ISSN: 0443-511
e-ISSN: 2448-5667
Herramientas del artículo
Envíe este artículo por correo electrónico (Inicie sesión)
Enviar un correo electrónico al autor/a (Inicie sesión)
Tamaño de fuente

Open Journal Systems

Cultural domain of the causes of diabetes in three generations of popular stratum in Guadalajara, Mexico

How to cite this article: García de Alba-García JE, Salcedo-Rocha AL, Hayes Bautista D, Milke Najar ME. Cultural domain of the causes of diabetes in three generations of popular stratum in Guadalajara, Mexico, México. Rev Med Inst Mex Seguro Soc. 2015 May-Jun;53(3):308-15.



Received: June 26th 2014

Accepted: January 26th 2015

Cultural domain of the causes of diabetes in three generations of popular stratum in Guadalajara, Mexico

Javier E. García de Alba-García,a Ana L. Salcedo-Rocha,a David Hayes Bautista,b María Eugenia Milke Najarc

aUnidad de Investigación Social, Epidemiológica y de Servicios de Salud, Instituto Mexicano del Seguro Social/Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara

bCentro de Estudios de Salud y Cultura Latinas, Universidad de California, Los Ángeles

cCentro Universitario de Ciencias de la Salud, Universidad de Guadalajara

Guadalajara, México

Communication with: Ana L Salcedo-Rocha

Telephone: (55) 3617 0060, 3668 3000, extensions 31818 y 31887


Background: The growing prevalence of diabetes must be confronted in several ways. Establishing the generational transmission of cultural knowledge offers some guidelines to prevent and control the disease. Once we identify and compare the semantic structures of shared knowledge we lay the foundations of a culturally comprehensive care. The objective was to characterize the main elements about cultural domain of the causes of diabetes in a population of grandparents, parents and children belonging to popular strata in Guadalajara, Jalisco, Mexico.

Methods: A cognitive anthropological study performed in 104 subjects selected randomly in Guadalajara. We applied the free listing technique in order to obtain the semantic model and the average of cultural knowledge on the causes of the disease through a consensus analysis.

Results: The studied groups were divided by generation: grandparents, parents and children. The data evidences intergenerational transmission, in form of a basic semantic structure, and a significant consensus around a single model.

Conclusions: The semantic structure on the causes of the diabetes includes: a) the emotions, as traditional dimension; b) certain behaviours related with the lifestyle, as everyday dimension; c) some biomedical concepts, like an emergent dimension.

Keywords: Type 2 diabetes mellitus; Cultural domain; Cultural consensus

Type 2 diabetes mellitus (DM2) is a global public health problem that has surpassed generational barriers. It currently affects 140 million people, and in two decades 300 million will suffer from it.1 In Mexico, the prevalence of DM2, 6.7% in 1993, increased to 8.2% in 2000,2 and in 2012 it was 14.6%.3

This increase has affected the response capacity of health institutions and threatens the financing of services,4 plus it raises other challenges, such as glycemic control in patients with DM2.5 It is estimated that this control is exercised in 35.8% of patients in the United States6 and in Mexico it ranges between 36 and 28%.2,7

This implies a challenge to the current model of DM2 care, which aims to promote the prevention and effective treatment of this disease.8

The spatial and temporal extent and complexity of the DM2 problem requires considering its cultural importance, which we believe has as much influence as transgenerational genetic and epigenetic effects.9,10 An example is some associated risk factors, such as obesity.11  

The process of cultural agreement is a complex consensual phenomenon that involves aspects of social reproduction and identity, linked in turn with customs, knowledge, practices, images, worldview, etc. This transmission has been evidenced as semantic similarity, which permeates health-related behaviors (in members of a family), an interaction in which knowledge and beliefs underlie these behaviors. Here we define the need to investigate these to integrate a broader conceptual framework.12

The importance of cultural consensus on chronic diseases has been highlighted in several studies,13 which have shown how the urban Latin American population continues to believe in explanatory models of disease that are different from the biomedical. This has obvious implications for care.8,14

Medical anthropology considers cultural knowledge as a process that takes place based in the patient, i.e., from their culture, where people give value, meaning, and significance to their ailments and health, as the bases of their quality and style of life.

Understanding and considering this knowledge from a transgenerational perspective can help obtain evidence for care with better human quality, mainly before the present and future challenges posed by DM2.15 Therefore the theoretical orientation of this work is the cognitive aspect of anthropology, which, through the theory of consensus,16 gives us evidence in specific groups of people and cultural models of a particular aspect of reality or semantic domain, in our case that of the cause of DM2 in three generational groups of the lower classes.

Although there are various definitions of culture, for this work we understand it as shared knowledge of systems of meanings and significance, communicated by natural language and other symbol systems with representational, directive, and affective functions that are capable of creating other cultural entities and giving a particular meaning to reality.17

Note that, like all social processes, culture affects and is affected by other systems of personality and of material and immaterial life. As a structuring and structured structure, this shared knowledge ensures intergroup and intragroup variability of constructed cultural models, either by sharing the culturally agreed knowledge or by social or economic restrictions in the context of the actors,18 which influences the behavior, attitudes, beliefs, norms, and values ​​of everyday life of these people.

The method for determining existence according to the construction of cultural knowledge is called cultural consensus analysis16,18,19 and it requires three conditions for it to be achieved:

  • The exploration of a single cultural domain at a time, which in our case is the causes of DM2.
  • Individual and spontaneous response according to the domain explored, the causes of DM2, which is rescued by structured technique (the next condition).
  • The application of questions, which must be formulated and answered independently by and for each respondent.

Our objective was to characterize the main elements related with the cultural domain of the causes of diabetes in a population of grandparents, parents, and children belonging to the lower classes in Guadalajara, Jalisco, Mexico.


Cognitive anthropological study, with random representative sample of 104 people over 20 years old, belonging to upper-low and middle-low strata (according to geo-economic classification of the Instituto Nacional de Estadística, Geografía e Informática [INEGI]) and who are residents of the sector Libertad in Guadalajara. These people were selected by block sampling, previously numbered. The minimum size was calculated by the formula for cultural consensus studies, which is based on a proportion of 50% with 95% confidence and 5% error, and 90% potency.18,20

The participants, who gave written informed consent, were members of three generational groups: grandparents (defined as having grandchildren over 18 years), parents (defined as having children over 18 years old) and children (adults aged 18 years and up), who live together in the same housing unit.

The study included adults of both sexes with or without evidence of DM2.

Data collection for the participating researchers was conducted during the second half of 2010, by using a form to gather patient demographic data (age, sex, marital status, education, and occupation), and the use of the technique of free lists, which consisted of asking each participant to express "all known causes that produce diabetes."

The free lists technique was applied to each respondent, by the same trained investigator, independently, in a quiet and private environment in each home. The researcher avoided verbally suggesting answers, encouraging the patient with monosyllables, to express the reasons they considered appropriate.18

The descriptive statistical analysis of the data consisted of obtaining absolute and relative frequencies, means, and standard deviations, according to the measurement scale. With inferential analysis we looked for significant differences (p < 0.05) between the distributions studied; we applied Snedecor F-test for numeric data and chi-squared for categorical data, using the program Epi Info, version 6.4.

Cultural knowledge about the causes of diabetes was obtained with the help of the program Anthropac,19 to obtain:

  • The hierarchical structure of the responses obtained, which integrate the cultural model on the causes of diabetes (location, number of mentions, and percentage).
  • The ratio of the variances of the models considered in a componential analysis, which shows the existence or non-existence of consensus on a semantic model that covers the greatest variability of the causes expressed.
  • The degree of group knowledge, expressed as a correlation between the consensus model and the averaged individual responses.

The protocol was approved by the IMSS Committee for Scientific Research and Ethics, with registration number 2010-785-001.


General features

Table I shows how grandparents, parents, and children, as generational groups, showed statistically significant differences in some characteristic variables, such as average age 69, 49 and 28 (F = 304, p < 0.001); marital status: mostly married (chi-squared = 73.6, p < 0.000); schooling inversely proportional to average group age (F = 251, p < 0.000); the percentage who have social security, mostly grandparents (chi-squared = 35.64, p < 0.000); the percentage of productive employment, inversely proportional to average group age (chi-squared = 17.86, p = 0.001); the proportion of people with parental history of diabetes, which was inversely proportional to average group age (chi-squared = 13.28, p = 0.01); and the percentage of subjects with history of diabetes, which was directly proportional to average group age (chi-squared = 33.26, p = 0.000).

Table I General characteristics of the three generational groups (N = 104)
Generational group
Grandparents Parents Children
n= 23 n= 37 n= 44
Age (in years) 69.95 ± 9.23 48.78 5.13 ± 28.72 ± 6.04
Education (in years) 5.17 ± 4.54 8.29 ± 3.27 10.63 ± 3.05
Mon thly income (in pesos) 1.56 ± 1.53 2.72 ± 2.24 3.18 ± 2.04
Weight (in kg) 71.33 ± 12.07 79.66 ± 13.03 75.97 ± 24.45
Height (in m) 1.56 ± 0.12 1.59 ± 0.09 1.64 ± 0.100
BMI (in kg/m2) 29.25 ± 5.91 31.12 ± 4.77 27.74 ± 6.67
Waist (in cm) 96.65 ± 24.39 96.36 ± 25.75 88.96 ± 24.84
Glucose (in mg/dL 150.78 ± 112.33 116.55 ± 37.89 104.18 ± 20.15
SBP * (in mm HG) 127.39 ± 48.78 131.1 ± 1635 118.52 ± 15.30
DBP * (in mm HG) 72.08 ± 24.97 83.91 ± 1019 75.5 ± 10.85
Pulse (in beats per minute) 69.65 ± 26.77 74.67 ± 21.79 80.43 ± 12.37
% % %
Sex Men 43.47 Men 32.43 Men 43.18
Women 56.52 Women 67,56 Women 56.81
Marital status Married 47.82 Married 81.08 Married 70.45
Single 8.69 Single 16.21 Single 25
Widowed 43.47 Divorced 2.70 Widowed 2.27
Divorced 2.27
Residential status Citizen 100 Citizen 97.29 Citizen 100
Other 2.70
Nationality Mexican 100 Mexican 97.29 Mexican 100
Other 2.70
Social security No 21.73 No 62.16 No 50
Yes 78.26 Yes 37.83 Yes 50
Occupation In the home 34.78 Employee 35.13 In the home 27.27
Retired 17.39 In the home 40.54 Employee 40.90
Employee 13.04 Unemployed 5.40 Unemployed 9.09
Unemployed 21.73 Laborer 2.70 Student 2.27
Laborer 4.34 Business-owner 16.21 Business-owner 13.63
Business-owner 8.69 Laborer 6.81
Fa ther's disease history High blood pressure 13.04 Diabetes mellitus 27.02 Diabetes mellitus 34.09
Diabetes mellitus 17.39 High blood pressure 16.21 High blood pressure 13.63
Obesity 8.69 Hypercholesterolemia 2.70 Hyperuricemia 4.54
Other 4.34 CVD 5.40 Hypercholesterolemia 4.54
None 65.21 Other 13.51 Obesity 9.09
None 51.35 None 47.27
CVD 9.09
Mother's disease history* High blood pressure 17.39 Hypercholesterolemia 5.40 High blood pressure 15.90
Diabetes mellitus 21.73 High blood pressure 21.62 Diabetes mellitus 9.09
Obesity 8.69 Obesity 10.81 CVD 9.09
Hypercholesterolemia 4.34 Diabetes mellitus 29.72 Obesity 4.54
Other 4.34 CVD 16.21 Other 2.27
None 52.17 Other 8.10 None 72,72
None 37.83
Personal disease history Hypercholesterolemia 4.34 High blood pressure 13.51 High blood pressure 4.54
High blood pressure 39.13 Diabetes mellitus 18.91 Diabetes mellitus 2.27
Obesity 13.04 Hypercholesterolemia 8.10 Uric acid 2.27
Diabetes mellitus 52.17 Hyperuricemia 2.70 Cholesterol 6.81
CVD 4.34 Obesity 10.81 Obesity 6.81
Other 17.39 Other 21.62 None 70.45
None 30,43 None 48.64 Other 9.09
Bad habits Television 95.65 Television 89.18 Television 93.18
Soft drinks 69.56 Soft drinks 72.97 Soft drink 81.81
Tobacco 17.39 Beer 16.21 Beer 22.72
Liquor 4.34 Tobacco 29.72 Tobacco 36.36
Beer 13.04 Table wine 2.70 Liquor 6.81
None 2.70 Table wine 2.27
None 2.27
BP = blood pressure; CVD = cerebrovascular disease
* Did not present statistical differences

In somatometry, height was greater in the younger generations (F = 5.29, p = 0.006); body mass index (BMI) was of overweight-obesity in all cases (F = 3.31, p = 0.04); waist was at-risk for grandparents and parents (F = 1.14, p = 0.02); also, in some metabolic parameters such as glucose, the average was definitely high in grandparents (F = 4.82, p = 0.009). The average diastolic blood pressure was higher in parents (F = 5.31, p = 0.006).

In addition, participants did not show statistical differences in sex ratio (chi-squared = 3.42, p = 0.18), maternal history (chi-squared = 5.89, p = 0.20), weight (F = 1.43, p = 0.24), systolic blood pressure (F = 2.35, p = 0.10) and pulse (F = 2.38, p = 0.09) (Table I).

Cultural consensus model

Table II shows the semantic models of grandparents, parents and children about the causes of diabetes

Table II Semantic models of causes reported by each generational group
Cause Grandparents
n= 23
n= 37
n= 44
Place % Place % Place %
Shock 1st 48 3rd 24 2 nd 34 Hierarchical structure of shared cause items:
Chi-squared = 10.18
Degree of freedom = 10
p= 0.42
Anger 2 nd 26 6 th 14 5 th 18
Obesity 2 nd 26 2 nd 38 5 th 18
Poor diet 5 th 17 1st 46 1st 39
Foods wi th sugar 5 th 17 4. 22 7 th 14
Joys 7 th 13 8. 8 10 th 7
Mortification 4. 22
Lack of exercise 4. 22 7 th 14
Genetics 7th 14 3rd 32
Overweight 4. 20
Fats 9 th 11
Stress 11 th 3
Ratio of variances between the first and the other estimated models 20.22 accounting for 92% of total variability 22.61 accounting for 93% of total variability 23.10 accounting for 92% of total variability High level of consensus and cultural knowledge for a single semantic model of causes
Group knowledge
Standard deviation
± 0.06
± 0.05
± 0.05

  1. They basically share the same items for causes (with statistically insignificant differences).
  2. The younger the group studied, the more the model incorporates causal items of a biomedical nature.
  3. The model of shared knowledge presents for componential analysis a ratio of variances greater than 3.0, which covers over 90% of the total variability of the causes indicated, which shows significantly that the cultural agreement of the group is mostly in consensus regarding the structure of the semantic model 
  4. All groups showed an average level of group knowledge of the model greater than 0.70.

The sample is representative of the upper-low and middle-low strata of the Libertad sector of the city of Guadalajara, and although it has the causal constraints of a quantitative cross-sectional study, it should be noted that its internal validity and cultural approach encourages the need to deepen the theme studied, given the demographic importance of the lower classes in urban areas of the country, in order to understand their perspective on the genesis of diabetes and improve health promotion.

Moreover, in the results reported, the differences are mainly explained by the socio-biological characteristics of the three groups studied.

In contrast, semantic models found in the three groups express generational agreement as similarities in their semantic elements (p = 0.42), which we believe are mediated by the culture that the informants share and control.11

We think that the items or elements that make up the semantic model of each generation are the cultural result of generational dynamics, related to the process of socialization and the experience of disease.21

In the structures of the generations we found that three major cognitive dimensions coexist:

• The traditional, which is related to emotional elements: shock, anger, mortification, and joy, which show the affect based in ancestral folk knowledge.

• The everyday, which is related to components of the lifestyle of lower-class groups: poor diet, foods with sugar and fat, lack of exercise,

• The emerging, which is built based on modern biomedicine and is gradually shared by the generations studied: genetics, obesity, overweight, and stress.

This three-dimensional model, in the three generations studied, presents high rates of shared knowledge (> 0.80), results that are consistent with other studies,6,22 but conducted in populations that do not differentiate generational groups, so our results show not only the existence and permanence of a lay cultural model, but also suggest the movement of shared cultural knowledge, in this case three generation groups from the lower classes, urban area inhabitants, for the causes of diabetes.

This leads us to suggest that the model found lies in a process of generational cultural transmission that works to, first, maintain the tradition that survives in Mexico to attribute loss of health to "strong" emotions (such as shock),23 causes that come before biomedical disease etiology and embody illness in the experience of people, to reconfigure their identity and to make sense of current stress and psychological distress,24 especially if we consider that the lower classes historically suffer structural violence, whether social, gender, or family. Hence their mentioning causes such as shock, anger, rage, and even redefining paradoxical emotions such as joy. 

Secondly, this process of cultural transmission serves to express priorities within the daily life of the lower classes, in which the satisfaction of the daily requirement of feeding oneself7 makes the food component occupy a prominent place, ranging from 43, 38 and 45% (p = 0.58) for generations of grandparents, parents and children, and thus the health and functionality of the individual is maintained.

Thirdly, this process serves to incorporate and adapt to its existence the impact of contemporary biomedicine, as it adds new items from this discipline: 25% in the generation of parents and 45% in the children.

According to Segall and Goldstein,25 similarities and differences found between and within the semantic models described, include and express, at first, the way people link health and disease patterns to wealth and poverty. For example, until the twentieth century, obesity was a marker of wealth, and malnutrition a marker of poverty. However, the development of a consumer economy paradoxically fostered obesity in poverty,11 which produced a high prevalence of overweight-obesity (> 70%)3 in the lower classes.

In a second stage, these similarities and differences explain for Segall et al. the incorporation of critical attitudes of dissatisfaction or recognition of the limits of biomedicine, as well as some traditions related to care practices, such as: the main causes have an external locus of control,26 such as those of emotion and food, which are issues that involve tensions with health professionals (as they favor the culture of reprimand, prohibition, and enforcement), a situation that requires understanding to facilitate self-care and care; otherwise, educational activities might seem like coercion by the health team.

In a third stage, these similarities and differences explain for Segall and Goldstein lay or specialized knowledge on the effects of lifestyle on health and the desire to exercise or not their personal responsibility for health. For example, it is said that the idea of ​​chronic disease is not well digested by the community, which sees many of its causes as reversible, causing treatment failures in the lay population, which believes that simply by no longer eating sweets, resting, or drastically reducing daily intake, their health will improve; however, by proposing this in a communication context of care, though formalistic, it may be defective, because of failure to use indirect communication for bad news, highly respected in lower classes, for whom conversational customs involve ritual presentation, demonstrations of respect, tranquility in the topic (not hurried) and relative proximity (a situation that is sometimes left out when communicating the diagnosis of diabetes).

The intergenerational transmission of knowledge and health behaviors is given by mechanisms such as values, socialization, assigned roles (whose extent depends on the presence of parents), quality of the relationship, similarity of gender, inherited status, exposure to similar structures of opportunity and, in the case of young adults, the propensity to use cultural stereotypes disseminated by the media, and religion.27 For example: socialization in the family makes its members learn what disease is and how it is treated; that is, as a mechanism for selection, it also homogenizes the cultural capital of its members, the experience of the disease. Especially if it is chronic.28

Thus the cultural dominance of the causes of diabetes evidences a complex process in which the dimensions are dynamically constructed and reconstructed: traditional, which maintains folk significance and meanings; everyday, product of domestic praxis for meeting basic needs; and the emerging, harmonizing this knowledge with modern biomedical care.

For this last reason it is necessary, among other things, to take into account the generational aspect to provide culturally comprehensive care when implementing specific adjustments to programs for prevention and control of diabetes.

Cultural studies formalize what appears obvious, as in the case studies of generational knowledge of the causes of diabetes mellitus, which can help create alternative programs29,30 that take into account the three dimensions of lay causality for diabetes mellitus, adapting these programs to group subculture, whether they are applied individually or in groups, both for healthy individuals and patients with type 2 diabetes mellitus, during institutional opportunities, being attended by the health team, situations in which it is possible to influence not only by increasing their knowledge, as is traditionally done, but also to develop skills and practices that generate self-confidence in the patient and consciousness in the health team.


A representative sample of grandparents, parents, and children belonging to the upper-low and middle-low strata in the sector Libertad in Guadalajara presented a model of lay causes of diabetes mellitus, similar in shared semantic elements, for three dimensions: traditional, everyday, and emerging. This structure can be a useful means of establishing culturally comprehensive educational programs for both patients and the health team.


The project received INN03D support from the Programa de Investigación en Migración y Salud (PIMSA), the Initiative for the Americas, and California Program on Access to Care to Berkeley School of Public Health.


We thank PIMSA for their support (INN03D) for the development of this work.

  1. Wild S, Roglic G, Green A, Scriee R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-53.
  2. Aguilar-Salinas CA, Velázquez-Monroy O, Gómez-Pérez FJ, González-Chávez A, Lara-Esqueda A, Molina-Cuevas V, et al. Characteristics of patients with type 2 diabetes in Mexico: results from a large population-based nationwide. Diabetes Care. 2003;26(7):2021-6.
  3. Encuesta Nacional de Salud y Nutrición 2012. Resultados Nacionales. Cuernavaca, México: SSA. INSP; 2012.
  4. Hernández Romieu AC, Elnecavé-Olaiz A, Huerta-Uribe N, Reynoso Noverón N. Análisis de una encuesta poblacional para determinar los factores asociados al control de la diabetes mellitus en México. Salud Pública Méx. 2011;53(1):34-9.
  5. Shah BR, Hux JE, Laupacis A, Zinman A, van Walraven C. Clinical inertia in response to inadequate glycemic control: do specialists differ from primary care physicians?. Diabetes Care. 2005;28(3):600-6.
  6. Koro CE, Bowlin SJ, Bourgeois N, Fedder DO. Glycemic control from 1988 to 2000 among US adults diagnosed with type 2 diabetes: a preliminary report. Diabetes Care. 2004;27(1):17-20.
  7. García de Alba JE, Salcedo Rocha AL, López Coutiño B. Una aproximación al conocimiento cultural de la diabetes mellitus tipo 2 en el occidente de México. Desacatos. 2006 May-Ago;(21):97-108.
  8. García de Alba García J, Salcedo Rocha AL, López I, Baer RD, Dressler W, Weller SC. “Diabetes is my companion”: lifestyle and self-management among good and poor control Mexican diabetic patients. Soc Sci Med. 2007 Jun;64(11): 2223-35.
  9. Martorell R. Diabetes and Mexicans: why the two are linked. Prev Chronic Dis [Internet]. 2005 ;2(1):A04 [aprox. 5 p.]. Available from
  10. Day T, Bonduriansky R. A unified approach to the evolutionary consequences of genetic and non genetic inheritance. Am Nat. 2011;178 (2):E18-36.
  11. Hosper K, Nicolau M, van Valkengoed I, Nierkens V, Stronks K. Social and cultural factors underlying generational differences in overweight: a cross-sectional study among ethnic minorities in the Netherlands. BMC Public Health [Internet]. 2011 ;11:105 [aprox. 10 p.]. Available from
  12. Cardol M, Groenewegen PP, Spreeuwemberg P, Van Dijk L, Van Den Bosch WJ, De Baker DH. Why does it run in families? Explaining family similarity in help-seeking behaviour by shared circumstances, socialisation and selection. Soc Sci Med. 2006;63(4):920-32.
  13. Dressler WW, Dos Santos JE. Social and cultural dimensions of hypertension in Brazil: a review. Cad Saúde Pública. 2000 Apr-Jun;16(2):303-15.
  14. Díaz-Nieto L, Galán-Cuevas S, Fernández-Pardo G. Grupo de autocuidado de diabetes mellitus tipo II. Salud Pública Méx. 1993;35(2):169-76.
  15. Beléndez-Vázquez M, Méndez FX. Procedimientos conductuales para el control de la diabetes. En: Simón MA, coord. Manual de Psicología de la Salud: fundamentos, metodología y aplicaciones. España: Biblioteca Nueva; 1999. p. 487.
  16. Rommey AK, Weller SC, Batchelder WH. Culture as consensus: A theory of culture and informant accuracy. Am Anthropologist. 1986;88(2):313-38.
  17. D’Andrade RG. Cultural meanings systems in culture theory: essays on mind, self and emotion. Eds.: Richard A Shweda, Robert A Levine. Cambridge: Cambridge University Press; 1984. pp. 87-119 .
  18. Weller SC, Rommey AK. Systematic data collection. Beverly Hills, CA: Sage; 1988. (Qualitative Research Methods; v. 10).
  19. Ruiz A, Gomez C y Londoño D. Investigación clínica: epidemiología clínica aplicada. Bogotá: Centro Editorial Javeriano; 2001.
  20. Borgatti S. Anthropac Software 3.02. Columbia: Analytic Technologies; 1990.
  21. Weller SC. Shared knowledge, intracultural variation and knowledge aggregation. Am J Behav Sci. 1987;31(2):178-93.
  22. Weller SC, Baer RD, Patcher LM, Trotter RT, Glazer M, García de Alba García JE, et al. Latino beliefs about diabetes. Diabetes Care. 1999;22(5):722-8.
  23. Rubel AJ. The epidemiology of a folk illness. Susto in Hispanic America. Ethnology. 1964;3(3):268-83.
  24. Mendenhall E, Seligman RA, Fernández A, Jacobs EA. Speaking through diabetes: rethinking the significance of lay discourses on diabetes. Med Anthropol Quartely. 2010;24(2):220-39.
  25. Segall A, Goldstein J. Exploring the correlates of self-provided health care behavior. Soc Sci Med. 1989;29(2):153-61.
  26. Tillotson LM, Smith AS. Locus of control, social support and adherence to the diabetes regimen. Diabetes Educ. 1996;22(2)133-9.
  27. Liefbroer AC, Elzinga CH. Intergenerational transmission of behavioral patterns: similarity of parents´ and children’s family life trajectories. Forthcoming 2006.
  28. Charmaz K. Experiencing chronic disease. In. Albrecht GL, Fitzpatrick R, Scrimshaw SC. The handbook of social studies in health & medicine. London: Sage; 2003. p. 277-92.
  29. Haro-Encinas JA. Cuidados profanos: una dimensión ambigua en la atención de la salud. En: Perdiguero E, Comelles JM, editores. Medicina y Cultura. Estudios entre la antropología y la medicina. Barcelona: Bellatera Editorial; 2000. p. 101-61.
  30. Salcedo-Rocha AL, García de Alba-García JE, Sevilla E. Dominio cultural del autocuidado en diabéticos tipo 2 con y sin control glucémico en México. Rev Saúde Púb. 2008;42(2):256-64.

Conflict of interest statement: The authors have completed and submitted the form translated into Spanish for the declaration of potential conflicts of interest of the International Committee of Medical Journal Editors, and none were reported in relation to this article.

Enlaces refback

  • No hay ningún enlace refback.