Mexican Cultural Competency in Health Education and Promotion

Culture can be defined as the sum total of beliefs and behaviors of a particular group of people. This may include personal identification, language, thoughts communications, actions, customs, beliefs, values, and institutions.  This “group” may be based upon national origin, race, creed, area of residence, or social interests.  These aspects of culture also influence what members believe about health-related issues and how they might react to health information and promotional efforts1, 2.

Part I: The Mexican Culture

One such culture that has significantly grown in numbers in the United States is that of Mexicans, many of whom immigrate, legally and illegally, as a result of better economic opportunities3, 4.

Social Structure

Most family units are quite large with the father, or oldest male, as the traditional patriarch and wielding the most authority over the family.  The remainder of the family members are expected to display submission and it is common for the patriarch to speak on their behalf5.  The male head gives permission for a family member to seek medical treatment, but the matriarch is typically responsible for determining when treatment should be pursued.  Despite this order in their culture, the entire family may be involved in making certain decisions6,7.

Religion

About 83% of Mexicans identify as Catholic and many of the remaining religions are Christian in nature such as Pentecostals, Jehovah’s Witnesses and other Evangelical churches.  Fewer than 5% claim no religious faith8.  The Aztec religion is almost non-existent, but some of the principles from that faith are still held by many Mexicans and incorporated into their religious viewpoint, including beliefs about health6, 9.

Literacy

Mexico’s official language is Spanish, which is spoken by the majority (almost 93%), but many Native American languages are still employed among about 8% of the population8.  Some Mexicans speak Spanish as well as a Native American dialect.  Most Mexicans (15 years and older) are literate at a current rate of 93.1%, up from only 87.6% in 1990.  Men are about 2% more literate than women with the younger generations being the most literate10.

Communication Style

Personal relationships are significant in Mexican culture and are often displayed through polite and respectful verbal communication.  In fact, the Spanish language contains two forms of “you” and all verbs exhibit a distinct conjugation for each.  The “tu” form is used when addressing peers or friends and is considered informal.  “Usted” and it’s respective verb forms is formal and used in conversation with elders, teachers, parents, and others in which one intends to show respect11.

In the Mexican culture, eye contact is not necessarily a sign of respect as it is among many other ethnic groups.  It may be interpreted as a form of intimidation or a challenge.  Silence is sometimes a sign of lack of understanding, but can also result from uncertainty, timidity or even simply an attempt to exhibit respect, but does not necessarily signify agreement or lack thereof.  Mexicans may also display discomfort when touched by someone that is not a family member or friend as this type of contact is usually reserved for those they are closest to12.

Socioeconomic position

Much of the growth of the Mexican population in the United States is due to the economic opportunities available in America.  Both legal and illegal Mexicans can typically acquire better paying jobs than they are likely to find in Mexico13.  Nonetheless, their economic and social circumstances are still often challenging.  For instance, the educational level of first-generation Mexican immigrants is usually rather low given the poorer scholastic standards in Mexico14.  Even in the United States, only 71% graduate from high school, much lower than the national average of 81%, and only 9% of Mexicans obtain a bachelor’s degree 15, 16.  The median income for Mexicans in the United States is also exceptionally low at about $20,000 per year compared to the median income of the general population of nearly $52,00017.  Nearly 1 in 4 Mexican-American families lives in poverty and fewer than 40% have health insurance18.

Traditional Health Beliefs

Mexicans often believe that health is the result of luck or consequences of “good” or “bad” behavior and thus has a supernatural connection7.  One common notion is that good health is the result of maintaining balance among the four humors of blood, yellow bile, phlegm and black bile.  Each is described as “hot” or “cold” and “wet” or “dry” and illness is often treated with medicine or herbs of opposite properties (e.g. one should treat a “wet” illness with a “dry” remedy)5.  Mexicans are often thus reluctant to treat an ailment with medication that is not seen as having opposite humoral properties to their illness as western medicine may prescribe6.

Disease may also be understood to result from “dislocation” of part of the body.  One such dislocation of the stomach, referred to as empacho, is thought to be caused by incidents of ingesting gum, eating the wrong kind of food or at the wrong time or consuming undercooked food19.  Mal de ojo is another such dislocation caused when someone with a “strong eye”
admires a child9.

Mexicans often also believe that people can experience fright sickness, or susto following a particularly startling or traumatic experience7.  It is thought that one’s soul leaves the body as a result of susto and causes symptoms of depression, anxiety, anorexia, irritability, insomnia and introversion.  Susto is typically treated with tea, relaxation, holy water and spitting water or alcohol unexpectedly into the face of the sufferer.  Sometimes a folk healer is used and may conduct an elaborate ritual to rid the sufferer of susto20.

Health Care Seeking Behavior

It is common for Mexicans to combine Western medicine and traditional healing into their health care practices.  Many times they will delay pursuing medical treatment to see if home remedies will prove successful first.  They may also rely entirely on them when medical treatment is unavailable or unaffordable or if they fear deportation.  They often seek ill care from family and close friends6.

If traditional remedies fail to heal, Mexicans may consult an herbalist or healer.  Curanderos may be men or women and help the ill to address the social, physical, spiritual and psychological segments of their lives to provide recovery.  During this process, the ill person may utilize religious rituals, prayers, symbols, shrines or promises6.

Travel to Mexico to acquire drugs, usually antibiotics, is a common practice, even among Mexicans with health insurance because many medications that are restricted in the United States may be purchased freely there21.  This can be especially true for those that wish to hide a medical condition and treat it themselves, but oftentimes pharmacies in Mexico cannot be trusted to deliver the proper dose, regimen or even medication6.

Part II: Applying Principles of Cultural Competency

Cultural Competency, and thus the effectiveness associated with it, cannot be expected to exist simply based on an understanding of facts concerning a particular culture.  That knowledge must translate into health-related strategies that effectively apply those facts.  Following are suggestions that can be helpful in the application of health education, promotion and professionalism as it relates to members of the Mexican culture.

Social Competence

As family is so significant to this group, including more than one individual, especially the head of the household, in health-related affairs may prove beneficial6.  For example, promotion of mammography among Mexican women may be more productive if the women are encouraged to discuss the procedure and its benefits with their husband.

Verbal cues, such as nodding “yes” should not be assumed to mean what they would if given by a non-Mexican6.  Nodding “yes” for instance, may simply be a sign of respect and does not necessarily mean “yes.”  Thus, it is important for health professionals, educators and promoters to verify agreement where necessary.

Religious Competence

There is little doubt that tolerance for the religious beliefs of another can build trust and intolerance can quickly destroy it22.  This is particularly true for Mexicans as they tend to place great value in their religious beliefs.  Thus, health educators, promoters and professionals should display acceptance and understanding towards religious values, even when they conflict with current health sciences.

Literacy Competence

Health professionals should be aware that although literacy rates among Mexicans are quite significant, educational training often is not.  Therefore, it may be necessary to ensure that health matters are presented in a way that can be understood by the general Mexican population or a given individual.  For instance, an elderly Mexican man may not recognize the need, or even existence of prostate exams (and therefore does not obtain one) and so a health professional should provide an explanation utilizing words and concepts that will be understood and also verify the subject’s comprehension.

Communicative Competence

When health professionals are interacting with Mexican subjects, they should avoid continuous eye contact in order to prevent intimidation.  It is also essential in any health-related activities that professionals determine a subject’s level of agreement.  This is particularly important in health-related matters since Mexicans often display verbal cues that might normally be interpreted as agreement when in fact there is none.

Before any “touching,” health professionals should seek permission from a subject so as to avoid discomfort or violation of social norms that may lead to mistrust23.  It is also important to build rapport with Mexicans as relationships are so central to their culture.  Sharing a story or engaging in “small talk” are effective ways to establish trust6.

Socioeconomic Competence

Health-related matters whether educational, promotional or professional in nature, should include any financial costs, particularly if there are none, when dealing with those of Mexican descent.  Oftentimes they will avoid health-related matters simply because they are concerned about the potential expense24.  For instance, recruitment for a study may prove unsuccessful among Mexicans if they are unaware that there is no cost to them.

Traditional Competence

Since many Mexicans practice folk medicine, health professionals should avoid messages of intolerance and disrespect for these customs.  They are likely to be more trusting of health professionals when they are asked their opinion regarding health-related issues (rather than simply being told)20.  Trust may further be nurtured as health education, promotion and practices include Mexican health beliefs such as incorporating benign folk remedies into a treatment regimen6.

Health Behavior        Competence

Some Mexicans reside in the United States illegally and therefore fear deportation.  Health education, promotion and practice should therefore include assurance that subjects are not being identified for deportation.  Additionally, when applicable, subjects should be asked about medications they are currently taking, particularly ones that may have been obtained in Mexico since they will not likely be forthcoming with this information6.

Conclusion

When a sound understanding of cultural beliefs in relation to health matters exists, it creates an environment that is most conducive to the needs of people and communities2.  Health education and promotion professionals and organizations are also better equipped to provide more culturally sensitive, responsive and effective programs, services and education that can reduce health problems and promote better overall health by enabling systems, agencies and professionals to operate more proficiently.  Better health communication, a result of a competent understanding of behaviors, language, customs, beliefs and perspectives, also contributes to better results for the individual and cultural groups1.

Works Cited

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