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The perception of health can be analyzed by fragmenting the individualistic social and lifestyle factors of one’s life. One way to delve into an individual’s unique idea of health would be to simply interview them with simple questions based on Kleinman’s theory of explanatory models(1). This theory proposed that people and groups have the ability to construct different ideologies of health and disease. Although current medical professionals are increasingly employing the biopsychosocial model when dealing with patients(2), a clinician’s explanatory model would emphasize largely the biomedical aspect of disease etiology(3). However, patients may have a completely different explanatory model.
In light of this question, interviews of two people explore how variations in explanatory models show that they are most likely influenced by their social and cultural contexts and prior experiences. For anonymity, the interviewees will be given names “A” and “S”. The interview was conducted in a comfortable, private space of the interviewee’s choosing, to establish trust. In addition to this, consent was given by both interviewees for audio-recording their answers to the interview questions prepared. Many factors such as a positive atmosphere with good eye contact; body language (angled towards the interviewee) as well as demonstrating active listening by nodding with appropriate posture, is essential for obtaining relevant information within a given time. Verbal communication was quite efficient as a combination of open-ended and closed questions was utilized, however, sometimes too many questions were asked in a row, therefore hindering the interviewee’s ability to explain their own experience with health(4). Lastly paralinguistic techniques such as tone, and emphasis on certain words of the question persuades the interviewee to answer in a specific way. However non-verbal cues demonstrated by the interviewee should have been noticed more, which would have enabled a follow-up to their answers.
One factor that is often overlooked when examining beliefs surrounding healthcare is culture. Culture has not only macro-scale influences that affect broad understandings of illness and healing, but also has micro-scale influences that affect face-to-face doctor-to-patient interaction leading to successful and failed effective communication. Kleinman’s Explanatory model states that the notions about an episode of sickness and its treatment that are employed by all those engaged in the clinical process(5). This means that both the cultural background of the patient, and the clinician play an integral role in managing health. The patient’s explanatory model is framed by ideas that are based on how the sickness evolved, and how will it affect them and their lifestyle. It is calibrated to their practical realities and pressing problems; focusing on their own experience, frustrations, and sources of knowledge, and will only be applied in emergency situations(6). On the other hand, the physician’s explanatory model is largely focused on etiology, pathophysiology, course of sickness, and treatment. Their model is rooted in formal logic and is always applied in routine contexts based upon explicit connections(6). Kleinman’s article provided multiple case studies in which the utilization of the Explanatory Model of Illness would have provided useful evidence to enhance communication between the patient and medical professional. Kleinman refers to a Chinese man who believes to have a physical injury and continued to use some traditional medical practices alongside the medicine prescribed by the clinical psychologist. As his health improves, he still believes his own practice was what helped with his ailment rather than Western medicine(5). Using Kleinman’s model, a plan that suited his cultural beliefs would have aided him in his healing journey.
Despite the Explanatory model demonstrating how it can be beneficial in identifying factors affecting the perception of health and therefore improving clinical communication between doctors and patients, there are two possible limitations: cultural mistranslation and interviewer bias. For an effective interview, there must be clear communication and understanding between the patient and the health professional, however, this also depends on the professional’s interpreting skills. They may have difficulties understanding the cultural differences and meanings behind the patient’s words, thus potentially perpetuating misunderstanding and confusion. In addition to this, different answers may be persuaded by the patient hence introducing interviewer bias.
Growing out of works by Hochbaum, Kegeles, Leventhal, and Rosenstock, the Health Belief Model revolutionized the idea that the behavior of the individual is solely dependent on their experience, which paved its pathway into aiding in preventative medicine(7, 8). According to the Health Belief Model (refer to Figure 1.), modifying factors, perceptions of disease, cues to action, and perception of behavior influence the chances of taking a recommended health action. When addressing perceived susceptibility and perceived severity, it is important to note that there is a wide variation in an individual’s point of view toward vulnerability to an illness or feelings of severity. Whilst interviewing my subjects, various differences and similarities in perceived susceptibility, severity, benefits, barriers, cue to action, and self-efficacy are depicted. Thus alluding to how altered social and lifestyle factors affects an individual’s perception of health.
In terms of perceived susceptibility, both Subject A and Subject S seem to think that as a result of their relatively healthy lifestyle, the injury seems to arise from their love of sports rather than lifestyle neglect. Both agree that in order to minimize susceptibility, continually improving physical health is essential. Additionally, both have similar standpoints on the perceived benefits of actions available to reduce the threat of illness- by taking the recommended preventative solution coupled with an altered lifestyle such as adding in more exercise, supplements, and vitamins.
In contrast to this, each subject’s feelings towards the seriousness of contracting the disease differ. Subject A understands the need to treat the health problem (as a result of his medical career), however in doing so, it can impact his behavior negatively. Subject S, on the other hand, seems to perceive it as a problem, however, the promise of a solution immediately diminishes its severity; irrespective of how severe the problem is. Moreover, there is a wide variation in a person’s feelings of impediments against the effectiveness of treatment. For instance, Subject A seems to undertake a cost-benefit analysis once provided with options from their health care in order to understand the weighted benefits to solve their injury however Subject S would undertake whichever treatment is suitable regardless of consequences. Both subjects realize the need to see a medical practitioner when the body sends “internal cues” however in Subject A’s case, they require independence and the need to research curable methods themselves rather than relying on family and friends. This renders Subject A more comfortable and in tune with making quick decisions. Lastly, self-efficacy is demonstrated more in Subject A as they seem to be highly confident in completing the tasks and routines required (which may be because of his pursuit of medicine). Although Subject S is medically competent, they are not very confident in doing this as a result of their previous complications with their health care regimen.
After thorough deliberation on both Kleinman’s explanatory models and the Health Belief Model, both posit changes in behavior toward health. However, I perceive that the Health Belief Model only has a weak predictive power in the case of health-related behavior. This is in part due to the vague construct definition with no predictive validity in core psychological concepts. Personally, Kleinman’s theory of explanatory models has better applicability in day-to-day clinical activities, as it would aid clinicians in establishing a strong interpersonal connection with their patients, not to mention providing them with the ultimate regimen for maximum recovery.
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