Four Domains of Mexican Culture:  Communication, Bicultural Ecology, Disease and Health Condition, and Spirituality

Current work provides literature review of the four domains of the Purnell Model for Cultural Competence, including communication, bicultural ecology, disease and health condition, and spirituality. The description of both verbal and non-verbal communication can help improve the interaction with Mexicans. The analysis of bio cultural ecology unveils that the citizens of this country have numerous roots in various ethnicities. The assessment of disease and health condition shows the major causes of death of the representatives of various ages, and the last domain describes the religious perceptions of Mexicans. They are highly religious people who follow Catholicism. The literature review of these domains provides the background to develop the recommendations directed on filling the gaps in available information. These recommendations help in identifying the communication methods with Mexicans who suffer from severe illnesses, prevalence of various ethnic groups to different diseases, finding the similarities in causations of major diseases and studying the religious views of pregnant women. The information presented in the current work will help establish close contact with the representatives of Mexican culture, understand their values, perceptions, cultural and religious views. This information is extremely important when providing high-quality caring services.

Nowadays, much attention is paid to the distinct features of various cultural groups to better understand their perceptions, traditions and norms. The current work provides the description and analysis of four domains of Mexican culture. These domains are communication, bicultural ecology, disease and health condition, and spirituality. The preparation of this description will identify gaps in available literature and help develop recommendations for future research. The discussed information is rather relevant to nursing practices, because its application can improve understanding and interaction between health care providers and patients and advance the quality of treatment.

Literature Overview

In the literature review such four domains of Mexican culture as communication, bicultural ecology, disease and health condition, and spirituality are analyzed.


According to Purnell Model of Cultural Competence, the communication domain includes language and dialects of the chosen population (Purnell, 2002). Additional attention should be paid to such factor as use of nonverbal communication. Style of communication reflects cultural values and aligns interaction between people. It is important to note the fact that both verbal and nonverbal communications influence the manner of interaction between patients and health care providers. Hence, experience in healthcare settings can influence care-seeking behaviors and treatment adherence.

Distinct Characteristics of Interaction

Social norms usually emphasize the importance of building relationships through verbal communication. It should be respectful and continuous. For example, health care providers should use the special Spanish “usted” form (the formal and polite form of “you”) when they address patients (Centers for Disease Control and Prevention, 2008). It is crucial to recognize such social value as familismo, which places family over individual and community. Moreover, speakers should express strong loyalty, solidarity, and reciprocity among family members. This value is usually reflected in the desire of patients to discuss treatment and care together with family members. Therefore, the provider should speak with both patient and family members. However, the provider should first obtain permission from the patient to discuss confidential information with family members.


The most widely spoken language in Mexico is Spanish (“Mexican languages,” 2016). The government recognizes 68 Mexican indigenous languages as official national languages (“Mexican languages,” 2016). However, the researchers found that 130 languages along with their cultures have disappeared (“Mexican languages,” 2016). Consequently, the government developed and realized numerous initiatives to promote further development of these languages. For example, the Law of Linguistic Rights developed in 2002 was aimed at protecting the native languages and encouraging their development through intercultural and bilingual education (“Mexican languages,” 2016). Currently, only 6 % of population (6 million Mexicans) speaks a native language, when 10-14 % of population indentifies themselves as representatives of indigenous group (“Mexican languages,” 2016). The most popular national languages are Nahuati (about 1.4 million speakers), Yucatec Maya (about 750 000 speakers) and Mixtec (about 500 000 speakers) (“Mexican languages,” 2016).

In fact, there is no official language in Mexico, what means that citizens of the country can use indigenous languages in official documents and governmental communication. This strategy provides more freedom and possibilities.

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In one of Mexican languages, people often use falsetto “as a sign of respect in greeting, through the entire formal exchange […] and for expression of emotions and attitudes” (Poyatos, 2002, p. 33). During the communication, there is less emphasis on words and figures and more emphasis on tone, voice setting, and feelings about the individual.

In communication, Mexicans try to avoid confrontation. Instead, they can give such answers as maybe or perhaps instead of no. They can freely share their thoughts concerning sports (soccer), their family and friends. At the same time, they avoid talking about such topics as religion and politics.

The verbal communication is reflected in eye contact and patients’ silence. Eye contact in this country can be interpreted as intimidation or challenge. Usually, silence is the major sign of doubts, shyness, disapproval, anger, and misunderstanding. Hence, it cannot be interpreted as disagreement or agreement with negotiator. Therefore, health care provider should clarify the meaning of patients’ silence and provide further explanations, if necessary. It can also mean the feeling of discomfort that may arise when health care provider touches a patient. That is why the examination should be performed in the presence of close friends and family members.

At the same time, Mexicans are considered as warm and affectionate individuals who can hold hand or touch each other’s shoulders. They tend to stand very close to negotiator and the effort to step back is discouraged and perceived as unfriendly.

In Mexico, citizens are obliged to include the mother’s maiden name in legal documents instead of father’s surname. This obligation is based on the understanding that numerous Hispanics have similar surnames. Thus, mother’s name is used to legally separate and identify individuals. Married women also insert their own maiden names in the documents for the same reason.

Bio cultural ecology

The next domain considered in the current work is bio cultural ecology. It includes ethnic and racial origins of Mexicans, skin coloration and distinct features in body structure, indicative illnesses, etc. (Purnell, 2002).

Mexicans represent various ethnic groups. The major part of the population is Mestizo (62 %) (Statista, 2016). The rest of the ethnic groups are predominantly Amerindians (21 %), Amerindians (7 %) and other (mostly Europeans) (10 %) (Statista, 2016).

The major European part of the mestizo Mexicans has its origins in Spanish population. The other take their roots from such countries as France, Germany, Italy, and Portugal; and very small part originates from the UK, Sweden, Greece, Romania, Poland, Russia, Albania, and Turkey (“Races of Mexico,” 2011). The indigenous components depend on the location of the country. Usually, it includes “Nahus, Zapotecs, Mixtecs, Zacatecs, Mazatecs, Coahuiltecs, Tamaulipecs, Yaquis” (“Races of Mexico,” 2011). Additional attention should be paid to the African root of the population. It dates back to the colonial times when African Americans were brought to the country. The majority of slaves were from Veracruz, Tabasco, Oaxaca, and Guerrero (“Races of Mexico,” 2011). At the current moment, black and partly black population represents only 1 % (“Races of Mexico,” 2011). Great difference in roots of the population reveal why Mexicans have various skin colors (very fair, fair, olive, tanned, dark brown and black).

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The body mass index (also known as BMI) tends to be larger in Mexican-Americans than in non-Hispanic whites (Ryan, 2002). Mexican children are usually short and overweight, especially at the age of 12 (Ryan, 2002). Shorter statures are caused by their genetic and ethnic origins. The reasons for obesity are thoroughly studied by various scientists. The most common are connected with the nutrition and absence of physical activity.

The utilization of drugs by representatives of this culture is studied. The research Evaluation of drug metabolism in Hispanic Americans with type 2 diabetes (2012) reviled that further investigations of the drug-related problems of this cultural group should be performed (Dowling et al., 2012, p. 4).

Disease and Health Condition

The next domain covers health status and diseases. The average life expectancy is 76 years (“Mexico’s health stats,” n. d.). The death rate is 5.27 per 1000 citizens (“Mexico’s health stats,” n. d.). This figure changed during the last 30 years (“Mexico’s health stats,” n. d.). The major cause of death is diabetes mellitus of type 2. Since 1980, the diabetes mellitus type 2 death rate increased to 14 % (“Mexico’s health stats,” n. d.). More than 400,000 of new cases are reported annually (“Mexico’s health stats,” n. d.). Among main causes of death are heart diseases, cancers, and respiratory diseases. This trend is explained by the lifestyle (physical inactivity), daily tobacco smoking, alcoholism and unhealthy nutrition. Moreover, the formation of these diseases is connected with low income (and even poverty) and unsanitary conditions. These factors also cause high rates of overweight and obese population. Currently, more than 70 million Mexicans of different ages suffer from this problem (“Mexico’s health stats,” n. d.). According to the investigations performed by the World Health Organization, the citizens of this country are the most obese in the world. Additional attention should be paid to the fact that this figure is not going to change in the nearest future, because Mexico has the highest amount of obese children in the world (more than 4 million) (“Mexico’s health stats,” n. d.). The majority of these diseases can be prevented by changing the habits of Mexicans. Having healthy nutrition, active way of live, periodic moments of abstinence from situations harmful to health (like stresses) and relaxation, elimination tobacco, alcohol and drugs can considerably lower the possibility of getting chronic diseases (“Mexico’s health stats,” n. d.).

Among leading causes of death of children under 1 are the following: malfunctions generated in the prenatal period (50 %), congenital malfunctions of the heart (about 9 %), acute lower respiratory infection (about 5 %), intestinal infectious diseases (about 2 %), and protein-energy malnutrition (about 1 %) (“Mexico’s health stats,” n. d.). The main causes of death of preschool children is intestinal infectious disease (8 %), acute lower respiratory infection (about 7 %), crashes (about 7 %), and congenital malformations of the heart (6 %) (“Mexico’s health stats,” n. d.). Children of school age (from 5 to 14 years) usually die from crashes (13 %), leukemia (8 %), and accidental drawing and submersion (4%) (“Mexico’s health stats,” n. d.). The clear understanding of the major causes of death of Mexican people of different ages will help health care providers identify the diseases and facilitate timely and effective treatment of patients.


The last domain of the Purnell Model for Cultural Competence analyzed in the current work is spirituality. It will cover the information concerning the religious practices, behaviors and traditions (Purnell, 2002).

The main religion in Mexico is Roman Catholicism. It was brought to the country during the Spanish conquest and accepted by the major part of the population. Christian traditions and believes mixed with the pre-Hispanic religious understandings. For example, the Virgin of Guadalupe was associated with goddess Tanantzin that existed in the pagan times. Thus, currently religion in this country is considered syncretic.

Catholic Church is rather powerful institution in the country that establishes strong Catholic believes. Catholic priests perform regular masses and officiate crucial events in the life of Mexicans, such as births, weddings, and death. Mexicans attend religious activities every week. It should be noted that women attend them more frequently than men, and express their intent to increase participation. Older people are more active in religious activities than younger. Church attendance is also significantly correlated with families. The major reasons for non-attendance are transportation issues and health problems.

Such religious adherence should be taken into consideration when providing health care to Mexicans, because it improves the interaction between patients and caregivers. As per special investigations, older people highly value when their religion is being respected, “having health care personnel that have respect for the person’s religion enhances the dying process” (Lujan & Campbell, 2006, p. 184). Strong religious beliefs are also associated with reduced participation in HIV-related activities. At the same time, religion can have positive or negative effect on health outcomes, because various people perceive health conditions differently. For example, some women accessing prenatal health care frequently consider pain as punishment from God or some king of purposeful action from Him. These patients feel that they have little control over their lives and should put their trust in God. Some researchers found the interdependence between the religiosity and hypertension. This health issue was more prevalent among Mexicans of older age who considered themselves as highly religious individuals. The researchers made the suggestion that hypertension was caused by the pressure to conform to high behavioral standards imposed by Christianity (Lujan & Campbell, 2006).

Religious activities of Mexicans have a considerable influence on their health practices. The most common rituals are praying, wearing of religious attributes (like, medals), burning of candles, and praying to God for health (Lujan & Campbell, 2006).

Strong religious believes created the situation when the majority of the population would prefer to seek assistance from a priest for moral concerns, mental health disorders, family problems, and other psychotically issues than go to the professional psychologist. Religion is considered the source of emotional support during stress. Moreover, people turn to religion in a greater extent when they or members of their families have some problems with physical health, like asthma and diabetes type 2 (Lujan & Campbell, 2006). The importance of religion for an individual increases, when a person faces the end of life. Thus, having a health care provider who respects the rituals and traditions, close family relations and necessity of praying and visits of priest is highly important for dying Mexican patients.

Recommendations for Research

The analysis of the available literature helps to provide recommendations for further research. These recommendations concern the four domains of the Purnell Model for Cultural Competence discussed above. The first one refers to the initiation of the additional investigations concerning the ways of communication between health care providers and Mexican patients. The emphasis should be made on the development and assessment of the effectiveness of informing Mexican patients about serious illnesses. This research should collect the information concerning the specifics of communication with Mexicans in stressful conditions, their perception of disadvantageous information, mitigation of emotional conditions, support through verbal and non-verbal languages, etc. All information should be gathered and represented in understandable methodology. Then, this methodology of communication should be applied in real life situation. Specially assigned person would observe the reaction of patients, document them, and provide the relevant outcomes concerning the effectiveness of the proposed solution. Hence, this would be qualitative research.

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The second recommendation relates to the bio cultural ecology. The current work reviled several gaps in accessible literature. It does not covers the topic of differentiations in treatment of representatives of various ethnic groups of Mexican population. As it was mentioned above, the population consists of several groups, which have their roots in other nationalities, like Americans, Europeans, etc. It is recommended to perform additional research concerning the prevalence of certain ethnic groups to the most common diseases in Mexico and make the emphasis on the necessity of providing different care to different representatives of these groups. The research should collect quantitative information concerning the amount of patients with certain illnesses and their ethnicity. The collection of the empirical data would enable analysis of the trend by using the statistical tools and form the relevant outcomes, which lead to understanding whether the representatives of various ethnicities have prevalence to different illnesses. The recommendation concerning the development of various caring methodologies for these ethnic groups would be based on the above-mentioned outcomes and on the information from various literature. Hence, such research would incorporate mixed mythology, i.e. both qualitative and quantitative.

The additional attention should be paid to further research of disease and health condition of Mexicans. It is recommended to study the interconnection between the major reasons of death in the country: diabetes mellitus of type 2, heart diseases, cancers, and respiratory diseases. These illnesses can have similar causations. It is proposed to reveal the main reasons. This study would be rather useful for the further development of initiatives directed on the minimization of number of these illnesses by using a complex approach. This study should be performed by using quantitative research. The statistical information, concerning the patients who suffer from these diseases and the similarities in their behavior, way of living, nutrition, symptoms, should be collected and analyzed. The analysis of this information would enable researchers to determine the same causes and develop the effective strategies for their elimination or minimization of their influence on the health of Mexicans.

The last recommendation concerns spirituality of Mexicans. As it was noted above, these people are very religious and highly value the specific attitude (like, respect and loyalty) from the side of health care providers. During the information search concerning this domain of the Purnell Model for Cultural Competence, there were no sources found concerning the specifics of providing care to pregnant women when they stay in hospital after the birth of the child. As per personal understanding, this event should be additionally researched, because health care providers should not violate the existing religious tradition concerning birth giving (consciously and unconsciously). It is proposed to use qualitative research with the application of phenomenology and perform deep study of this issue. This study can be realized by any student or employee of health care providing institution. The outcomes of the study can be used to develop special recommendations to doctors and nurses directed on increasing the understanding of traditions concerning the pregnancy of Mexican women and increasing the effectiveness of treatment. This research would also help minimize any misunderstandings, which may arise during care giving.

Application to the Practice

The information provided in the current work and the proposed recommendations are rather useful to nursing practice, because this information can improve the quality of medical treatment. The study of communication domain provides the understanding that health care providers should pay additional attention to the silence of patients. Mexicans are considered rather communicative people and their silence can hide a great variety of emotions. Hence, it is extremely important to understand the reasons of such behaviors. To solve this issue, nurses can ask additional questions and build closer contact with patients.

The description of the second domain forms the understanding that Mexican people represent the mix of various races and ethnicities. The additional research on the differences of illnesses and treatment of various ethnic groups would enable to use more effective practices and improve the quality of health care.

The analysis of the information concerning disease and health condition revealed the major causes of death of children of different age groups and adults. This information provides encourages health care providers to pay attention to the symptoms of the common diseases during the pretreatment examination. This knowledge would enable faster diagnosis and treatment of illness.

The study of spirituality gives the understanding that Mexican people tend to discuss their psychological problems with their priests instead of searching help from professionals. Hence, nurses should consider the mood and emotions of patients and thoroughly explain the necessity to refer to the professional psychologists by making the emphasis on the fact that they can help in dealing with stresses.


Thus, the current work provides the description of the following four domains of the Purnell Model for Cultural Competence: communication, bio-cultural ecology, disease and health conditions, and spirituality. These domains were applied to the life of Mexicans. These people are considered rather outgoing. In the same time, their silence can be caused by the great variety of reasons, including anger and inconvenience. Hence, health care providers should determine the reasons of this silence. Moreover, these people prefer to avoid direct eye contact. Mexicans have deep roots in the great variety of ethnicities, representing Europeans, Native Americans, Southern Americans, Africans and event Turkish people. The most common language is Spanish. However, the government also recognizes a great number of other national languages, which can be freely spoken and used in official documents. Mexicans suffer from diabetes mellitus of type 2, heart diseases, cancers, and respiratory diseases. These illnesses have close connection with nutrition and the lifestyle of citizens of this country. It should be also mentioned that Mexicans are highly religious people. The majority of the population is Catholics. This distinct feature has both positive and negative influences on the attitudes of people towards their illnesses. Moreover, they tend to refer with their psychological problems to priests instead of seeking help from professionals. This literature review of four domains forms the background for the development of recommendations for further research. The aim is to fill the gaps in the literature. The first recommendation is to develop methodology of the effective informing and communication with Mexican patients who have severe illnesses. The next recommendation suggests studying the prevalence of various ethnic groups to different diseases. The third suggestion is to determine similar causes of major diseases. The last recommendation is to study the religious beliefs when providing care to pregnant women and treating them during the after birth period. All the information provided in the current work has the aim to improve the quality of health care offered to Mexicans through the better understanding of distinct characteristics of their life and culture.

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