acknowledged, and the roles
and power relations between users and mental health
professionals . . . evaluated’. Kalathil (2008, 16) discusses an
intersection of race and class where middle class profession-
als, who have the resources and willingness to volunteer their
time, feel awkward around black people with whom they are
otherwise unfamiliar. These dynamics were identified as
additional barriers to BME (and, we would argue, working-
class) involvement in SUR. Kalathil’s work suggests that a cul-
turally safe approach could make a strong contribution to
easing such concerns by facilitating a reflection on such

dynamics among researchers. Indeed, McCleland (2011)
advocates starting with community protocols rather than
with ready-made academic methods which shows how pro-
foundly research processes and the excluding academic par-
adigms discussed by Barber et al. (2011) might change if
power relations were more balanced.
Anderson et al. (2003) extend the applicability of cul-
tural safety beyond Indigenous and immigrant groups by
arguing that English-speaking Europeans also suffer and
experience barriers to accessing resources and services. As
we have seen, cultural safety, although arising from a focus
on Indigenous groups and non-English language communi-
ties, nonetheless considers power relations not only on the
basis of ethnicity and experiences of racism and colonisation
but also on dimensions of age, gender, class, ability, sexual
orientation and so on. It considers such factors in terms of
the sociopolitical context of inequality, suggesting that cul-
tural safety ‘. . .should have explanatory power for all of our

research participants’ (Anderson et al. 2003; 210). This is
particularly so since, as Anderson et al. (2003) point out, var-
ious scholars argue against the idea that ‘colonised’ and
‘coloniser’, or ‘whites’ and ‘blacks’ are always opposing
categories. This is not only because colonial experience is
nuanced with colonised and colonisers co-operating, collud-
ing or resisting in state regimes but also because these expe-
riences dehumanise everyone, regardless of where we are
positioned.
In terms of research, this insight challenges notions that
health professionals and researchers always belong to the
dominant colonising ‘white’ culture and the researched
from oppressed minorities (Anderson et al. 2003; Reimer-
Kirkham et al. 2009) and binary opposites of service user/
academic are not sustainable in SUR (Phillips 2006; Kara
2013). However, such binaries are powerful, for example
when BME people are pressured to separate out parts of
their identity (ethnicity) from other parts (service user) and

silenced when they raise issues of racism, being told that they
are there as a service user not as a member of a particular
group (Kalathil 2008). Cultural safety could support SUR
teams in negotiating such dynamics by encouraging partici-
pants to articulate how their social experience is related to
structured responses to ethnicity, culture, class, gender, dis-
abilities and sexuality, for example and what implications for
their research might arise from such endeavours (Simpson
et al. 2014).
Cameron et al. (2010) make similar points in explor-
ing the possibility of a ‘culturally safe epidemiology’. For
example, they argue that in epidemiology the practice of
deeming ethnicity as an independent risk factor has
been discredited as ‘black box’ epidemiology that merely
homogenises diverse people on the basis of cultural ste-

reotypes. Such an approach cannot enhance understand-
ing of the complex interplay of social experience, health
determinants, historical factors and power issues which
inform high rates of morbidity and mortality. In contrast,
culturally safe research requires researchers to turn the
research lens back to ‘. . . their own cultural assumptions
and analyse critically the impact their theoretical stance
has on the knowledge they generate’ (Cameron et al.
2010, 95).
As Browne et al. (2009, 171) argue, cultural safety draws
attention to ‘critically orientated knowledge’; their research
shows ‘. . .that it is not primarily cultural beliefs or cultural
barriers that influence how people manage their health, ill-
ness or access to care’ but structural constraints and limits to
life opportunities. So just as we saw that it is ideas about dis-
ability that are disabling so too we can see that health
inequality is not so much about worldviews (idealised
notions of the cultural beliefs of ‘others’). It is how life is

experienced that holds the keys to understanding inequality,
injustice and ill-health (Kelly 2006; Cox and Taua 2013), a
research paradigm that would be a consequence of a cultur-
ally safe approach.
Browne et al. (2009) offer a sophisticated analysis of
the epistemological8 foundations of cultural safety seeing
cultural safety as compatible with critical enquiry con-
cerned with human freedom and social justice. They, like
Anderson et al. (2003) and Racine (2009), draw on post-
colonial feminist theory to develop what Seaton (2010,
151) calls a ‘critical cultural theory’. Such a theory would
consider human freedom by emphasising ‘. . . intersecting
oppressions’ (Browne et al. 2009, 168). Together these
studies make a convincing argument that cultural safety
can help us consider whether research is dominated by
certain cultural agendas, views or positions and what this
means for the capacity of research to improve the
human condition.

THE LIMITATIONS OF CULTURAL SAFETY
A limitation of cultural safety is that it draws attention to cul-
ture which can lead researchers’ focus away from marginali-
sation and oppression. However, applying cultural safety’s
ways of thinking about culture is transformative and deepens
understanding of the diversity and complexity in peoples’
everyday experience (Browne et al. 2009). This is an impor-
tant point as research shows that assumptions about race,
colour, age and gender impact on medical care and health
(Kelly 2006; Kalathil 2008) and Tolich (2002) suggests that
similar dynamics apply in research.
For example, in Australia, an inverted age pyramid
related to decreased life expectancy and high birth rate for
the Indigenous population vs. the general population, prob-
lematises age-based criteria. There new immigrants too are
younger than the general population while longer term
immigrants are older (Minas et al. 2013). Therefore, selec-
tion criteria must be nuanced to avoid skewed results

Journal of Public Policy & MarketingVol. 32 (Special Issue) .docx

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