Causal attributions of cleft lip and palate across cultures

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 (enviro nment, 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.