Defining and Theorizing About Culture The Evolution of the Cultural Determinants of Help-Seeking, Revised

Background: The recent interest in defining and theorizing about social determinants of health has illuminated the importance of culture as a central phenomenon of interest. However, cultural processes appear in multiple places in social determinants of health models, and their specifics are not delineated or operationalized. Objectives: This theory development article describes the complexity of defining cultural variables and uses medical anthropology to show how cultural domains, constructs, and variables can be defined. Methods: Using cultural anthropology theory, empirical work, and a literature synthesis as a starting point, the evolution of the cultural determinants of help-seekingheory is explored and the revision of the theory is highlighted. Results: The expanded theory include structural concepts as control variables, reframes illness as "suffering," and adds concepts of course, cure, manageability, meaning in life, functioning, social negativity, and perceived need. Discussion: Strategies for and benefits of isolating and operationalizing cultural variables for middle-range theory development and testing are discussed.