P1: SFK/UKS P2: SFK
BLBK128-Hark December 17, 2008 14:56
APPENDIX 2
Kleinman’s ExplanatoryModel of Illness
Kleinman and associates (1978) in their seminal paper further dis-cuss the importance of the explanatory model: “Eliciting the patient’s(explanatory) model gives the physician knowledge of the beliefs thepatient holds about his illness, the personal and social meaning heattaches to his disorder, his expectations about what will happen tohim and what the doctor will do, and his own therapeutic goals.Comparison of patient model with the doctor’s model enables theclinician to identify major discrepancies that may cause problems forclinical management. Such comparisons also help the clinician knowwhich aspects of his explanatory model need clearer exposition topatients (and families), and what sort of patient education is mostappropriate. And they clarify conflicts not related to different levelsof knowledge but different values and interests. Part of the clinicalprocess involves negotiations between these explanatory models,once they have been made explicit.”
Eliciting the Patient’s Explanatory Model of illness through a setof targeted questions shown below is an important tool for facilitat-ing cross-cultural communication, ensuring patient understanding,and identifying areas of conflict that will need to be negotiated. Thewording and number of questions used will vary depending on thecharacteristics of the patient, the problem, and the setting.� What do you think has caused your problem?� Why do you think it started when it did?� What do you think your sickness does to you? How does it work?� How severe is your sickness? Will it have a short or long course?� What kind of treatment do you think you should receive?
217
Achieving Cultural Competency: A Case-Based Approach to Training Health Professionals
Edited by L. Hark, H. DeLisser © 2009 Blackwell Publishing Ltd. ISBN: 978-1-405-18072-6
P1: SFK/UKS P2: SFK
BLBK128-Hark December 17, 2008 14:56
218 Appendix 2
� What are the most important results you hope to receive from thistreatment?� What are the chief problems your sickness has caused for you?� What do you fear most about your sickness?
Adapted from, Kleinman A., Eisenberg L., Good B. Culture, illness,and care: clinical lessons from anthropological and cross-culturalresearch. Ann Intern Med 1978;88:251–88.
P1
:S
FK
/UK
SP
2:S
FK
BL
BK
12
8-H
ark
Jan
uar
y2
4,2
00
92
1:4
0
Ap
pe
nd
ix3
:D
om
ain
4:C
om
mu
nic
ati
on
Sk
ills
Sp
ecifi
cD
om
ain
5:U
seo
fD
om
ain
6:S
elf
-re
fle
cti
on
,C
ult
ure
of
To
ols
Fo
rA
sse
ssin
gD
om
ain
1:H
ea
lth
Dis
pa
riti
es
Do
ma
in2
:C
om
mu
nit
yS
tra
teg
ies
Do
ma
in3
:B
ias/
Ste
reo
typ
ing
toC
ross
-Cu
ltu
reC
om
mu
nic
ati
on
Inte
rpre
ters
Me
dic
ine
Cu
ltu
ral
Co
mp
ete
ncy
Tra
inin
g
K1.Definerace,ethnicityandculture
K2.Identifypatternsofnationaldata
K3.Describepatternsofhealthdisparities
K4.Identifykeyareasofdisparities
K5.Discussbarrierstoeliminatinghealth
disparities
S1.Concretizeepidemiologyofdisparities
S2.Gatherandusedata2010
S3.Criticallyappraiselit.ondisparities
A1.Recognizedisparitiesamenable
tointervention
A2.Valueeliminatingdisparities
K-1.Describechallengesincross-cultural
community
K-2.Understandpopulationhealthvariability
K-3.Describecommunity-basedelements
K-4.Identifycommunitybeliefsandhealth
practices
S-1.Collaboratewithcommunities
S2.Describemethodstoidentifycommunity
leaders
S3.Proposeacommunity-basedhealth
intervention
A1.Valueandaddresssocialhealthdeterminants
K1.Identifyhowraceandculturerelatetohealth
K2.Identifyphysicianbiasandstereotyping
S1.Demonstratestrategiestoaddress/reducebias
S2.Describestrategiestoreducephysicianbias
S3.Showstrategiestoreducebiasinothers
A1.Valuehistoricalimpactofracism
S4.Elicitinformationinfamily-centeredcontext
S5.Usenegotiatingandproblem-solvingskills
S6.Assessandenhanceadherence
A1.Respectpatient’sculturalbeliefs
A2.Nonjudgmentallisteningtohealthbeliefs
K1.Describefunctionsofaninterpreter
K2.Listeffectivewaysofworkingwith
interpreter
S1.Identifyandcollaboratewithaninterpreter
K1.Describethephysician-patientpower
imbalance
S1.Recognizeinstitutionalculturalissues
S2.Engageinreflectionaboutownbeliefs
S3.Usereflectivepracticesinpatientcare
A1.Valuetheneedtoaddresspersonalbias
Intr
od
ucti
on
Ca
se1
:R
uth
Fra
nk
lin
XX
XX
XX
Ca
se2
:C
arl
Jo
ne
sX
XX
XX
X
Ca
se3
:M
ari
aM
ora
les
XX
XX
XX
Ca
se4
:M
ay
aM
oh
am
ma
dX
XX
XX
X
Ca
se5
:J
on
Le
eX
XX
XX
XX
Ca
se6
:N
ad
iaR
ose
nb
erg
XX
X
Ca
se7
:Is
ab
el
De
lga
do
XX
XX
Ca
se8
:G
eo
rge
De
nn
isX
XX
XX
X
Ca
se9
:M
ary
Jo
ne
sX
XX
XX
X
Ca
se1
0:P
riy
aK
rish
na
mu
rth
yX
XX
XX
X
Ca
se1
1:C
arl
os
Cru
zX
XX
XX
Ca
se1
2:D
en
ise
Sm
ith
XX
XX
XX
Ca
se1
3:M
ae
Lin
gX
XX
XX
X
Ca
se1
4:E
arl
Co
llin
sX
XX
X
Ca
se1
5:Ir
ma
Ma
tos
XX
XX
Ca
se1
6:E
ile
en
Cla
rkX
XX
XX
Ca
se1
7:L
esl
ieO
’Ma
lle
yX
XX
XX
X
Ca
se1
8:J
ua
na
Ca
ba
nX
XX
XX
X
Ca
se1
9:A
lice
Gre
go
ryX
XX
XX
X
Ca
se2
0:S
uli
pG
uh
aX
XX
XX
X
Ca
se2
1:P
ep
pe
rH
aw
tho
rne
XX
XX
XX
X
Ca
se2
2:A
lik
aN
ku
utu
XX
XX
X
Ca
se2
3:M
igu
el
Co
rte
zX
XX
XX
Ca
se2
4:N
ao
mi
Fu
lto
nX
XX
XX
X
Ca
se2
5:B
ob
by
Na
pie
rX
XX
XX
XX
X
D=
Do
mai
nK
=K
no
wle
dg
eS
=Sk
illA
=A
ttit
ud
e
28.D
A.L
ie,J
Bo
ker,
SC
ran
dal
l,C
ND
eGan
nes
,DEl
liott
,MD
,PH
end
erso
n,C
Ko
djo
,an
dL
Sen
g.R
evis
ing
the
Too
lfo
rA
sses
sin
gC
ult
ura
lCo
mp
eten
ceTr
ain
ing
(TA
CC
T)fo
rcu
rric
ulu
mev
alu
atio
n:F
ind
ing
sd
eriv
edfr
om
seve
nU
Ssc
ho
ols
and
exp
ert
con
sen
sus.
’Med
Edu
cO
nlin
e.20
08;1
3:11
.
Ava
ilab
leat
htt
p://
ww
w.m
ed-e
d-o
nlin
e.o
rg
α=
Cro
nb
ach
’sα
for
Do
mai
n,α
for
42-i
tem
TAC
CT=
0.90
5
P1: SFK/UKS P2: SFK
BLBK128-Hark January 30, 2009 8:40
219
Achieving Cultural Competency:A Case-Based Approach to Training
Health Professionals
Duration: Maximum of 25 hours, each case should take 1 hourCredit: Up to 25 AMA PRA Category 1 CreditsTM, each case is awarded1 AMA PRA Category 1 CreditTM
Original Release Date: June 1, 2009Last Review Date: January 5, 2009Expiration: May 31, 2012
Completion Instructions� To receive CME credit for each case that you complete from thisbook, please visit the University of Pennsylvania Office of Contin-uing Medical Education website at: http://www.med.upenn.edu/cme/culture/� Once on the site, you will be presented with the option to choosefrom two topics. The topic for this book is called “Achieving CulturalCompetency Book Cases (Wiley-Blackwell 2009)”. After choosingthis topic, you will be presented with a complete list of cases
from this book.
Select the case(s) for which you would like to receive CME
credit.� In order to access any of these cases, you must have an account onthe CME Website (complementary).� If you do not have an account, sign-up (click on member sign-up
at the top of the page).� If you have an account, log into the site with your e-mail addressand password (click on log-in at the top of the page).� Next, register for a particular activity (case) by using the link in the“Course Materials” box on the right. When prompted for an accesscode, enter: culturebook (Note: the access code is case-sensitive).� Click on the “Get CME” link in the “Course Materials” box.� You now need to complete the Post-Test.� After successfully completing the Post-Test, with a score of 75% or
higher, you will be directed to the Evaluation.� After completing the Evaluation, you will be able to view, print, orsave a CME certificate verifying your credit for this activity.
Top Related