Download Community-Based Strategies to Improve the Health of Mexican

Community-Based Strategies to Improve the
Health of Mexican American Men
MARY C. SOBRALSKE
Shriners Hospitals for Children
Honolulu, Hawaii
This article focuses on the barriers that dissuade Mexican American men from seeking health care using a focused ethnography of
Mexican American men living in the Northwest United States.
Also highlighted are community-based strategies that can be
employed to improve the likelihood that Mexican American men
will access the health care system and become more aware of their
health status in general.
Keywords: men, Mexican American culture, community-based
health strategies, machismo
L
atinos constitute the fastest-growing minority population in the United States. In
fact, one of every eight Americans is Latino, accounting for over 37 million people
or 13% of the population. Of this segment, almost 70% are of Mexican ancestry
(Ramirez & de la Cruz, 2003). Demographers predict that by 2010, Latinos will be
the largest ethnic group in the United States. Because of the growing numbers and
the racial and ethnic disparities, the health status among the Mexican American
community is a major concern (Hatcher, 2002; Smedley, Stith, & Nelson, 2002).
Numerous factors influence minority men’s health status (Forrester, 2000), for
instance, the lack of social support, environmental stressors, lack of knowledge of
everyday health habits, a paucity of health care resources, and cultural and religious
beliefs and practices. Although researchers have paid attention to health issues of
Mexican American women and children, few have focused solely on Mexican
American men’s health. Of particular interest is how the concept of masculinity and
its influence can affect a man’s health status (Galdas, Cheater, & Marshall, 2005;
Kimmel & Messner, 2001). For instance, men’s higher mortality rates have been
linked to their masculine identity, gender roles, and patterns of socialization (WalCorrespondence concerning this article should be directed to: Mary Sobralske, PhD, RN, Shriners Hospitals for Children–Honolulu, 1310 Punahou Street, Honolulu, HI 96826. Electronic mail: msobralske@
shrinenet.org.
International Journal of Men’s Health, Vol. 5, No. 2, Summer 2006, 153–171.
© 2006 by the Men’s Studies Press, LLC. All rights reserved.
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SOBRALSKE
dron, 1995). Forrester (2000) and Waldron (1995) argued that men’s higher mortality rates are associated with various gender-related behaviors as well as inequities
experienced by minority men in employment settings and their exposure to occupational hazards. Men, it seems, are more likely to engage in a variety of high risktaking behaviors like drinking and driving, participation in extreme sports, and use
of firearms (Chavez, Becker, Wiggins, Key, & Samet, 1993; Marin, Posner, &
Kenyon, 1993; Sabo & Gordon, 1995).
CULTURE AND HEALTH
The notion that culture and health are linked can be supported by examining how
various people from different cultures respond to stress, bodily aches and pains, and
various illnesses (Leininger & McFarland, 2006). The fact is that health and illness
are culturally defined and encompass much more then physical symptoms and medical conditions.
How a man defines illness forms the basis of his decision about when to seek
health care (Kanu Dunn, 1987). An understanding of what motivates Mexican
American men to seek help for illnesses, how they make decisions to seek health
care, and what they view as important in defining their health are only a few of the
issues that health care professionals must ask if they are going to assist Mexican
American men to achieve better health care.
MASCULINITY AND HEALTH
Gender identity can be expressed as either masculine or feminine and is defined as
the sense that one belongs to a particular gender (“I’m a woman” or “I’m a man”)
(Sobralske, 2005). Most gender scholars accept the idea that a person’s gender identity is largely shaped by a culture’s male and female gender role definitions (Stillion,
1995). As most men strive to prove their manhood and masculinity to others by
shows of strength, virility, stamina, and fortitude, these very behaviors and their
related values and attitudes may lead to men’s high mortality rates (Hoga, Alcantana, & De Lima, 2001; Murphy, 1990; Sabo & Gordon, 1995).
For instance, Vicki Helgeson (1995) found that men who hold less traditional
beliefs about their masculinity adjust more successfully to illness and subsequently
have faster recoveries. Seemingly, men who espouse less traditional beliefs (i.e., less
macho) about their masculinity are more amenable to health education messages
than are men with more traditional beliefs about their masculinity.
ACCULTURATION
Acculturation is the process whereby a person adopts or adapts to a culture different
than the one he or she was raised in (Spector, 2003; Suarez & Ramirez, 1999). For
instance, an immigrant to the United States is considered as evidencing acculturation
by showing a preference for and fluency in English and a preference for American
foods (Randall-David, 1989; Villarruel, 1993).
Many Mexican Americans, however, retain a sense of their heritage and original
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STRATEGIES TO IMPROVE THE HEALTH OF MEXICAN AMERICAN MEN
culture (Cuellar, Arnold, & Maldonado, 1995; Leek, vande Kamp, & Kinne, 1991).
They prefer to speak Spanish, although becoming proficient in English to some
degree (Arcia, Skinner, Bailey, & Correa, 2001; Balcazar, Castro, & Krull, 1995).
Several authors (Adams, Briones, & Rentfro, 1992; de Paula, Lagana, & GonzalezRamirez, 1996; Randall-David, 1989) suggest that rural Mexican Americans are less
acculturated than those in urban areas and that those who live in barrios, or segregated neighborhoods, retain their original cultural ways more so than those who live
in integrated communities.
Being Mexican American requires a balance between two cultures, which takes
incredible patience, insight, effort, and diplomacy (Balcazar, Castro, & Krull, 1995;
Ramos-Sanchez, 2000). Most Mexican Americans see the need for adopting more
Anglo lifestyles. For example, whereas Mexican American women are often
required to take a more active role in providing for their families’ well-being, many
Mexican American men have had to take on more family roles like cooking and
child care, behaviors more traditionally assigned to women.
METHODOLOGY
The ethnographic approach (Germain, 2001) employed in this study began with participant observation in the community. The study specifically focused on men’s
health care–seeking beliefs and behaviors within communities where Mexican Americans constitute a majority or a large minority of the total population (Sobralske, 2004).
As the study progressed, the focus narrowed to a selected portion of the population.
RESEARCH SETTING
The Northwest United States was chosen as the research setting because Mexican
culture plays a significant role in this geographic area. Spanish-speaking radio stations and music, Spanish language billboards, Mexican restaurants, and brownskinned people all stand out in contrast to the dominant white population/culture of
the area.
Previous studies have used the allopathic health care system as their point of
entry to study the Mexican American population. This approach is problematic,
however, because many Mexican American men never use allopathic health care
and may choose to seek out a folk healer or a lay person in the community for help.
To determine where men seek help, research participants were met through contacts
in the communities where they lived and, therefore, outside of the standard health
care system.
Entry into the research setting was a gradual process. Data collection started with
visits to local museums, historical societies, libraries, and art exhibits to discover the
local and regional history of Mexican Americans. Small talk with store proprietors,
employees, and their customers, both Mexican American and non-Mexican Americans, was insightful. Research participants were met while attending community
activities, at public schools, and at churches. One female participant was encountered at a Mexican drug store, a yerbero. She was a friend of the proprietor and
helped translate for non-Spanish-speaking customers. She assisted in purchasing
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amulets and explained their meaning to patrons and members of our research team.
Visiting places where Mexican Americans congregated, such as local parks on a
Sunday afternoon and Mexican restaurants and bakeries patronized by Mexican
Americans, provided access to the population under study.
PARTICIPANT OBSERVATION
Participant observation is one way to understand the behavior, values, and customs
of a group of people (Nanda & Warms, 2004). It is the nature of ethnography to
meet research participants by first observing them and then engaging them in the
community (Roper & Shapira, 2000). Although contacts from allopathic health care
facilities were not targeted, several research participants were part of the health care
system. They were interested in the study and wanted to contribute in some way.
Observing men in the community and participating in activities that allowed
interaction with them and their families, friends, co-workers, and other community
members added to understanding men’s masculine identity and how it influenced
their decisions about seeking health care. From these interactions, the researchers
were able to identify many of the barriers blocking men’s health care activities.
RESEARCH PARTICIPANTS
The Mexican American community with its social network of loosely connected
members provided access to the eventual research participants. A snowball technique (Creswell, 1998) was used to select participants who fit a selection criteria
outlined by Gilchrist (1992).
Two types of research participants were selected: primary and secondary. Adult
Mexican American men who were (a) well informed and accessible, (b) willing and
able to participate by being interviewed in-depth, (c) stable residents (not migratory
workers), (d) identified themselves as similar to other Mexican American men they
knew in their community, and (e) capable of providing insights about health
care–seeking activities made up the primary research participants.
The secondary research participants were similar to the primary research
group’s characteristics, but differed in that this group was composed of adult men
and women who provided insights about health care–seeking beliefs and behaviors
of Mexican American men, could contribute to the social and cultural context of the
study, and could confirm, validate, and add to the data collected from the primary
research participants. The focus of interviews with secondary research participants
was mainly to confirm the data provided by the primary research participants as well
as to add to the data collected. These men and women (i.e., the secondary group)
were interested in, working with, or somehow related to Mexican American men. Of
24 secondary research participants, nine women and four men were formally interviewed and audio-taped.
The primary research participants and several secondary participants were interviewed in their homes or at a place of their choice that allowed for privacy; for
example, a room in a church hall or a private booth in a restaurant. Interview questions identified and explored the health care–seeking beliefs and behaviors of Mexi156
STRATEGIES TO IMPROVE THE HEALTH OF MEXICAN AMERICAN MEN
can American men. The questions were based on selected concepts from Chrisman’s
(1977) health-seeking process and Kleinman’s (1980) ideas on symptom interpretation. Sociodemographic and ethnographic information provided a basis for determining the primary research participants’ level of acculturation.
Secondary research participants were interviewed about men’s health care–seeking
behaviors as they were known to occur within their families or in the Mexican American community in general. We asked how family members, co-workers, and friends
helped in decisions about men’s health care seeking, how men are involved in the
decision-making process in seeking health care within their families, what influences
family members and friends have on a man’s decision to seek health care, and how
family members and friends help men who are ill.
A total of 36 men and women participated in the study. Eight men were chosen
as primary research participants (see Table 1). Their average age was 47.5 years
(ranging from 24 to 73 years of age). Their level of education ranged from completion of second grade to post-graduate education. The average grade completed was
twelfth grade or its equivalent. These men held a variety of occupations, and some
men had more than one occupation at a time. All had lived and worked in the Northwest for different lengths of time.
Determining the level of acculturation of the primary research participants was
based on ideas drawn from acculturation rating scales that already existed and are
well established in research with Mexican Americans (Cuellar, Harris, & Jasso,
1980; Marin, Sabogal, VanOss Marin, Otero-Sabogal, & Perez-Stable, 1987; RamosSanchez, 2000). Congruent with ethnographic methodology, the participants were
asked about their level of educational attainment or years of formal education, age,
religious affiliation, occupation, birthplace of participants and their parents, the
amount of time they had lived in the United States if born in Mexico, and the length
of time they had lived in the Northwest United States.
Acculturation data included:
Language(s) spoken and written (Spanish, English) and which language was
commonly spoken at home
Country where the participant’s childhood had been spent (Mexico, the United
States, or both)
Personal history
Current circle of friends (Mexican American, Hispanic, or non-Hispanic)
Sense of pride in having a Mexican background or heritage
Sense of ethnic loyalty, pride, affiliation, and identification
Commitment to and involvement in cultural customs and rituals
Sense of family cohesiveness
Sense of acculturative stress and coping strategies used to deal with this
Social support from community members
Perceived discrimination (if any)
Table 1 includes an indication of the overall level of acculturation of the participants
based on these factors.
Determining the level of acculturation also included observations used to assess
157
158
30
M
Catholic
Home
visitor
12
Texas
Mexico
Mexico
22
11
Moderate
24
M
Apostolic
Farm
worker
10
Mexico
Mexico
Mexico
5
5
Low
Eduardo
High
24
32
Mexico
Texas
Texas
16
S
Catholic
Community
outreach
32
Carlos
* Acculturation level is based on answers to questions on acculturation.
Age
Marital
status
Religion
Present
occupation
Education
(grade)
Nativity
(self)
Nativity
(mother)
Nativity
(father)
Years
in U.S.
Years in
WA state
Acculturation
level*
Felipe
Low
15
30
Unknown
Mexico
Mexico
18+
M
Catholic
Educator
49
Manuel
Low
29
33
Mexico
Mexico
Mexico
2
M
Catholic
Factory
worker
55
Chique
Table 1
Demographic Characteristics of Eight Primary Research Participants (Pseudonyms)
60
Tomás
Moderate
36
57
Mexico
Texas
Texas
14
High
13
60
Texas
Texas
Texas
12+
D
M
Catholic
Catholic
State
Social
employee
services
57
Ruben
Moderate
55
73
Mexico
Mexico
Texas
10
M
Catholic
Construction
73
Roberto
SOBRALSKE
STRATEGIES TO IMPROVE THE HEALTH OF MEXICAN AMERICAN MEN
the general living environment, the use of technology in the home, the kinds of food
eaten and clothes worn, and physical appearance (Leininger, 2001).
ETHNOGRAPHIC DATA ANALYSIS
Analysis progressed from lower to higher levels of abstraction, moving from collection of raw data to identifying common patterns and then formulating major cultural
themes (Leininger & McFarland, 2006). Taped interviews were transcribed verbatim
and converted into word-processed transcripts. Transcribed data and fieldnotes were
entered using the Ethnograph 5.0 computer program (Seidel, Friese, & Leonard,
2002).
Recurrent patterns of meaning, expression, interpretation, and explanation of
relevant data were discovered. This involved comparing, contrasting, and sorting
data using a determinate number of categories (Fetterman, 1989). Synthesis and configuration analysis, interpretation of findings, and the creation of formulations led to
our conclusions. Pattern analysis identified consistent and recurrent patterns across
data sources, leading to the emergence and discovery of four major cultural themes,
which will be described below.
RESULTS
The men varied in their level of acculturation and the number of years they had lived
in the targeted area. Most lived in or near towns or small cities that are neither rural
nor urban. Mexican Americans were not living in insulated, self-contained communities segregated from mainstream society. Although small neighborhoods contained
many Mexican American families, the communities were more or less integrated.
Participants’ lives were firmly established in both cultures—their Mexican heritage
and the dominant culture of the United States. Most were bilingual and spoke both
English and Spanish at home and in the workplace.
Four cultural themes emerged from data analysis. A thorough explanation of the
analysis and formulation of these themes has been presented in a prior publication
that focused on the health care–seeking process of Mexican American men
(Sobralske, 2006).
Theme 1: The identity of manhood in Mexican American culture dictates health
care–seeking behavior.
Theme 2: Good health means being able to be a man.
Theme 3: Illness means not being able to be a man.
Theme 4: Men seek health care when their sense of masculinity (manhood) is
threatened or impaired.
Discovering these cultural themes enabled health care providers to decipher what is
important to Mexican American men in order to devise strategies to promote their
health. Since this paper focuses on these strategies, the findings that are most relevant to that effort are presented. The participants’ words with the researchers’ reflections support and substantiate the findings.
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WHAT IS IMPORTANT TO MEXICAN AMERICAN MEN?
Men in the study generally regarded themselves as hard working. They achieved as
much as they could, given the opportunities available to them. Many of the men
talked about finding a balance between the “old and new ways.” They appreciated
the “old ways,” defined as the desirable values and beliefs of their parents, including
a strong work ethic, providing for their families, and following religious teachings
and rituals. They respected their ancestors’ fortitude and ability to look to the future
and give their children more than they had had in their own lives. For example,
Eduardo (aged 30) talked about how his parents “worked hard so he and his brothers
and sisters could get an education.”
Our participants also recognized the “new ways,” namely, the values that the
dominant society holds. Ruben (aged 54), for example, was proud of his ability to
speak and read English and Spanish equally well. “If Mexican Americans are bilingual, they have many job opportunities helping other Spanish-speaking individuals.”
Ruben had friends from a variety of ethnic backgrounds and liked working with people from “all walks of life. Many Mexican Americans in this country face the decision about whether they should adopt the language and culture of the U.S. so that
they can be more successful. A balance of both seems to be the solution for now.”
He believed that his community is “a good place for Mexican Americans to live. I
feel like I fit in here and I’ve heard that from many people.”
The “new ways” also meant getting a good education and being employed in a
secure occupation. Receiving an education themselves and providing an education
for their children was highly valued. Men’s pride in academic achievement was a
recurring finding. Several men proudly explained that they acquired a GED (General
Equivalency Degree) later in life because they did not have the opportunity to receive a high school diploma when they were young. The men were earning a living in
stable employment. A high school diploma was not necessary because they had
proven themselves to their employers, but they wanted to earn a diploma to set a
good example for their children and to enhance their own ability to pursue additional
employment opportunities. For example, Roberto, the oldest primary research participant at age 73, proudly described how, “after acquiring my GED when I was in my
50s, I marched in the local high school graduation ceremony with my 18-year-old son
who was also graduating.” Roberto mentioned that his granddaughter had recently
been accepted by several colleges. He was very proud when he introduced her.
MALE IDENTITY, MACHISMO, AND HEALTH
Although the eight men had varying backgrounds and life experiences, they
described common patterns of connection between masculinity and health. A man’s
identity in the Mexican American culture has a marked influence on his health
care–seeking beliefs and behaviors (Sobralske, 2004). The culture has definite
expectations about the role men should play and how they should think and act. Men
appeared to feel a need to explain what being a man means to them and how this
affects the meaning of health, illness, and whether or not they seek health care.
Understanding the meaning of manhood is critical. Although traditional cultural
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STRATEGIES TO IMPROVE THE HEALTH OF MEXICAN AMERICAN MEN
values of Mexican American men may be changing as they adapt to mainstream
society, inevitable changes in values do not necessarily alter the basic meaning of
being a man. Machismo, the Spanish word describing a set of attitudes and the identity associated with the Mexican concept of masculinity and manliness (Urrabazo,
1985), continues to be an important value in the Mexican American culture. A Mexican American man’s self-worth is based on being able to fulfill the cultural expectations of being a husband, lover, father, son, brother, and worker. It means being able
to earn a living and provide for and protect the welfare of his family. The participants explained what it is like to be a Mexican American man and how they would
behave when ill and needing help. “Men don’t complain about things because a man
is supposed to be a man. Men are not supposed to complain about things like aches
and pain” (Lavita, aged 52). “When I was growing up and got injured, I would just
keep working because that was expected of men and older boys” (Chique, aged 55).
Mexican men often put the welfare of their family above their own needs. When
they become ill enough to see that it is a threat to their manhood and impedes fulfilling their cultural obligations, they will then seek health care. Rather than attributing
the level of acculturation, socioeconomic status, and educational background as predictors of health care–seeking behaviors, the best predictor is when men experience
their manhood as having been compromised (Sobralske, 2004). Illness disrupts a
man’s family life, work, and ability to earn a living, as well as interrupting his social
and community activities. The psychological costs, such as the stigma attached to a
man who needs help and the humiliation he experiences if other men perceive him
as being weak, were apparent in our research findings. The reasons why they seek or
do not seek health care were often linked to their gender identity within their culture
(Sobralske, 2006).
Severe pain and disability are major motivating factors in seeking health care.
Some men seek care only when they have enough pain to keep them from working
and performing activities of daily living. Mateo, a 47-year-old male Mexican American health care professional employed in a clinic that serviced a large population of
Mexican Americans, offered that, if a man’s pain is not responding to the “usual
stuff, like Tylenol and ibuprofen, or if the pain is not alleviated by applying home
remedies, like rubbing alcohol or putting grilled tomatoes on the painful area,” he
will seek care.
Men may develop medical conditions such as hypertension and diabetes and fail
to see the benefit of early detection and treatment. Jose (aged 39), a Mexican American medical interpreter working with Spanish-speaking patients in several health
care facilities, explained that severe problems like “bad circulation of the blood” and
obvious conditions like “their feet turning purple” will prompt Mexican American
men to seek care eventually.
Not knowing what is going on with the body “scares the living heck” out of
Eduardo. In responding to a probe, he admitted that it is the unknown that prevents
him from seeking health care. Eduardo admitted that when his “testicles hurt and
hurt and it wouldn’t go away, and I had a lump in my groin,” he was afraid to tell his
wife at first, but two days later he decided to tell her about the pain. She told him,
“It’s time to go,” and they went to see his doctor together. “If a health problem is
severe in a man’s mind, it is difficult to ignore.” Ruben sought care because he had
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red blood in his urine once. Seeing the “source of life coming out of my manhood”
made him afraid that something was “gravely” wrong. Both men and women said
that men have a lot of pride. Lavita explained, “Men do not just go to the doctor for
nothing. Men have to be really sick to go to the doctor. It’s viewed as a sign of
weakness if men go to the doctor without being really sick.” Men sometimes seek
health care when everything else fails, including over-the-counter medications and
home remedies. Some men only go to a doctor if it is the “last resort,” “there is
excruciating pain,” “the pain is not going away,” and “they can’t stand it anymore.”
“This macho attitude was typical in my family and extended family; my uncles,
grandfather, and father” (Carlos, aged 32).
WOMEN’S ROLE IN MEN’S HEALTH
Many men in this study did not seek health care readily on their own. When men
were ill, the power in the family often shifted from the husband to the wife. Most
men relied on their wives for health care advice and assistance and their input about
seeking health care. They depended on their wives to be caretakers of their health
status. Wives often encouraged men to seek care from their doctors. They used a
variety of ways to get their husbands to seek help. Some, including Gloria (aged 26),
said they ignored their husbands or withheld sex until the men agreed to get help.
“Women have the weapons to make men get help. I get angry with my husband. I
don’t acknowledge him at home, in bed, any place. I ignore him [laughs].” When
asked how long she would do that before she gives up, Gloria laughed and
answered, “When I have achieved what I want.”
Rosita, an elder Mexican American mother, said she would not let her son visit
her until he went to the doctor to get treated when he was sick. When men do access
health care they are often accompanied by their wife or someone else. They often
will not go by themselves. For men who were not married, the person from whom
they most commonly asked for advice was their mother. Men saw their mothers as
the traditional caretakers in the family as they were growing up. Jose agrees
that it’s the woman who sees her husband not getting up out of
bed. Then she thinks you need to go to the doctor because things
aren’t getting any better. First she calls the aunts . . . try this, try
that . . . quite a few people try to use up all their resources whether
it is their neighbor or somebody like that, before they make it to
the doctor.
MENTAL HEALTH CARE
Ruben and Tomás (aged 57 and 60, respectively) reported that men often drink alcohol infrequently but drink large quantities of alcohol when they do drink. “Mexican
American men use alcohol to cope with mental health disorders like depression and
anxiety” (Tomás). As men learn about what mental health care can offer, however,
they are more likely to seek it out and use it.
Mexican American men are taught to tough it out when they have problems, not
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STRATEGIES TO IMPROVE THE HEALTH OF MEXICAN AMERICAN MEN
just physical pain, but also psychological disturbances. The researchers often saw
depression among Hispanic men; for example, alcohol addictions due to depression
that is not diagnosed. Men are brought up to think they have to know everything
because they are men. In the community studied, the local police department recommends mental health services to men who often get into trouble with the law
(Ramiro, aged 40).
Mexican American men may avoid seeking help for mental health problems
even if they recognize that there is a problem. Factors that influence their perceptions of mental health care include cultural beliefs and the stigma associated with
being mentally ill, lack of education, social isolation, language barriers, unfamiliarity with the health care system in general, bureaucratic barriers, and unavailability of
service compatible with their cultural needs. Lavita, a Mexican American mental
health care specialist, observed that, if the mental health care workers are not Mexican American, men will not seek care. They will not turn to “strangers.”
BARRIERS TO HEALTH CARE
Patty (aged 45) pointed out that “men have difficulty identifying and describing their
symptoms. Problems are often not recognized until they become obvious to men.”
According to Lavita, Mateo, and Sandra, language was a perceived barrier to health
care access. Lavita explained that men will spend hours in the waiting room before
they even tell anyone they are there to be seen. According to Patty, a health care
administrator in a small clinic, a man’s presenting reason for being there is commonly “my wife (or my employer) told me I had to come.” She reported that men
needed to be reassured that it was all right to seek help for their health problems.
Some men had lived in the United States for many years but still did not speak English, and this inhibited them from seeking health care. In general, men who were
less acculturated needed special consideration regarding the unfamiliarity of the
health care setting.
Lack of financial resources was also a barrier to care for some men. Lack of
health insurance or money to pay for gas to drive to a health care facility, or being
unable to pay for a babysitter, were some of the barriers cited. Even if people had
health insurance, however, they still had to meet the co-payment, which some men
could not afford.
On the other hand, men who had health insurance and/or access to health services did not necessarily seek help when they had problems. Alonso, a 36-year-old
Mexican American male community outreach worker, believed that “if women cannot pay or lacked health insurance, they would still seek care and worry about the
bill later.” Ruben’s opinion was that “some men use the lack of the ability to pay as
an excuse to not seek care.”
Sandra (aged 50) talked about how she grew up with grandparents who were not
born in the United States. She realized that in “their generation, they were not out
actively looking for medical help.” Her father finally sought health care when he was
70 years old when he “got into a dentist’s chair, and the dentist told him he could not
work on his teeth because his blood pressure was so high.” After that, her father
began to see a doctor. “He is more informed now and is interested in his health.
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He asks the doctor questions, something he never would have done when he was
younger.”
Lorena’s (aged 46) elderly grandfather was recently diagnosed with diabetes
and some other health problems. “My grandfather had no experience taking medication, so he was taking all of his medications at one time—in the morning. He did not
know that he needed to spread them out over the day. Without any experience taking
medications, a man cannot draw on prior knowledge.”
Patty admitted that in her experience working with Mexican American men for
over 15 years she had witnessed many men wait a long time before going to a health
care provider when they were ill. Some men were very sick and still did not access
health care. “I believe that in men’s minds, they are confident they will get better.” In
the ambulatory clinic where she works, her staff tracks patients who fail to keep their
appointments. Men often do this, and they represented the greatest number of people
who walked out of the clinic before they were seen by a health care professional.
If men have to wait to be seen for a length of time that exceeds
their expectations, they leave the clinic. If a man brings his son,
and his son witnesses this behavior, he models his behavior on his
father’s behavior.
Several men mentioned that they did not want to admit they believed they had a
folk illness like empacho. Empacho is a condition that can be explained as a ball of
food getting stuck in the stomach or a feeling of indigestion. This condition usually
occurs when a man is under stress during or immediately after eating or from eating
improperly cooked food (Marsh & Hentges, 1988). A folk healer or a knowledgeable
family member treats the person by pulling the skin on his back, massaging his back
and stomach, or by administering cooking oil by mouth. While touching the patient,
the folk practitioner recites religious prayers. For men, admitting they have empacho
means taking a risk that a health care professional may laugh at them. They were
embarrassed about this belief, and this kept them from seeking health care.
Gloria mentioned that her husband was embarrassed when he had a cyst
removed from his foot.
I insisted he go and have it removed. And I was serious about it.
He had a shot in his back that numbed him from the waist down
[spinal anesthesia]. He complained that when he woke up he was
naked. He doesn’t like anyone to see him. The nurse [female] saw
everything. He blames it on me. It was my fault because I made
him go. I think it’s the machismo thing. His friends find out and
they tease him.
Mexican Americans prefer health care congruent with the cultural expectation
of personalismo, or personalized attention. Personalismo denotes an emphasis on
warm, intimate, interpersonal relationships (Purnell, 2003). Having a personal bond
with the health care provider is important in building an atmosphere of trust (Caudle,
1993). Lack of personalismo is perhaps the major source of dissatisfaction with
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health care. In a busy health care facility, men feel they are being treated as a thing
to be processed rather than as people. Cultural expectations of personalismo are
ignored, dismissed, and not valued. These feelings increased the chances Mexican
American men would not seek care for health problems.
Medical technology also acted as a barrier between the patient and the health
care system if too much emphasis was placed on medical equipment and not enough
on the patient. Chique complained that his family members were asked to leave the
hospital during several recent hospitalizations. “As soon as visiting hours were over
they kicked my wife and kids out, even if they were helping me eat or taking care of
me. Why can’t they just let them stay with me?” His wife offered that “the staff
probably gets tired of all the Mexican American families hanging around the hospital all the time.”
SUMMARY
Zoucha and Purnell (2003) claim that good health for many Mexican Americans
means to be free of pain, to be able to work, and to have a general feeling of wellbeing. Villarruel and Ortiz de Montellano (1992) found that Mexican Americans
endure illness and pain as a sign of showing strength, and they do not seek help until
pain or the condition become unbearable. Sabo and Gordon (1995) have pointed out
that gender socialization predicts how males adopt masculine behaviors from
observing what is happening around them.
If men do not seek health care until they can no longer work and provide for
their families, chronic diseases will have progressed far enough to produce bothersome symptoms. Late detection and treatment of life-threatening diseases can, however, shorten a man’s life (Sabo & Gordon, 1995). Chavez et al. (1993), Marin,
Posner, and Kenyon (1993), and Neff and Hoppe (1992) note that consuming large
quantities of alcohol and a high rate of alcoholism contribute to mental health problems in Mexican American men. Health care providers need to routinely assess
patients’ participation in health promoting behavior and encourage them to make
changes in their health habits (Hulme et al., 2003).
The goal of health care is to provide effective, appropriate interventions that are
mutually agreed upon by the patient and the health care provider (Kavanaugh,
1995). The inability of patients to speak English and the lack of health care
providers who speak Spanish have been identified as significant barriers to health
care access (Torres, 1996). Elders can use culture brokers to coach, protect, and navigate patients through the allopathic health care system and to help assure greater
adherence to recommended health treatments. Such brokers act as bridges, links, and
mediators between health care professionals, patients, and their families so that language and cultural barriers can be overcome (Chalanda, 1995).
The literature attests to the fact that lack of financial resources to pay for health
care is a barrier to seeking care (Ell & Castaneda, 1998; Spector, 2003). Mexican
Americans often do not have health insurance; therefore, they do not have access and
financial support to use health services (Perry, Kannel, & Castillo; 2000). Those who
are uninsured are less likely to have a regular source of health care and rate their
health status as excellent or very good (Trevino, Moyer, Valdez, & Stroup-Benham,
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SOBRALSKE
1991). For example, according to the National Center for Health Statistics (2002),
51% of Latinos in the United States aged 18 to 64 years old said they had not seen a
dentist in the past year.
A lack of personalismo permeates the American health care system, where relationships between health care providers and their patients may be impersonal and
distant (Delgado, 1995). Mexican Americans have a preference for health care
encounters that emphasize the patient’s relationship with health care providers in an
atmosphere of trust and intimacy (Warda, 2000). Health care providers should therefore learn as much as possible about the Mexican American culture, ideally directly
from the people under their care (Urrabazo, 1985). Feelings about lack of personalismo increase the chances Mexican American men will not seek care for health
problems and make it imperative that health care professionals understand and
engage in culturally competent practice. Medical technology itself also adds to barriers
between people of different cultures (Leininger, 2001).
Norcross, Ramirez, and Palinkas (1996) found that men were 2.7 times more
likely than women to be influenced to seek health care by a member of the opposite
sex. They concluded that women exert a significant influence on men’s decisions to
seek health care and from whom to seek it, regardless of ethnicity. Women, especially wives, acted as health care brokers for men. Heusinkveld (1993) and Zoucha
(1997) support the idea of engaging women as advocates for men’s health. Specifically, Gleason (2006) found that women force Latino men to seek health care.
Averill (1997) found that the family plays an important role in solving problems, making decisions, and providing support. When Mexican Americans are being
treated for health problems, there is usually a family member involved with the care
(Berry, 2002). Families make health care decisions together, and in most cases it is
not an individual patient’s decision (Warda, 2000).
RECOMMENDATIONS FOR COMMUNITY-BASED HEALTH STRATEGIES
Several community-based strategies can be employed to improve the health of Mexican American men. First, men need to become more knowledgeable about health
issues, recognize when they have a problem, and know what to do if there is a problem. Mexican Americans have more access to information through television and
radio than ever before. Therefore marketing health promotion and care to Mexican
American men through various media is important. Community leaders can assist in
marketing strategies that are successful in the Mexican American community.
Manuel (aged 49), Ruben, Tomás, Carlos, and Roberto all agreed that Mexican
Americans in their communities got most of their news by listening to the radio,
especially Spanish radio. They frequently watch Univision (2006), a Spanish television station. According to many research participants, the most effective way news
travels within the Mexican American community is by “word of mouth as it moves
through the grapevine.” Delgado (1995) emphasized that health promotion programs
should target the specific communities where Mexican Americans seek health care.
Addressing the objectives from Healthy People 2010 (United States Department
of Health and Human Services, 2000), a national health promotion and disease prevention initiative, is important for the Mexican American population. Healthy People
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STRATEGIES TO IMPROVE THE HEALTH OF MEXICAN AMERICAN MEN
2010 promotes health screening, health education, and learning about common health
problems. Community leaders and health care professionals can create communitybased initiatives, such as working in partnership with community organizations. For
example, programs such as the Hispanic Academic Achievers Program (Columbia
Basin School Districts, 2005) are avenues to interest children in their health early in
life. The strong network of Mexican American families that often exists in a community can be used as an infrastructure for community-based health initiatives.
Churches and the school system are stable sources for promoting health and health
care. Children can learn about health and, in turn, can influence health decisions and
actions taken by their parents and grandparents.
Community centers and churches can offer classes on techniques such as cardiopulmonary resuscitation and first aid, engaging community members in health
initiative efforts. Family or community sports activities that usually appeal to men
can be organized to promote healthy behaviors.
Juarbe (1996) maintained that a community-based paradigm is needed to promote cardiac health among Mexican American men and women. She suggests that
schools, the workplace, women’s organizations, and community-based organizations
can effect change. Juarbe adds, however, that community-based programs will not
be successful without state and local policy support.
The skills that health care professionals need in serving Mexican American men
include bilingualism, objective listening skills, subjective caring, providing personal
care, and knowing when to give advice. If health care providers keep an open mind
and are nonjudgmental about cultural and religious beliefs a patient may hold, they
will avoid embarrassing the patient and themselves. Health care professionals might
consider building relationships with folk healers if a Mexican American population
is utilizing their services.
Theresa, a 42-year-old Mexican American woman, lost her husband to an early
death when he was 25 years old because he sought health care too late. She suggested that health care professionals “catch a man when you have him,” meaning,
convince him to be examined or screened for health problems when the opportunity
arises if he does access the health care system or even if he happens to be in a health
care facility with his children.
Community leadership is a significant factor in promoting effective transcultural health care. Community leaders can have great impact on health care policy
and practice, improving and enhancing heath care organizational culture and serving
as role models. It is wise to engage clergy and staff at churches where Mexican
Americans are members to provide input and support for health programs.
If health promotion, disease prevention, and early detection strategies are not
reaching Mexican American men, perhaps these could be directed toward women so
that they can reach the men in their families and communities about health-related
issues. How women, especially wives, influence Mexican American men’s health
status should be further explored. Women may help improve health-promotion
awareness and action among the men in their lives. Health care professionals and
community leaders might recruit women to become health care advocates to men,
because often this is the traditional role of women in the culture. Women can learn
how to be cultural brokers for the men in their lives.
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