Page 151 - Cultural Competence in Health Education

Developing Culturally Appropriate Needs Assessments and Planning 129

some of these languages, such as Mixteco and Zapotec, less than a decade ago, and the
existence of many different dialects means that this work will take time.
Complicating matters even further for health educators is the illiteracy problem
among the indigenous people in Mexico. According to the 2000 census in Mexico, 5.9
million Mexicans are illiterate in Spanish, and 34 percent of this group is indigenous.
Spanish illiteracy rates are three times higher among indigenous people than among
mestizo Mexicans (Instituto Nacional Indigenista, 2001). Health educators working
with indigenous populations with the characteristics of high illiteracy in Spanish or
another major language and also the absence of a written indigenous language of their
own need to take these factors into consideration at the time of developing assessment
and evaluation tools and need to opt for those instruments that will allow them to over-
come these communication barriers. For instance, they can select focus groups and
oral interviews instead of written surveys.
Health educators should also take into consideration communication that is nei-
ther oral nor written, such as communication through body language and space orien-
tation, because these types of communication also differ across cultures. “ Sociologists
say that 80 percent of communication is non - verbal. The meaning of body language
varies greatly by culture, class, gender and age ” (ICE Cultural and Linguistics Work-
group, 2004). For instance, whereas most European Americans interpret the lack of
eye contact during a conversation as lack of respect, indigenous Mexicans show
respect by lowering their heads and avoiding direct eye contact when they are talking
to a stranger or someone they consider superior (Centro Binacional para el Desarrollo
Indigena Oaxaqueño, 2007). Finding out the most common nonverbal ways of com-
municating in a given culture can help health educators avoid potentially inappropriate
actions in interventions.
Health Beliefs and Practices

Culture influences the people ’ s perceptions of their health and hence the ways and
methods they pursue to maintain and restore their health. Although the predominant
model is the allopathic medical model, which explains illness and disease in terms of
pathological agents (Luquis & Pérez, 2003), many cultures throughout the world have

nosologies (classification of diseases), etiologies (causation theories), diagnosis meth-
ods, and concepts of prevention that are markedly different from those of clinical
biomedicine (Bade, 2004). For instance, Mixtecs from Mexico — along with other
indigenous people from Latin America — believe that illness can occur “ when a healthy
individual has been exposed to a potentially disruptive force, be it physical, such as
heat or cold, social, such as a relationship with a relative or neighbor, or spiritual, such
as entities that occupy caves, roads and rivers ” (Bade, 2004, p. 234).
Therefore, in order to plan interventions that are culturally appropriate, it is cru-
cial that health educators take the time to assess and identify the health beliefs of their
target population and the ways that population members are practicing these beliefs in
the United States. Are they combining Western medicine with traditional medicine?
Are they following certain rituals intended to preserve their health?

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