Effective health care intervention with various ethnic groups requires special attention to cultural differences. This is especially true for elderly Mexican Americans, many of whom retain a strong attachment to indigenous values, including those about health care. Culturally specific beliefs and attitudes about folk healing play an essential role in elderly Mexican Americans' approach to their own health and use of health care resources. Despite this fact, little knowledge is available about the role of folk healing in the lives of this population.
MEXICAN FOLK HEALING
Mexican folk healing evolved from early Aztec and pre-Columbian civilizations. In Mexican American communities today, folk healing is referred to as curanderismo. In this article, folk healing is defined broadly as a set of health beliefs and practices derived from ethnic and historical traditions that have as their goal the amelioration or cure of psychological, spiritual, and physical problems. These health beliefs are based on notions that healing is an art that includes culturally appropriate methods of treatment delivered by recognized healers in the community who capitalize on a patient's faith and belief systems in the treatment process (Trotter & Chavira, 1981). It involves beliefs in "natural" and "supernatural" illnesses, a metaphysical connection to the spiritual world, and a view of God's divine will and centrality in all aspects of life. Healing is administered by individuals who have a divine gift (don) for healing and who intervene through natural or supernatural means of treatment.
Folk healing can be practiced informally with families and neighbors by individuals not recognized by the community as folk healers (Woyames, 1981) using home remedies such as herbs, candles, and other healing paraphernalia (Mayers, 1992), or it may be practiced by specialized practitioners known as curanderos (Trotter & Chavira, 1981). There are other well-known and respected folk medicine practitioners such as herbalists (yerberos), bone and muscle therapists (hueseros and sobadores), and midwives (parteras) (De La Cancela & Martinez, 1983). Because there is considerable overlap in practices and beliefs among practitioners and patients, labels have limited value in identifying discrete categories and functions of natural healers (Vega, 1980).
The best-known folk healer, the curandero, is recognized by the community to treat individuals with physical, spiritual, and psychosomatic illnesses as well as traditional folk illnesses (Mayers, 1992). A curandero may intervene at various levels, including the spiritual, mental, and material level (Trotter & Chavira, 1981). Traditionally, Mexican American communities have included a great number of curanderos; however, because their existence is a closely guarded secret to outsiders and even to many residents of the community, it is often impossible to estimate the number of curanderos.
Within any community, the extent of folk healing use varies depending on the strength of the traditional belief system and the availability of folk specialists. In communities such as border towns, folk healing is prevalent and a part of a dual health care system of conventional and traditional medicine (Trotter, 1982). The size of the community does not affect the use of folk healers as much as satisfaction with conventional medical care, language, self-perceived health status, and income (Higginbotham, Trevino, & Ray, 1990).
HEALTH CARE SERVICES UTILIZATION
A number of researchers have studied the determinants of and barriers to health care services utilization by Mexican Americans and other Latinos (Anderson, 1968; Anderson, Lewis, Giachello, Aday, & Chiu, 1981; Anderson & Newman, 1973; Veeder, 1983). Although these studies discussed the use of modern services, they generally tailed to recognize folk healing. Other studies have emphasized ethnographic description of folk methods, beliefs, and remedies in the Mexican American population in general, but relatively few have examined the effects of ethnic group influences and cultural beliefs on the health care practices of elderly Hispanic people (Eve & Friedsam, 1979; Lopez-Aqueres, Kemp, Staples, & Brummel-Smith, 1984; Woyames, 1981). …