Received: 23 September 2019 | Revised: 10 August 2020
DOI: 10.1002/jcop.22440
SPECIAL ISSUE ARTICLE
Construction of an intercultural preventive
strategy of alcohol use in rural Mapuche
communities: A community‐based participatory
research
Alba Zambrano1 | Gabriela Garcés2
Miguel Treumún4 | Francisca Román1
1
Department of Psychology, Universidad de
La Frontera, Temuco, Chile
2
Fundación Tierra de Esperanza, Temuco,
Chile
3
Department of Psychology, Magíster y
Especialización en Psicología Comunitaria,
Universidad de La Frontera, Temuco, Chile
4
Lonko Comunidad Mapuche de Coipuco,
Carahue, Chile
Correspondence
Department of Psychology, Universidad de La
Frontera, Temuco 4811230, Chile.
Email: Alba.zambrano@ufrontera.cl
J Community Psychol. 2020;1–20.
| Accepted: 13 August 2020
| María P. Olate3 |
Abstract
The research presented in this paper consists of a case
study that analyses the elements necessary for a culturally
grounded methodological strategy for the prevention of
problematic alcohol consumption in rural Mapuche com-
munities in the Araucanía region. To do this, we proposed
to answer the questions: what are the particularities that
alcohol consumption adopts in the local space? And what
are the elements that should be considered for an inter-
cultural preventive strategy for alcohol consumption?
Oriented to the perspective of community‐based partici-
patory research, data were collected through group inter-
views with the local community, participant observation
and in‐depth interviews with people who consumed alco-
hol, were recovering from consumption and nondrinkers. A
total of 84 people participated and the information gath-
ered was analysed using ATLAS.ti software. The results
show key aspects that must be considered for the design,
including: strengthening the cultural identity, providing
spaces for shared reflection in places where the community
converges (schools and rural health centres), and pro-
blematising alcohol consumption from their own concep-
tions of normal and problematic consumption. Therefore,
there is a need to focus on strengthening intracultural
wileyonlinelibrary.com/journal/jcop © 2020 Wiley Periodicals LLC | 1
2 | ZAMBRANO ET AL.

processes in community spaces, with a preventive strategy

within the logic of action research, with increasing degrees
of community participation.

KEYWORDS
alcohol drinking, community‐based participatory research, culture,
indigenous population, prevention

The Mapuche people are the largest group of original people in Chile. Currently, they constitute 10% of the total
population (Instituto Nacional de Estadísticas, 2017). This population is concentrated in the Metropolitan and
Araucanía regions. “The territorial identities, which constitute the Mapuche people, are defined according to their
geographical location: Pehuenche—people from Pehuen; Huenteche—people of the plain; Nagche—bass people;
Lafkenche—people from the coast; Huilliche—people from the south. These territorial and linguistic identities are
located in seven provinces of the Chilean territory: Arauco, Bío‐Bío, Malleco, Cautín, Valdivia, Osorno and Chiloé”
(Consejo de Todas las Tierras, 1997, p. 13). This study was carried out in the province of Cautín, in the municipality
of Carahue, and in the territory of the Lafkenche people, who are characterised by their roots with the land and
their connection with water areas. Productive activities carried out by this group include the collection of marine
resources in the lake, river and sea, and agricultural activities in the coastal zone, where 16 Mapuche Lafkenche
communities are currently found (Foerster, 2008).
In this article, words from the Mapuche language (Mapudungun) are used according to the unified Mapuche
grafemarium (Sociedad Chilena de Lingüística, 1988). Those words are written in italics through the article and
their meaning given in parentheses.
According to the World Health Organisation (WHO, 2018), excessive alcohol consumption is the main risk
factor for death and disability in the Americas. In addition to being associated with health problems, it is a source of
a variety of psychosocial problems such as domestic violence, loss of labour productivity, unemployment and
economic difficulties.
Indigenous communities in the Americas region are particularly vulnerable to this problem, given the levels of
poverty they face and their limited access to services, especially those for the prevention and treatment of alcohol‐
related problems (Pan American Health Organisation [PAHO], 2016). The impact and influence of the region's
colonial past on alcohol consumption patterns and related problems are also documented, especially the perpe-
tuation of poverty and the destruction of indigenous culture and values (PAHO, 2016).
Despite this, policies have directed little effort to increase knowledge of the specific and dynamic factors
related to problematic consumption in this population. As a result, the responses to reducing social and health
problems related to alcohol in these communities have been limited. The tendency has been to focus on the
treatment of alcoholics, but not on the transformation of the environment where alcohol is used (PAHO, 2016).
According to a WHO report (2018), Chile has the highest alcohol consumption in Latin America with an
annual per capita consumption of 9.3 (litres of pure alcohol), registering a slight increase over the previous
period (8.8 L in 2003/2005). The average in the Americas is 8 L (WHO, 2018). Alcohol consumption is responsible
for 50% of deaths among Chilean men between 15 and 29 years old and 20% among women of this age group
(Castillo‐Carniglia, Kaufman, & Pino, 2013). Regarding the indigenous population, the most prevalent disorders
are related to depression, suicide, and alcoholism. This could be due to indigenous peoples' exposure to certain
social, political, economic, and cultural conditions that are different from those of the general population, which
make them more prone to mental health issues (PAHO, 2016).
ZAMBRANO ET AL. | 3

The Araucanía region presents levels of problematic alcohol consumption that are above the national
average (Servicio Nacional de Prevención y Rehabilitación del Consumo de Drogas y Alcohol [SENDA], 2016).
The problem is that alcoholism is prevalent in areas of high rurality and a high density of indigenous popu-
lation, where it is difficult to achieve an accurate assessment of the situation and to develop effective
prevention tools regarding this issue (Ministerio de Salud de Chile, 2016). Alcohol consumption is associated
with transgenerational cultural patterns, unemployment, and easy access to alcoholic beverages. In the lit-
erature, aspects of sociohistory and identity have been pointed out, such as the introduction of alcohol as an
instrument for the occupation and appropriation of territory, its use as a method of payment, exchange, and
commercial measurement parameter, and its link to agricultural work as a form of reciprocity and mutual help
(Bengoa, 2000; Muñoz Sougarret, 2008). This situation has also been reported among indigenous peoples in
other regions of the world (Dudgeon, Milroy, & Walker, 2014; Kirmayer & Brass, 2016; Paradies, 2016;
Walker, Lovett, Kukutai, & Henry, 2017).
The increase in consumption has meant a deterioration in the quality of life of these communities im-
pacting on family and community economies and on the high incidence of family and social violence (Berruecos,
2013; Clought et al., 2014; Ramamoorthi, Jayaraj, Notaras, & Mahiban, 2014). In this context, the problem is
related to the absence of alcohol use prevention strategies that consider sociocultural and identity issues in
their approach.
Although the preventive approach that is being currently implemented through Chilean public policy ac-
knowledges the need to give relevance to preventive interventions, it does not show a theoretical–methodological
approach to the specific sociocultural factors of Mapuche Lafkenche people and communities. It lacks a specific
strategy that addresses the problem by incorporating its own cultural references (SENDA, 2018).
At an international level, there is evidence regarding the characteristics needed for effective programmes for
specific groups. It has been suggested that the cultural relevance of a programme refers to the incorporation of
considerations or adaptations related to beliefs, values, customs and behavioural patterns contemplating the
historical, contextual, and social conditions of the population (Brown, Dickerson, & D'Amico, 2016; Castro, Barrera,
& Martínez, 2004). It is important to keep in mind that cultural groups are not homogeneous, and this should also
be considered in preventive interventions. This is particularly relevant if we consider that Mapuche people build
their social identity based on their belonging to a specific territory (Foerster, 2008).
Considering the cultural differences in the patterns of substance use and in the predictors of
substance use, authors such as Okamoto, Kulis, Marsiglia, Holleran, and Dustman (2014) suggest that
interventions that take account of the norms and values of the specific groups to which they are targeted are
more effective.
However, it is possible to identify differences among programmes that seek to adjust culturally. On the one
hand, there are authors who raise the need to culturally adapt programmes that show evidence of their effec-
tiveness, which means adjusting language and materials, among other aspects (Falicov, 2009). Other authors
emphasise the importance of building culturally grounded programmes (Lee, Vu, & Lau, 2013; Okamoto, Helm
et al., 2014; Okamoto, Kulis et al., 2014). These approaches put the culture of the participants at the centre of the
design and implementation. That is, the intervention is developed from the values, beliefs, practices and socio-
historical perspectives of the target group (Lauricella, Valdez, Okamoto, Helm, & Zaremba, 2016; Marsiglia &
Booth, 2013; Okamoto, Kulis et al., 2014).
Although the first approach involves creating cost‐effective interventions, its implementation is quicker; the
second, which involves the active participation of the beneficiaries, requires a longer time for design and im-
plementation. However, the benefits of the latter focus on the adjustment of the intervention to the needs,
characteristics, and worldview of the target group, as well as fostering community participation in different stages
of the intervention (Okamoto, Kulis et al., 2014).
4 | ZAMBRANO ET AL.

1 | P A R T I CIP A T O R Y A N D C U L T U R A L LY R E L E V A N T P R E V E N T I V E
STRATEGIES

Consistent with the background outlined above, community‐based participatory research (CBPR; Minkler &
Wallerstein, 2003) approach was adopted for this study. This approach is based on issues of importance to
the community, with the aim of merging knowledge and action for social change (Yonas, Garretson, Gielen, &
Parker, 2013). Community members play an active role in all the stages of the research process: (a) iden-
tifying the needs or concerns of the community, (b) assessing the efficacy of the intervention, and (c)
reporting the research results, while researchers provide a theoretical framework, as well as scientific
systems, and methods of data analysis that guide the research process (May & Law, 2008).
As mentioned by several authors, this study perspective is the paradigm of prevention science
with the greatest potential to develop an evidence‐based prevention programme based on culture (Parsai,
Castro, Marsiglia, Harthun, & Valdez, 2011). It allows the development of postcolonial and hybrid knowl-
edge, which includes the theories and knowledge of the original peoples (Quijano, 2000). At the same time, it
widens the discourse to include the cultural and social meanings of the “world of life” (Wallerstein &
Duran, 2010).
A major challenge for preventive strategies in intercultural contexts lies in responding to the ecological
complexity that they require, but also being able to read how that context has been historically, socially, and
politically structured. In the particular case of this study, it involves entering an area crossed by power relations,
which have affected the development of Mapuche communities.
The evidence produced on the experiences of community preventive intervention shows the efficacy of
strategies that consider prevention as an interactive process, aimed at strengthening the social and community
fabric (Le Bossé, 2007; Zambrano, 2019).
Regarding participation, Labonté and Laverack (2008), have pointed out that trust is key to fostering cohesive
relationships and building capacity through the distribution and delivery of responsibilities. Participation in groups
with shared motivations and a common reality can help people to compete for limited resources and increase the
sense of personal control in their lives. From this perspective, when participation moves towards critical and
problematising participation, it contributes to a process of community empowerment, alongside other conditions
(Baum, 2008; Zambrano, 2019).
The evidence provided by community preventive interventions (Nation et al., 2003) suggests
that the success indicators for the assessment and guidance of the interventions would be: (a) empowering
people and valuing local resources and acquisitions; (b) having planned intervention management with clear,
achievable objectives; (c) establishing alliances with the communities involved; (d) promoting autonomy
and decision‐making power; and (e) using several intervention strategies and resources of different origins
to help the project or the group involved, both internally and externally (Fréchette, 2001). In addition, as
previously stated, in the indigenous population it seems central to consider the explanatory
frameworks and local theories on the development of psychosocial problems and the impact of the processes
of transculturation and loss of culture to design preventive strategies and contents (Garcés &
Zambrano, 2019).
As we have argued, the multicultural context in which the research problem and the
strategy are framed requires observation and consideration of the cultural and identity aspects of the
problem. From a decolonial perspective, authors such as Mitchell, Arseneau, and Thomas (2019), Paradies
(2016), and Sonn, Stevens, and Duncan (2013) stress the need to consider the effects that colonisation
processes and current intercultural relationships, in the context of power inequalities, have on indigenous
populations. Therefore, we next discuss the need to address the construction of preventive programmes, not
only from a strong culturally relevant, participatory and community perspective but also from a noncolonial
approach.
ZAMBRANO ET AL. | 5

2 | A L C OH O L C O N S U M P TIO N FR OM A D EC O L ON I A L P ERS PE C T I VE

Alcohol is used among the different indigenous peoples throughout the Americas; however, the academic literature
shows an increase and change in consumption patterns based on colonisation processes (PAHO, 2016). According
to colonial theories, this growth in consumption is complexly related to the extended position of subordination and
marginalisation of indigenous peoples in contrast to the rest of society (Kirmayer, Gone, & Moses, 2014; Trout, Mc
Eachern, Mullany, White, & Wexler, 2018).
According to decolonial theories, the subaltern condition of indigenous peoples results from the imposition of
the colonial power matrix that remains in force and is based on control of the economy, authority, and knowledge
(Mignolo, 2009). This subordination is materialised in the joint mechanisms of physical and symbolic violence,
which is exercised at various levels of daily life, perpetuating, in a more or less violent way, the cultural weakening
of certain peoples (Quijano, 2015).
The marginalisation of the indigenous population, as a result of the processes described above, leads to
alarming rates of poverty, lack of land, low wages, high unemployment, high rates of illiteracy (especially in
women), school dropout, unsatisfied basic needs and an epidemiological profile where preventable diseases prevail
(PAHO, 2016). It is known from the existing evidence that these conditions are risk factors for problematic alcohol
consumption and alcoholism (Coimbra, Santos, & Escobar, 2003; Menéndez, 1988, Menéndez & di Pardo, 2006).
The concept of Colonial Trauma assumes the historicity of alcoholism in indigenous populations and states that
the loss and denial of cultural identity could be related to a trauma experienced collectively, continuously, cu-
mulatively and that is spread between generations in indigenous communities (Evans‐Campbell, 2008; Hartman &
Gone, 2014; Hawkeye, 2015; Kirmayer et al., 2014; Mitchell et al., 2019). It has been pointed out that the
sociocultural update of trauma has a complex logic, linked to the loss of cultural reference systems, conceptions of
reality, beliefs, values, rules, customs and modes of production. This impacts at a social level with community
dilution and disintegration, and at an individual‐subjective level with the devaluation of one's identity (Mitchell
et al., 2019). It is thought that as there is no opportunity for grief or reconciliation in relation to colonial trauma,
the consequences of this are passed on, becoming intergenerational trauma, which is aggravated and extended like
the transmission of major trauma, producing internal conflicts and a cultural dislocation because of internalised
oppression (Hartman & Gone, 2014; Kirmayer et al., 2014).
When indigenous communities are forced to adopt new cultural modes, in the context of an asymmetric
relationship with the dominant society, they go through processes of transculturation and gradual loss of the
original cultural base (Mujica, 2002). In the case of Chile, these integration mechanisms have been promoted from
the nation‐state, first violently and then through neocolonial integration strategies (Restrepo & Rojas, 2010). Thus,
belief systems and appraisals of the Chilean western cultural system are acquired, from which the belief and
thought systems of the Mapuche people are made invisible and denied. As a consequence, the existence of a hybrid
or highly mixed culture is currently appreciated and subject to the norms of the dominant culture (Marileo &
Salas, 2011).
This background would then link processes of structural and symbolic violence to mental health and substance
abuse problems since indigenous peoples face various forms of stress, exploitation and physical vulnerability as
well as phenomena of discrimination and social exclusion (PAHO, 2016). A central issue in these processes is
cultural identity, which, when weakened by the processes described above, can be associated with important
consequences for the development of people and communities (PAHO, 2016).
The evidence provided by research and experience that links ethnic‐cultural identity with the incidence of
mental health problems shows that cultural identity plays an important role in people's well‐being (Williams, Clark,
& Lewycka, 2018). A study that investigates the construction of self‐esteem in the indigenous youth of Costa Rica
(Román & Moreno, 2010) shows a statistically significant relationship between the formation of ethnic identity and
self‐esteem, confirming that commitment to ethnic practices that came from “indigenous reserves”, was associated
with feelings of high self‐esteem in young people. Another study conducted in Mexico (Guitart, Rivas, & Pérez,
6 | ZAMBRANO ET AL.

2011) correlated data on ethnic identity and self‐esteem from 517 students (256 mestizos and 261 indigenous
people). The correlation was positive and significant in the indigenous group, but negative and not significant in the
case of mestizos, concluding that a positive ethnic identity, linked to personal self‐esteem, would serve to fight
discrimination, negatively correlating with isolation and depression measures.
Meanwhile, evidence from other regions of the world links mental health with a strengthened positive cultural
identity. In Australia, a qualitative study on the perception of 170 indigenous participants belonging to rural
communities suggested that the approach of identity, life project, sense of hope, and the incorporation of family
and elderly bearers of culture are part of an effective and preventive rehabilitation process (Nichols, 2010).
Another study conducted in Canada correlated suicide rates with the use of native language in indigenous com-
munities, showing that youth suicide rates fell to zero in the few communities where at least half of the members
reported a colloquial knowledge of their own “native” language (Hallet, Chandler, & Lalonde, 2007).
In the United States, a study that measured perception of achievement, cultural identity, dispositional opti-
mism, academic achievement and depressive symptoms in 164 adolescents from indigenous reserves, showed the
importance of cognitive self‐regulation and cultural identity processes in the depressive experiences of indigenous
youth (Tyser, Scott, Readdy, and McCrea, 2014). In New Zealand, a nationally representative cross‐sectional study
concluded that young Maori, who have a strong cultural identity, were more likely to experience good mental
health outcomes (Williams et al., 2018). Similarly, a local study that analysed the role of Mapuche cultural identity
in alcohol use from the perspective of Mapuche authorities (Zambrano, Donoso, Aguilera, Candia, & Alarcón,
2018), reports that for the interviewee's alcohol dependency is a state that disconnects the person from their own
culture and generates conflicting conditions for the family and community. This study identifies the regulatory
potential of Mapuche cultural identity, but also the threat it faces in its relationship with the dominant group. The
need for sustained actions that support the strengthening of Mapuche cultural identity is emphasised.
As a conclusion to the above, we stress the need to address cultural identity as a critical aspect in preventive
strategies. Next, we will consider this challenge in the context of Mapuche culture.

3 | S T R E N G T H E N I N G OF TH E M A P U C H E C U L T U R E A N D K N O W L E D G E

As has already been pointed out, problematic use of alcohol can be explained by a complex set of factors, where
cultural and identity issues experienced by the subjects and groups play an important role. The Mapuche people, as
has also happened with other indigenous groups, have experienced processes of transculturation, a weakening and
loss of their original culture, which has affected the construction of the cultural identity of people and groups, and
thus hindered its development and well‐being.
The concept of cultural vitality (Giles et al., 1977, in Harwood, Giles, & Bourhis, 1994), refers to the likelihood
of a group behaving as a distinctive and collective entity within an intergroup context. This concept, coined in
ethnolinguistic studies, affirms that the more vitality and ethnolinguistic group has, “the more likely it is to survive
and thrive as a collective entity in an intergroup context” (Harwood et al., 1994, p. 168). On the other hand, the
concept of interculturality suggested by Saaresranta (2011), refers to the right to be educated based on one's own
culture to later develop a relationship based on equity with other cultures. According to Aparicio Gervás and
Delgado Burgos (2011), this is achieved by looking, in a cultural sense,

to the person and the culture itself, trying to make people value themselves socially and culturally,
through the complexity and internal difference of the social group itself. Once this objective is
achieved, progress could be made in covering intercultural or multicultural issues (2011, p. 15).

A study carried out in rural Mapuche communities (Garcés & Zambrano, 2019) suggested that the link be-
tween transculturation processes and problematic alcohol use does not emerge explicitly in what the interviewees
ZAMBRANO ET AL. | 7

say, but in the cultural code that naturalises and makes processes invisible: cultural loss expressed in a low
identification and cultural appraisal, the weakening of collective memory, and low social and community cohesion.
In this context, there is a need to activate practices of “process awareness” and community healing. This can be
achieved through the recognition of history, the recovery of collective memory, and from an intracultural approach,
in which culture is valued and strengthened in dialogue with the other interacting rationalities: institutional and
evidence‐based prevention theory.
Approaching an understanding of these dynamics in Mapuche communities means paying attention to his-
torical processes of transculturation and acculturation that have affected and continue to affect Mapuche com-
munities with the loss of values, of their own ways of thinking and norms of the formation of the Mapuche person
or Az Che (being a person; Salas, 2009). The reflection and anticipation are core characteristics of the Mapuche
culture and linked to Rakizuam (Thought) concepts: think, reflect and Gnezuam (become aware): analyse, arrange
what is reflected.
For the Mapuche Kimün (knowledge, wisdom), spirituality permeates the every day, being present to all
aspects and dimensions of reality, and thus an indissoluble feature of the individual and the collective experience of
the natural environment. Alcoholism is a disease that affects the patient's physical, psychological, social, cultural
and spiritual being (Quidel, 2001), and retrieving their foundational values involves retrieving the regulatory
frameworks of behaviour and the meaning of being human.
Considering the above, and in particular the need to build community‐based preventive strategies, the general
aim of this study was: to characterise a culturally grounded strategy for the prevention of problematic alcohol
consumption, in rural Mapuche Lafkenche communities.
The specific objectives were: (1) to identify significant sociocultural elements for the construction of a
preventive intervention strategy in rural Mapuche sectors and communities; (2) to systematise the main
milestones and components of the prevention process in Mapuche Lafkenche communities; and (3) to sug-
gest methodological criteria that should be included in a community‐based preventive strategy.

4 | METHODS

In this study, a qualitative methodology framed in the perspective of CBPR was used (Minkler & Wallerstein,
2003). This process stresses the active role that participants play in documenting their own history and
experience or that of their community and the current conditions of their problem and the conditions that
prevent change at a local level are systematically analysed (background and consequences functional ana-
lysis; Balcazar, 2003).

4.1 | Participants

The research setting was the Lafkenche coast of the Araucanía region, 30 km from Carahue (nearest urban centre),
in the towns of Coi‐coi and Bajo Yupehue, which are mostly inhabited by a Mapuche Lafkenche population. The
ethnographic reality was established during the period 2016–2017. The process involved a research team com-
prising of members of the SENDA prevention programme of the Carahue commune, researchers from a regional
state university and a Lonko (traditional Mapuche Authority) as a cultural guide. This team accompanied and
facilitated the process with the communities, and was responsible for producing, analysing and systematising the
data. The other social actors in the process were those in charge of rural health centres; the headteachers of three
rural schools and intercultural education teachers of the second basic cycle in both locations; and users of local
health care centres and the community.
8 | ZAMBRANO ET AL.

4.2 | Participants

The key informants who facilitated access to the study participants were those in charge of rural health centres in both
communities, the two headteachers of rural schools and the two intercultural facilitators. The inclusion criteria of the
study participants were to belong to the Mapuche Lafkenche communities. Nine adults were selected to participate in
the in‐depth interviews according to the following criteria: three problematic alcohol users, three people recovered
from consumption and another three adults without problematic alcohol consumption. A total of 30 men and women
users of rural health centres participated in the diagnostic workshops and participatory workshop.

4.3 | Data collection techniques

Participants were observed (Guber, 2011) in six diagnostic workshops, using participatory group interviews
(Holstein & Gubrium, 2006). These workshops were held in the waiting rooms of the rural health centres in the two
targeted locations. Three participatory diagnostic and participant observation workshops were also held in in-
tercultural education classes with boys and girls of the second basic cycle (10–14 years) of the rural schools in the
two sectors. These workshops were supervised by the class teacher. During this period, nine in‐depth interviews
were conducted in the form of life stories (Vasilachis et al., 2006) with nine adults attached to the Mapuche
cultural identity and inhabitants of rural towns along the coast of the Carahue commune. All interviews were held
in the community of Coi‐coi and each one lasted between 90 and 120 min and were transcribed for later analysis.
The topics addressed in the diagnostic workshops with both adults and children were: the personal, familial
and community consequences of alcohol use; risk and protective factors of consumption in children and adoles-
cents; and parental preventive skills, as well as aspects of Mapuche traditional knowledge, value systems and
cultural identity. The interviews were oriented to construct life stories within the familial, community and so-
ciocultural context. The life story technique allows the discovery of every day, that is, life practices that have been
left aside or ignored by the dominant viewpoint, and the story of and from those in subordinate positions. At the
same time, it highlights the importance of the individual perspective as a way to know society in general (Ferrarotti,
1988). Theoretical sampling was used to select participants according to their potential to help refine or expand
the concepts developed (Glaser & Strauss, 2006).

4.4 | Data analysis

The data collected in the participatory and in‐depth interviews were systematised and analysed through a cate-
gorical content analysis based on Grounded Theory (Glaser & Strauss, 2006). Open coding was performed using
Atlas.ti version 6.0 software. Triangulation by informants was performed using the viewpoint of more than one
person per dimension investigated, and expert triangulation (Denzin, 1989). The analysis was triangulated and
validated by holding socialisation workshops and reporting the results to the community and health and education
teams. Investigator and data triangulation were also used, to achieve greater interpretative and analytical depth
(Cornejo & Salas, 2011). Different sources and instruments of data collection were also used, such as ethnographic
observations, participatory and in‐depth interviews (Hernández, Fernández, & Baptista, 2014).

4.5 | Ethical considerations

Once the communities and potential participants were reached, they were informed about the research objectives
and procedures. Informed consent protocols were given to the traditional authorities of both targeted
ZAMBRANO ET AL. | 9

communities, who allowed access to meeting spaces and community participation; consent protocols were then
given to the interviewed subjects. These consents were approved by the Scientific Ethics Committee of the
Universidad de La Frontera (Approval Act No. 099, issued on November 16th, 2016).
An informed consent protocol was developed for the heads/authorities of the two communities involved. An
informed consent protocol was also given to the nine interviewees, in which the objectives of the investigation
were explained, as well as the protection of confidentiality and the voluntary nature of participation, among other
aspects. For the analysis, the anonymity of the interviewees was maintained by coding their names using the
following nomenclature: number of person (P1, P2, and so on).
Basic ethical consideration was that the information constructed was reported to, and problematized by, local
actors. That information should be used to build strategies to focus on prevention at the local level.

4.6 | Procedures

This study was carried out in agreement with the Prevention Programme of SENDA and the Universidad de La
Frontera. The purpose was to obtain locally produced records, with participatory components to: in a first phase, to
achieve access to the communities through the Municipal Health and Education Department of Carahue and the
Office of Mapuche Affairs. In this phase, the above‐mentioned key informants were contacted. In a second phase,
to develop a participatory diagnosis in both locations, and in a third phase, to carry out workshops to assess
cultural identity and prevent alcohol consumption which took place in the health centres and schools of the two
Mapuche communities.

4.7 | Procedure for the diagnosis and design of a prevention strategy

In this study, the methodology comprised a comprehensive, participatory and respectful perspective of culture,
which opened spaces for dialogue between local and institutional knowledge. The complementarity of information
production and the construction of interaction and reflection spaces made it possible to talk with the communities
about their views, as well as generating proposals for prevention. We needed to make the first approach with the
preventive team to access their own representations of alcohol consumption in the Mapuche population, and the
strategies currently implemented. This approach identified a degree of sensitivity to the issue but also confirmed
that an appropriate theoretical–methodological approach was lacking.
In the first stage, a team comprising professionals from a prevention programme, two researchers and a
cultural counsellor, was formed. The latter had a central role in relation to problematic alcohol consumption and
cultural identity within the communities. In the process of building the strategy, the cultural counsellor, a lonko
(traditional Mapuche authority), fulfilled the following functions:
At a content/cognitive level, he collaborated in the joint and situated construction of preventive contents. As a
person of traditional authority, he is the bearer of local knowledge (Mapuche kimün), of language, spirituality and
worldview, and of historical and local memory, and thus could provide crucial elements for the formulation and
reformulation of preventive content.
At the dialogical/procedural level, the cultural counsellor had an important role in the
theoretical–conceptual empowerment process of the teams. As an interlocutor in the dialogue between
Mapuche and institutional/western rationalities, he transferred meanings to the team about the Mapuche
worldview, values, norms, lifestyles and ways to regulate behaviour. Thus, the institutional preventive team
was able to incorporate linguistic‐conceptual categories of Mapuche culture. Also, in this interactive context,
it acquired notions and foundations of the institutional preventive approach built on the evidence‐based
biopsychosocial model.
10 | ZAMBRANO ET AL.

At the methodological/procedural level, the social legitimacy of his traditional authority position (lonko) fa-
cilitates examination of the problem of alcoholism, to which people and communities show certain resistance and
sensitivities related to the normalisation of problematic consumption, and express frustration and lack of control
over possible solutions. The cultural counsellor was able to facilitate the access and linking of the preventive team
with the local communities, reducing the sociocultural and psychosocial distance from the institutional intervention
teams, who were mainly urban and non‐Mapuche.
Meanwhile, the preventive team collaborated with the joint and situated construction of preventive content,
providing evidence‐based content. At a methodological level, the team led on the elaboration of the plan and a
consensual diagnosis of preventive needs with the targeted communities. They organised and carried out the
activities with the communities, in collaboration with the cultural counsellor and coordinated local resources with
the institutional networks in the localities: education and health, among others.
The research and intervention process was developed as a set of three complementary stages: (a) participatory
diagnosis of preventive needs with communities; (b) design and implementation of workshops aimed at significant
adults and children; and (c) return of results to the community and closure. These stages are detailed below:

4.7.1 | Participatory diagnosis of preventive needs with the communities

This relates to two central focuses: on the one hand, the local construction of the risk of problematic alcohol
consumption, described in the first specific objective, and on the other, the level of cultural vitality present in the
communities. Some indicators were defined which allow the configuration of a diagnostic basis for the construction
of preventive contents in a situated way:

(1) Presence/absence of traditional Mapuche authorities in the sector/community.

(2) Traditional ceremonies that are organised by families and the community, and/or those in which they
participate.
(3) Mapudungun speakers (grandparents, fathers and mothers, boys and girls).
(4) Relationship with, and provision from the natural environment (medicinal herbs, sacred sites,
symbolical–cultural schemes applied in the territory).
(5) Agency/recognition and valuing of cultural identity.

The results obtained in this phase were shared and contrasted with members of the community to guide the
second stage of the process.

4.7.2 | Design and implementation of workshops aimed at significant adults and

children

The design of the content was carried out jointly with the cultural counsellor considering the results of the
diagnostic stage. These results established the need for localities to strengthen the valuing of cultural identity
based on identity resignification and recovery of local community memory.
Twelve meetings were held as part of a participatory workshop that lasted 2–3 h. Each workshop consisted of
three moments: the first one supported communication and participation through a dynamic presentation and a
reminder of the topics seen in the previous workshop, the second aimed to problematise the issues addressed, and
the third was a final reflection that synthesised the contents seen and planned the next workshop.
With adults, the emphasis was on problematising the normalisation of alcohol use in contexts of family and
community socialisation. The aim was to create a dialogue focused on making explicit the values that are essential
ZAMBRANO ET AL. | 11

to the formation of the person according to the Mapuche worldview. Ideas about evidence‐based prevention were
also shared.
With children, workshops enhancing cultural identity were implemented based on data collected during the
diagnostic stage. The topics addressed were related to the worldview, the formation of the person, through
participative and experiential teaching, and memory through the meaning of children's Mapuche surnames in
schools. In addition, as introductory prevention content, issues of personal self‐care and strengthening self‐esteem
were addressed.

4.7.3 | Return of results to the community and closure

A milestone of the process' closure was reached through a collective reflection on the experienced process.
Besides, participants were able to discuss some continuity actions to develop in the future.

5 | RESULTS

The results will be reported to respond to each of the specific objectives, to finally carry out an integrated analysis
that addresses the general aim of the research.

5.1 | Significant sociocultural elements for the construction of a preventive

intervention strategy in rural Mapuche sectors and communities

From the results obtained, the need to incorporate a diachronic and ecological–relational point of view is noted,
both in the analysis of consumption patterns and in the preventive approach. Any conceptualisation of risk and
protective processes and scenarios of alcohol consumption in rural Mapuche communities should consider the
historical perspective, the role of memory in identity construction, and the internalisation of consumption patterns
in everyday socialisation contexts. That is, to overcome the binary division between protective and risk factors and
to assume the complexity of cultural practice. Next, we will analyse two key issues that allow us to understand
consumption practices in the communities involved in this study:
The first consideration was the cultural construction of alcohol consumption and the cultural identity at stake.
In the study locations, it was noted that there is a high normalisation of alcohol consumption in family and
community interactions. This normalisation is not made visible nor are community resources available to combat
the conditions that facilitate and normalise consumption, such as clandestine sale and abusive consumption in
social situations of community life. This situation is reflected in the following textual quotation:

It's just that here chicha1 has always been present, here everyone has apples, fruit trees, so that will
always be present. So, it's very difficult to end that because people keep planting (P1).

Migration from rural communities, for either temporary or permanent work in urban areas, means exposure to
new consumption possibilities (fruit seasons in the central area, work in private homes, high school studies) and
situations of discrimination and culture shock.

1
Chicha: traditional Chilean drink made from fermented apples.
12 | ZAMBRANO ET AL.

(…) they got together in the farmland, there we drank in secret, but then at 14 I started going
outside to work in the north and from there I started (P2).

(…) and there I remember that if I felt discriminated against, I realised that sometimes they
said, they called him mapuchón, or they told him the Indians, that they don't know how to eat
bread, that they only eat toasted flour and locro, that was like the saying,… we were treated as
Indians, as cholos, that these eat radishes for example, because they ate yuyo, yuyo was like a
food they had (Pnc1).

In a complementary way, the participants' discourse revealed historical processes of transculturation that are
reproduced and updated through the socialisation patterns reflected in the loss, denial and weakening of the value
granted to cultural identity in adults and children, due to the need to adopt new cultural values and adaptation in
contexts of discrimination. This suggests culture identity as in tension or conflict.

Yeah, I was a little boy, mum taught us the language, so she taught us the mother tongue. And dad
taught us Spanish, he knew Spanish and Mapuche, he knew both languages. Dad told us, don't keep
speaking Mapuche because you are going to be discriminated against (Pnc3).

Furthermore, the Christian Evangelical churches that have been present in these zones since the mid‐
20th century have influenced the processes of transculturation and loss of Mapuche culture. They currently
represent a community space with spiritual content that conflicts with the spirituality of the Mapuche
culture but provides a sense of belonging and support that is sustaining. Thus, people who integrate cul-
turally must reformulate part of their worldview, renouncing important components of their culture. In some
cases, the incorporation of people with alcoholism into religious communities has reportedly allowed some
of them to be rehabilitated.
As a result, there is a division of the community between belonging to the local Christian church and parti-
cipating in the revitalisation of traditional Mapuche ceremonies, which creates tension and fragmentation in the
current community dynamics.

Here in the community, they disappeared for the same reason, the evangelicals arrived and then
nobody else wanted to be machi. Then, in 1960 they say that the evangelical brothers arrived, and
the same thing, they half identify themselves as evangelicals (Pr1).

As protective circumstances, there is a set of values and practices of the Mapuche culture and worldview that
constitute the meaning of “being a good person” and these are integrated into a social and spiritual system. Related
to the values of the Az che (righteous, kind, wise, strong), the factors which give protection are associated with the
rural lifestyle: respect for the elderly, community solidarity bonds, geographical and sociocultural distance from
problems typical of urban marginality (such as crime and drug trafficking) and closeness to the family and colla-
borative work.
Traditional Mapuche ceremonies (We tripantu: new solar cycle) are currently organised in the communities, in
addition to participation in territorial organisations linked mainly to land recovery and the defence of maritime
sovereignty for access to sea resources. In terms of public policy, the figure of the intercultural facilitator has been
integrated into the school context, which allows aspects of the Mapuche language and culture to be passed on to
children.
Another scenario offering protection from consumption is the valuation and strengthening of cultural identity
in the family context, as reflected by some nondrinking participants:
ZAMBRANO ET AL. | 13

No, they consumed alcohol, everything mediated, children were not given. My father was delicate,
he wanted his children to be decent people, that's why people respected him, to this day, that's why
I have many friends (Pnc3).

In summary, our results show that cultural identity runs between two conflicting poles. On the one hand, there
are active transculturation processes that result in the loss, weakening and devaluation of the original culture,
where identity is experienced with greater tension and conflict by the subjects, being configured as a risk factor.
On the other hand, cultural strengthening processes result in the revitalisation and appreciation of culture, where
cultural identity is configured as a protective factor. From this tension, the need for a preventive strategy that
includes intracultural strengthening elements becomes clear.
In this regard, dialogue processes are suggested to allow the communication of tension points between traditional
Mapuche and Christian beliefs. In doing this, people from the communities themselves who have reconciled these
beliefs and ways of seeing the world could have an important role in promoting a dialogue between these different
perspectives. This would allow the formation of collective spaces that protect population health.
Regarding children, vitalisation and cultural appreciation are required to strengthen and handle elements of
prevention and self‐care. Although there is an institutionalised intracultural space in elementary school, it is still
suggested to enrich contents regarding the valuation of Mapuche culture and to generate actions that integrate
the family and the community in this learning context.

5.2 | Methodological criteria that should be included in a community‐based preventive

strategy

Five complementary aspects for preventive intervention arise from participants' experiences which will be de-
veloped below.

5.2.1 | To implement culturally‐based strategies to activate processes of cultural

promotion and revitalisation

The first refers to the need to implement culturally grounded strategies with the Mapuche Lafkenche population
by which processes of cultural promotion and revitalisation are activated. This implies a need for the interweaving
of local knowledge and institutional knowledge, creating spaces in the team for the recognition of Mapuche culture
and its regulatory‐normative aspects of behaviour. At the same time, it means understanding the sociohistorical
processes linked to the loss of culture, which constitute risk processes and scenarios, to promote recognition
actions and activate personal, collective and historical memory, through intracultural actions. From the recognition
of life stories and a local memory that narrates these processes of loss and weakening of culture.

When I was younger I was suddenly ashamed to be called Mapuche and that bothers me and I was
suddenly ashamed, not now, I would like to be more with my relatives, to speak and participate in
the culture (Pr2).

5.2.2 | Design of a differentiated preventive strategy

This strategy considers the trajectories of consumption associated with the life course of people, in which factors
associated with age range and rural–urban migration (for study and work reasons) are involved. Based on the data,
14 | ZAMBRANO ET AL.

it has been possible to identify risk scenarios and processes related to the initiation of alcohol consumption in
childhood and youth and its link to cultural identity dynamics: problematic alcohol consumption at home, domestic
production of fermented drinks and their use as food.

It is not that I, they gathered in the farmland, we drank there secretly, but later at the age of 14 I
started to go out to work in the north and that's where I started (Pr2).

During childhood, initiation is associated with low parental supervision and tolerance of certain levels of
consumption in farm work settings. This, in turn, is related to communication gaps within the family, and to
curiosity and desire for experimentation. During adolescence, initiation is associated with the need to belong to
peer groups, and to peer pressure, as well as with greater social tolerance of alcohol consumption.

Not suddenly when we went out to play soccer on Sunday afternoons, it was not frequent… and you
had to drink, after soccer there (Pc2).

In addition, temporary migration to the north of the country appears to be a situation in which new patterns
and types of consumption are acquired. The analysis of individual trajectories revealed risk processes associated
with cultural identity, these being: the loss of Mapuche culture at home and in the community of origin, disregard
for the culture and/or its functional assessment in relation to subsidies and state guarantees, discrimination, stigma
and social exclusion.

The youth later felt ashamed of being a Mapuche for the same reason, because as they were
discriminated against then they felt ashamed of speaking Mapuche, the same my mom, she knew a
lot of Mapuche but after that, it was over and my mom is very little what she knows how to speak
Mapuche. Not my grandmother, my grandmother sent us to do this Mapuche style, I understood her
but I, to continue talking Mapuche to the end, I cannot, that is our problem (Pc2).

In a complementary way, it is relevant to strengthen certain protective scenarios and processes in both people and
communities, which are associated with cultural identity, family bonds during childhood and adolescence, and community
bonds. Regarding cultural identity, issues of cultural vitality at home and in the community of origin, the valuation and
awareness of cultural identity, and the transfer of values and regulatory norms of behaviour must be considered. In
relation to family bonding in childhood, attention should be given to parental supervision, effective communication within
the family, consumption regulation and family knowledge of the risk of dependency development.

… she [mother] always told me that you have to fight, you have to get ahead, you have to be
someone in life (Pnc1).

Family bonds in the adolescent stage are associated with the supervision of socialisation spaces and belonging
to groups of nonconsumer peers, regulation of household consumption and strengthened self‐esteem.
Community bonds are associated with activities such as community participation in spaces that reinforce
cultural identity, mutual support and collective action.

5.2.3 | A team prepared to deploy such interventions

This demands the recognition of their own cultural identity, others' cultural identity, and their valuation and
development of a process‐oriented both theoretically and methodologically towards decolonial approaches. The
ZAMBRANO ET AL. | 15

methodological approach should include principles of reflexivity and thinking that are part of the Mapuche ra-
tionality and philosophy. This is indicated in the following quote:

“When we reflect on something, when we analyse a situation that concerns us, we are using our
rakizuam, our way of thinking, and then we reflect again on what we have thought, we reconsider it,
we sort it out. There we are using our gnezuam, to become aware and restore balance. It's part of
our kimûn” (Lonko M.T).

This strategy should be built on the dialogue and cultural decentralisation of the facilitator team supported by
a cultural counsellor (bearer of cultural knowledge, validated by the local community) to find communication and
joint construction bridges bearing in mind the symbolic systems of the local community. In this way, certain topics
can be identified with members of the communities, to move towards understanding how people feel about alcohol
use in everyday life, and when this consumption becomes problematic for them.

5.2.4 | Development of prevention policy at the local level

Throughout this process, the coordination of intersectoral prevention networks, based on existing institutional and
local resources and capacities in the territory (education, health and social organisations), becomes relevant. This
intersectoral work should move towards greater coherence by mainstreaming interventions. The state entity
responsible for prevention should generate mechanisms to collect local evidence and systematise processes and
progress in local work with an intercultural emphasis. For this, coordinated work with local universities is crucial.

5.2.5 | Generation of mechanisms that ensure the sustainability and projection of

preventive work

The work developed in this study was implemented in little more than a year, but to maintain a preventive initiative
at the community level, much more extensive support is required, not only to improve conditions for cultural
valuation and strengthening and empowerment of community capacity but also to help the community deal with
the specific issue of problematic alcohol consumption. This requires institutional support to make this form of work
sustainable, facilitating support and continuous monitoring in communities for a longer period of time.

6 | DI SCUSSION AND C ONCLUSIONS

The results obtained in the study confirm the multidimensionality of the factors associated with problematic
alcohol consumption (WHO, 2018). Alcohol use crosses social life in communities and is only perceived as a
problem when labour productivity decreases or when family or community relations are violently affected. In-
flection points can be identified in consumption trajectories marked by the contexts in which the experiences take
place (work, migration, studies in the urban environment) and by the life cycle. Aspects such as easy access to
alcohol, normalisation of its use, but particularly the lack of positive valuation of the Mapuche cultural identity and
the processes of discrimination and forced transculturation operate as important risk factors for problematic
consumption.
At the community level, a dimension that is particularly interesting, the sense of community and cultural
vitality operates as an important mediator both in the ability of the community to cope with problematic con-
sumption and in the engagement of members in problematic consumption (Okamoto, Helm et al., 2014). The
16 | ZAMBRANO ET AL.

strengthening of cultural vitality then appears, from an intracultural perspective (Aparicio Gervás and Delgado
Burgos, 2011), as a priority in a preventive strategy. This is in the perspective of what is highlighted by Australian,
African and Latin American community psychology to strengthen the communities' own personal, sociocommunity
and cultural resources to increase development and collective well‐being (Seedat, Suffla, & Christie, 2017; Sonn &
Quayle, 2014).
Mapuche identity expresses an ideal based on the teaching of Mapuche knowledge kimun, through oral
transmission from the elderly to the young. This knowledge is comprehensive; it includes customs, traditions,
ceremonies and fundamental values of righteousness (norche), strength (newenche), generosity/cordiality (kümeche)
and wisdom (kimche), providing fortitude in the face of difficulties (Salas, 2009). A person with Mapuche identity, in
accordance with the values and practices that they must embody, would exercise self‐control in their alcohol
consumption (avoiding excess), because not doing so would affect the balance of all aspects of life, affecting not
only the individual but their family and community (Salas, 2009).
As is widely reported in the literature, the deepest causes of problematic alcohol consumption in indigenous
populations are linked to precarious living conditions where the devaluation of culture occurs as a consequence of
complex transculturation processes. Thus, the increase in alcohol use that some communities are experiencing is
both a consequence and a cause of the gradual destruction of indigenous culture and values (Berruecos, 2013;
Menéndez, 1988 Mitchell et al., 2019).
Particularly in the studied communities, Mapuche cultural identity emerges as a potential regulator against
alcohol use. However, the regulatory capacity is challenged by the influence of western culture on this identity,
which entails processes (Escobar, 2007), that make identities invisible and damaging by placing them in a position
of subalterity (Quijano, 2015; Restrepo & Rojas, 2010; Walsh, 2010). This in turn impacts on the subjectivities of
people and on the process of identity construction. It emerges from the foregoing, as has been argued by
Saaresranta (2011), that strengthening one's own culture from an intracultural perspective (Aparicio Gervás and
Delgado Burgos, 2011), is the main component in a prevention strategy in spaces such as the one outlined here.
As recorded in international evidence (PAHO, 2016), prevention programmes are more effective when they
meet the needs of a given population, they involve all relevant sectors and also include scientific evidence,
monitoring and evaluation. In this study, the participatory component and the community and intersectoral or-
ientation, despite having slowed down the process, supported the involvement of various community and in-
stitutional actors. The positive availability of key actors such as the cultural counsellor who accompanied the
process, the nursing technicians in charge of rural health centres, and residents in the territory, facilitated entry to
the community although there is resistance to addressing the issue of alcoholism. The mediation of a Mapuche
authority was key to reaching the communities, as well as establishing a culturally relevant dialogue with the
participants in the reflective and educational activities.
Two strategic entities emerge to access communities and develop preventive activities: rural health centres
and rural schools. This involves both a concerted effort in coordination and trust‐building and expenditure of time
and resources that are not easy to manage from the programmatic logic of specialised programmes in Chile.
The experience gained in the course of this study also highlights the necessity for intercultural, disciplinary,
interinstitutional dialogue, where multiple rationalities and logics cross over, thus the need to deepen the pre-
ventive approach from a decolonial viewpoint and to form an ethnographic point of view in institutional teams is
clear.
From the perspective of community action, this study provides support for the public policy of preventing
problematic alcohol consumption, together with content and methodological guidelines for the design of culturally
relevant strategies with indigenous communities. However, it is important to point out that for a more robust
analysis of a strategy, the strategy must be monitored and evaluated for a longer period, which is beyond the scope
of this study.
In summary, the results of the research confirm the importance of integrating a sociocultural and community
perspective in the preventive approach, overcoming the view of individual risks and needs, to include sociocultural
ZAMBRANO ET AL. | 17

and community contexts as spaces for the development of skills, and personal and collective resources (Zambrano,
Muñoz, & Andrade, 2014).

PEER REVIEW
The peer review history for this article is available at https://publons.com/publon/10.1002/jcop.22440.

DATA A VAILABIL ITY STA TEMENT

The data that support the findings of this study are available on request from the corresponding author.

ORCID
Alba Zambrano https://orcid.org/0000-0002-0052-3456
Gabriela Garcés https://orcid.org/0000-0003-4333-9154
María P. Olate http://orcid.org/0000-0002-6276-1038
Miguel Treumún http://orcid.org/0000-0003-2584-0594
Francisca Román https://orcid.org/0000-0003-3798-0834

R EF E RE N C E S
Aparicio Gervás, J. M., & Delgado Burgos, M. A. (2011). Entre dos Orillas. Revista transnacional para la convivencia
intercultural, 5(9), 11–16.
Aukiñ Wallmapu Ngulam [Consejo de Todas las Tierras]. (1997). El pueblo mapuche: su territorio y sus derechos. Temuco.
Balcazar, F. (2003). Investigación acción participativa (IAP): Aspectos conceptuales y dificultades de implementación.
Fundamentos en Humanidades, 4(7‐8), 59–77.
Baum, F. (2008). Foreword to Health promotion in action: From local to global empowerment. Retrieved from https://www.who.
int/healthpromotion/conferences/7gchp/track1/en/
Bengoa, J. (2000). Historia del pueblo mapuche (Siglo XIX y XX). Santiago, Chile: Lom Ediciones.
Berruecos, L. (2013). El Consumo de Alcohol y el Alcoholismo en México: El Caso de las Comunidades Indígenas. El
Cotidiano, 181, 73–80.
Brown, R. A., Dickerson, D. L., & D'Amico, E. J. (2016). Cultural identity among urban American Indian/Alaska Native youth:
Implications for alcohol and drug use. Prevention Science, 17(7), 852–861. https://doi.org/10.1007/s11121-016-
0680-1
Castillo‐Carniglia, A., Kaufman, J. S., & Pino, P. (2013). Alcohol‐attributable mortality and years of potential life lost in Chile
in 2009. Alcohol and Alcoholism, 48(6), 729–736.
Castro, F. G., Barrera, M., & Martínez, C. R. (2004). The cultural adaptation of prevention interventions: Resolving tensions
between fidelity and fit. Prevention Science, 5, 41–45. https://doi.org/10.1023/B:PREV.0000013980.12412.cd
Clought, A. R., Fitts, M., Robertson, J., Shakeshaft, A., Miller, A., Doran, C., … West, C. (2014). Study Protocol—Alcohol
Management Plans (AMPs) in remote indigenous communities in Queensland. BMC Public Health, 14, 15. https://doi.
org/10.1186/1471-2458-14-15
Coimbra, C. E. A., Jr., Santos, R. V., & Escobar, A. L. (2003). Epidemiologia e saúde dos povos indígenas do Brasil. Rio de Janeiro,
Brazil: Fundação Oswaldo Cruz/ABRASCO.
Cornejo, M., & Salas, N. (2011). Methodological rigor and quality: A challenge to qualitative social research.
Psicoperspectivas, 10(2), 12–34.
Denzin, N. K. (1989). Strategies of multiple triangulation. In N. K. Denzin (Ed.), The research act: A theoretical introduction to
sociological methods. New York, NY: McGraw Hill.
Dudgeon, P., Milroy, H., & Walker, R. (2014). Working together, aboriginal and wellbeing. Canberra, Australia: Commonwealth
of Australia.
Escobar, A. (2007). La invención del Tercer Mundo. Construcción y deconstrucción del desarrollo. Caracas, Venezuela:
Fundación Editorial El perro y la rana.
Evans‐Campbell, T. (2008). Historical trauma in American Indian/Native Alaska communities: A multilevel framework for
exploring impacts on individuals, families, and communities. Journal of Interpersonal Violence, 23, 316–338.
Falicov, C. J. (2009). Commentary: On the wisdom and challenges of culturally attuned treatments for Latinos. Family
Process, 48(2), 292–309.
18 | ZAMBRANO ET AL.

Ferrarotti, F. (1988). Sobre a autonomia do método biográfico. In A. Nóvoa & M. Finger (Eds.), O método (auto) biográfico e a
formação (pp. 17–34). Lisbon, Portugal: Ministério da Saúde. Depart. de Recursos Humanos da Saúde/Centro de
Formação e Aperfeiçoamento Profissional.
Foerster, R. G. (2008, August). Una aproximación a las identidades territoriales y su nexo con el Estado: el caso lafkenche. Paper
presented at IX Congreso Argentino de Antropología Social. Misiones, Argentina.
Fréchette, L. (2001). La Prévention et la Promotion de la Santé Metale: des incourtunables en Psychologie Communautaire.
In F. Dufort & J. Guay (Eds.), Agir au cœur des communautés (pp. 217–248). Quebec, Canada: Les Presses de
l'Université Laval.
Garcés, G., & Zambrano, A. (2019). Significados en torno al desarrollo del consumo problemático y dependencia alcohólica
en comunidades mapuche rurales de la región de la Araucanía. Salud Colectiva, 15, e1932. https://doi.org/10.18294/
sc.2019.1932
Glaser, B., & Strauss, A. (2006). The discovery of grounded theory: Strategies for qualitative research. Chicago, IL: Aldine
Publishing Company.
Guber, R. (2011). La Etnografía. Método, campo y reflexividad. Argentina: Buenos Aires.
Guitart, M., Rivas, M., & Pérez, M. (2011). Identidad étnica y autoestima en Jóvenes indígenas y mestizos de San Cristóbal
de las Casas (Chiapas, México). Acta Colombiana de Psicología, 14(1), 99–108.
Hallet, D., Chandler, M., & Lalonde, E. (2007). Aboriginal language knowledge and Youth suicide. Cognitive Development,
22(3), 392–399.
Hartman, W., & Gone, J. (2014). American Indian historical trauma: Community perspectives from two great plains
medicine men. American Journal of Community Psychology, 54, 274–288. https://doi.org/10.1007/s10464-014-9671-1
Harwood, J., Giles, H., & Bourhis, R. (1994). The genesis of vitality theory: Historical patterns and discoursal dimensions.
International Journal of the Sociology of Language, 108, 167–206.
Hawkeye, R. (2015). The trauma of colonization: A psycho‐historical analysis of one aboriginal community in the north
american “north‐west. Interamerican Journal of Psychology, 49(3), 312–314.
Hernández, R., Fernández, C., & Baptista, M. (2014). Metodología de la investigación. México DF, Mexico: McGraw‐Hill
Interamericana.
Holstein, J., & Gubrium, J. (2006). The active interview: Qualitative research methods series (Vol. 37). London, UK: Sage
Publications.
Instituto Nacional de Estadísticas. (2017). CENSO Nacional de población y vivienda. Instituto Nacional de Estadística,
Chile. Retrieved from https://www.censo2017.cl/
Kirmayer, L., & Brass, G. (2016). Addressing global health disparities among indigenous peoples. The Lancet, 388, 105–106.
Kirmayer, L., Gone, J., & Moses, J. (2014). Rethinking historical trauma. Transcultural Psychiatry, 51(3), 299–319.
Labonté, R., & Laverack, G. (2008). Health promotion in action from local to global empowerment. London, UK: Palgrave
MacMillan.
Lauricella, M., Valdez, J., Okamoto, S., Helm, S., & Zaremba, C. (2016). Culturally grounded prevention for minority youth
populations: A systematic review of the literature. The Journal of Primary Prevention, 37(1), 11–32. https://doi.org/10.
1007/s10935-015-0414-3
Lee, R. M., Vu, A., & Lau, A. (2013). Culture and evidence‐based prevention programs. In F. A. Paniagua & A. M. Yamada
(Eds.), Handbook of multicultural mental health (pp. 527–546). San Diego, CA: Academic Press.
Le Bossé, Y. (2007). L'approche centrée sur le développement du pouvoir d'agir: une alternative crédible? Retrieved from https://www.
anas.fr/L-approche-centree-sur-le-developpement-du-pouvoir-d-agir-une-alternative-credible_a524.html
Marileo, A., & Salas, R. (2011). Filosofía occidental y filosofía mapuche: Iniciando un diálogo. Inclusión Social y Equidad en la
Educación Superior, 9, 119–138.
Marsiglia, F., & Booth, J. (2013, April). Cultural adaptation of interventions in real practice settings. Paper presented at the
Bridging the Gap Conference, Houston, TX.
May, M., & Law, J. (2008). CBPR as community health intervention: Institutionalizing CBPR within community based
organizations. Progress in Community Health Partnerships: Research, Education, and Action, 2(2), 145–155. https://doi.
org/10.1353/cpr.0.0019
Menéndez, E. (1988). Alcoholismo, grupos étnicos mexicanos y los padecimientos denominados tradicionales. Nueva
Antropología, 34, 55–80.
Menéndez, E., & di Pardo, R. (2006). Alcoholismo: políticas e incongruencias del sector salud en México. Desacatos, 20,
29–52.
Mignolo, W. (2009). La idea de América Latina (la derecha, la izquierda y la Opción decolonial). Crítica y Emancipación, 2,
251–276.
Ministerio de Salud de Chile. (2016). Orientaciones técnicas para la atención de salud mental con pueblos indígenas: Hacia un enfoque
intercultural. Retrieved from http://www.repositoriodigital.minsal.cl/bitstream/handle/2015/875/028.MINSAL-salud-
mental-indigena-2016%20%281%29.pdf?sequence=1&isAllowed=y
ZAMBRANO ET AL. | 19

Minkler, M. & Wallerstein, N., (Eds.). (2003). Community based participatory research for health. San Francisco, CA:
Jossey‐Bass.
Mitchell, T., Arseneau, C., & Thomas, D. (2019). Colonial trauma: Complex, continuous, collective, cumulative and
compounding effects on the health of Indigenous peoples in Canada and beyond. International Journal of Indigenous
Health, 14(2), 74–94. https://doi.org/10.32799/ijih.v14i2.32251
Mujica, L. (2002). Aculturación, inculturación e interculturalidad. Los supuestos en las relaciones entre unos y otros. Revista
de la Biblioteca Nacional del Perú, 43(44), 118.
Muñoz Sougarret, J. (2008). Notas sobre la relación entre alcohol y trabajo en la frontera sur de la Araucanía. Segunda mitad del
XIX. Alcohol y Trabajo. El alcohol y la formación de identidades laborales en Chile Siglo XIX y XX. Osorno, Chile:
Universidad de Los Lagos.
Nation, M., Crusto, C., Wandersman, A., Kumpfer, K., Seybolt, D., Davino, E. M., & Davono, K. (2003). What works in
prevention. American Psychologist, 58(6/7), 449–456.
Nichols, F. (2010). Take the best from both cultures: An aboriginal model for substance use prevention and intervention.
Aboriginal and Islander Health Worker Journal, 34(3), 10–14.
Okamoto, S. K., Helm, S., Pel, S., Mc Clain, L. L., Hill, A. P., & Hayashida, J. K. P. (2014). Developing empirically based,
culturally grounded drug prevention interventions for indigenous youth populations. Journal of Behavioral Health
Services & Research, 41(1), 8–19.
Okamoto, S. K., Kulis, S., Marsiglia, F. F., Holleran, L. K., & Dustman, P. A. (2014). A continuum of approaches toward
developing culturally focused prevention interventions: From adaptation to grounding. The Journal of Primary
Prevention, 35, 103–112.
Pan American Health Organization (PAHO). (2016). Promoción de la salud mental en las poblaciones indígenas. Una
colaboración entre la OPS/OMS, Canadá, Chile y Socios de la Región de las Américas 2014‐2015. Washington, DC.
Paradies, Y. (2016). Colonisation, racism and indigenous health. Journal of Population Research, 33(1), 83–96. https://doi.
org/10.1007/s12546-016-9159-y
Parsai, M.‐B., Castro, F., Marsiglia, F. F., Harthun, M., & Valdez, H. (2011). Using community based participatory research to
create a culturally grounded intervention for parents and youth to prevent risky behaviors. Prevention Science, 12,
34–47.
Quidel, J. (2001). Cosmovisión mapuche y etiología mapuche de la salud. In J. Ibacache, F. Chureo, S. McFall, & J. Quidel
(Eds.), Promoción de la Medicina y Terapias Indígenas en la Atención Primaria de Salud: El Caso de los Mapuche de Makewe‐
Pelale (pp. 15–25). Washington, DC: Panamerican Health Organisation.
Quijano, A. (2000). Colonialidad del poder, eurocentrismo y América Latina La colonialidad del saber, eurocentrismo y ciencias
sociales: perspectivas latinoamericanas, compIn E. Lander.. Buenos Aires: Consejo Latinoamericano de Ciencias
Sociales‐UNESCO.
Quijano, A. (2015). Colonialidad del poder y subjetividad en América Latina. Contextualizaciones latinoamericanas, 3(5),
1–13.
Ramamoorthi, R., Jayaraj, R., Notaras, L., & Mahiban, T. (2014). Alcohol‐related violence among the Australian Aboriginal
and Torres Strait Islanders of the Northern Territory: Prioritizing an agenda for prevention‐narrative review article.
Iranian Journal of Public Health, 43(5), 539–544.
Restrepo, E., & Rojas, A. (2010). Inflexión decolonial. Fuentes, conceptos y cuestionamientos. Popayan, Colombia: Universidad
del Cauca.
Román, M., & Moreno, M. (2010). Autoestima en jóvenes indígenas: Borucas y Terrabas. Revista de Ciencias Sociales, 126‐
127, 33–44.
Saaresranta, T. (2011). Perspectivas hacia una educación intracultural en el contexto indígena originario campesino.
Tinkazos, 14(30), 127–144.
Salas, R. (2009). Filosofía mapuche, en Dussel, E. Mendieta, E., y Bohorquez, C (editores). El pensamiento filosófico
Latinoamericano, del caribe y “Latino” (1300‐2000) (pp. 41–46). Siglo XXI Editores.
Seedat, M., Suffla, S., & Christie, D. (2017). Emancipatory and participatory methodologies in peace, critical, and community
psychology. Cham, Switzerland: Springer.
Servicio Nacional de Prevención y Rehabilitación del Consumo de Drogas y Alcohol (SENDA). (2016). Décimo Segundo
Estudio Nacional de Drogas en Población General de Chile. Santiago de Chile. Retrieved from http://www.senda.gob.cl
Servicio Nacional de Prevención y Rehabilitación del Consumo de Drogas y Alcohol (SENDA). (2018). Propuesta de
incorporación de un enfoque de interculturalidad en la implementación de estrategias de prevención del consumo de drogas y
alcohol. Unpublished document.
Sociedad Chilena de Lingüística. (1988). Alfabeto Mapuche Unificado. Temuco: Universidad Católica de Temuco.
Sonn, C., & Quayle, A. (2014). Community cultural development for social change: Developing critical praxis. Journal for
Social Action in Counseling and Psychology, 6(1), 16–35.
20 | ZAMBRANO ET AL.

Sonn, C. C., Stevens, G., & Duncan, N. (2013). Decolonisation, critical methodologies and why stories matter. In G. Stevens,
N. Duncan, & D. Hook (Eds.), Race, memory and the apartheid archive: Towards a transformative psychosocial praxis (pp.
295–314). London, UK: Palgrave/McMillan.
Trout, L., Mc Eachern, D., Mullany, A., White, L., & Wexler, L. (2018). Decoloniality as a framework for indigenous youth
suicide prevention pedagogy: Promoting community conversations about research to end suicide. American Journal of
Community Psychology, 62(3‐4), 396–405. https://doi.org/10.1002/ajcp.12293
Tyser, J., Scott, W., Readdy, T. M., & McCrea, S. M. (2014). The role of goal representations, cultural identity, and
dispositional optimism in the depressive experiences of American Indian youth from a northern plains tribe. Journal of
Youth Adolescence, 43, 329–342. https://doi.org/10.1007/s10964-013-0042-2
Vasilachis, I., Ameigeiras, A., Chernobilsky, L. B., Béliveau, V. G., Mallimaci, F., & Soneira, A. (2006). Estrategias de
Investigación Cualitativa. Barcelona, Spain: Gedisa Editorial.
Walker, J., Lovett, R., Kukutai, T., & Henry, D. (2017). Indigenous health data and the path to healing. The Lancet,
390(10107), 2022–2023. https://doi.org/10.1016/S0140-6736(17)32755-1
Wallerstein, N., & Duran, B. (2010). Community‐based participatory research contributions to intervention research: The
intersection of science and practice to improve health equity. American Journal of Public Health, 100(S1), S40–S46.
Walsh, C. (2010). Interculturalidad crítica y educación intercultural. In J. Viaña, L. Tapia, & C. Walsh (Eds.), Construyendo
interculturalidad crítica (pp. 75–96). La Paz, Bolivia: Convenio Andrés Bello, Instituto Internacional de Integración.
Williams, A. D., Clark, T. C., & Lewycka, S. (2018). The associations between cultural identity and mental health outcomes
for indigenous Māori youth in New Zealand. Frontiers in Public Health, 6, 319. https://doi.org/10.3389/fpubh.2018.
00319
World Health Organisation (WHO). (2018). Global status report on alcohol and health. Retrieved from https://www.who.int/
substance_abuse/publications/global_alcohol_report/en/
Yonas, M., Garretson, M., Gielen, A., & Parker, E. (2013). Integrating principles of community‐based participatory research
(CBPR) with the injury prevention and control agenda. Injury Prevevention, 19(2), 149. https://doi.org/10.1136/
injuryprev-2013-040788
Zambrano, A. (2019). Las encrucijadas del empoderamiento comunitario. Revista Conceptos, 504, 249–284.
Zambrano, A., Donoso, E., Aguilera, S., Candia, A., & Alarcón, P. (2018). Influencia de la identidad cultural mapuche/
lafkenche en la regulación del consumo de alcohol: la perspectiva de autoridades tradicionales mapuche/lafkenche
del sector costero de la IX región de la Araucanía. Revista Cambios y Permanencias, 9(1), 324–356.
Zambrano, A., Muñoz, J., & Andrade, C. (2014). Manual de Intervención, Práctica y Gestión en Redes. MMIDA® Modelo
Multidimensional de Intervención Diferenciada con Adolescentes. Temuco, Chile: Ediciones Universidad de La Frontera.

How to cite this article: Zambrano A, Garcés G, Olate MP, Treumún M, Román F. Construction of an
intercultural preventive strategy of alcohol use in rural Mapuche communities: A community‐based
participatory research. J Community Psychol. 2020;1–20. https://doi.org/10.1002/jcop.22440