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Health Education Theoretical Models and Multicultural Populations 109

two or more people who are emotionally connected. Family includes members of both
the nuclear and extended family and close and distant blood and nonblood relatives
and significant others. Family composition and roles change according to age, genera-

tion, marital status, relocation or immigration, and socioeconomic status, obligating
each individual to rethink his or her beliefs and lifestyle. Finally, a person is a human
being who is constantly biologically, psychologically, sociologically, and culturally
adapting to his or her community and environment. In general, in Western culture an
individual is thought of as a unique being and singular member of society; whereas in
Asian culture a person is identifi ed fi rst as a member of a family rather than a simple
element of nature (Purnell & Paulanka, 2003; Purnell, 2005).
On the micro level the model displays a framework of twelve domains and sets of
concepts common to all cultures. The domains are interconnected and have implica-
tions for organizing health promotion and disease prevention interventions in a manner
that respects the differences among racial and ethnic groups. The twelve domains are
(1) overview/heritage, (2) communication, (3) family roles and organization, (4) work-
force issues, (5) biocultural ecology, (6) high - risk behaviors, (7) nutrition, (8) preg-
nancy and child - bearing practices, (9) death rituals, (10) spirituality, (11) health care
practices, and (12) health care practitioners (Purnell & Paulanka, 2003; Purnell, 2005).
The first domain, overview/heritage, involves concepts related to country of origin,

current residence, the effect of the topographies of the country of origin and of the current
residence, economics, politics, reasons for emigration, and educational status. These con-
cepts are interconnected. For example, the social, political, and economics forces of the
country of origin can often be the major reason for emigration. In addition, the value placed

on education can influence the reason for emigrating among ethnic and racial groups
( Purnell & Paulanka, 2003). For instance, second - and third - generation Mexican Americans

have significant job skills and education; however, many current Mexican immigrants,
especially from rural areas, have poor educational backgrounds and may not place a high
value on education (Zoucha & Purnell, 2003). “ Being familiar with the individual ’ s per-
sonal educational values and learning modes allows health care providers, educators, and
employees to adjust teaching strategies for clients, students, and employees ” (Purnell &
Paulanka, 2003, p.13). Thus health educators need to consider and understand these con-
cepts as part of any health needs assessment.
The communication domain involves verbal and nonverbal interactions and con-
siders the dominant language and use of language, dialects, paralanguage variations,
eye contact, facial expression, and touch among other variables likely to be distinctive
in each cultural group. Health educators must be aware of these communication
patterns as they can affect the educators ’ interactions with members of racial and
ethnic groups. (See Chapter Eight for further discussion of communication patterns.)
For example, some groups may have limited English language ability; other groups
may be willing to share personal thoughts and feelings only with family members and
close friends and not with other people; and others may need to have their personal
space respected (Purnell & Paulanka, 2003). Public health educators also need to under-
stand that communication issues are interrelated with issues in all the other domains.

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