Dichos en la salud: Development of a dichos-based weight loss curriculum for Mexican-origin men: A mixed methods study



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Mexican-origin men suffer disproportionate rates of chronic disease and are underrepresented in the health literature. This dissertation contains three separate investigations on Mexican-origin men. First, health perspectives were explored through phenomenological interviews (n = 15; 40 - 64 y). The men stated a reactive health culture, valemadrismo, and socioeconomic status as primary barriers to health. Educational preferences included culturally relevant Spanish material. The second study involved a content analysis of the interview transcriptions. Content analysis revealed that men utilize dichos, culturally established Spanish metaphors, in health discussion. The findings demonstrated how dichos may help identify patient perspectives and simplify complex health concepts. The purpose of the final investigation was to develop a dichos-based health curriculum, since dichos remained the only unexplored cultural dimension in the health literature. We conducted a three-phase formative assessment involving a mixed methods review of dichos, community advisory board, and formative review. Phase I involved one-on-one semistructured interviews among 12 participants (52.9 ± 5.1 years; 35.4 ± 4.1 BMI) with a pile sort of dichos into health topics. Most (11/16) of the dichos were recognized by 100% of the participants and the majority (75%) of the men supported dichos for health education. Phase II curriculum development involved the integration of dichos


and behavior theories using the DESIGN Process. A community advisory board provided input for language simplification and session content. The final formative assessment on knowledge gain and cultural appropriateness was completed by 9 curriculum naïve men (55.8 ± 5.7 years; 33.2 ± 4.7 BMI). The knowledge assessment involved a developed, curriculum specific test. Cultural appropriateness was assessed on a 5-point scale previously validated and utilized among Hispanics. Knowledge scores showed an increase from pre (76.6 ± 8.4) to post (97.2 ± 4.2) review. The overall curriculum rating for cultural appropriateness was 4.9 ± 0.2. The curriculum was well received and supported because of its cultural familiarity of dichos and visuals. The data suggest that dichos may serve as an educational tool to counter, compliment, and simplify health concepts. This first ever dichos- based health curriculum provides insight on the educational utility of dichos for education among Mexican men.



Dichos, Cultural tailoring, Metaphors, Linguistics, Health disparities, Hispanic health