Explanatory Model of Illness
by Lauren Hodsdon
The Explanatory Model is used to determine differences in cultural norms between western medicine and the patient’s disease belief system (1). This belief structure can be based on religious beliefs, cultural beliefs, spiritual beliefs, or any other influential experience or environment represented by the patient (1). Through a series of questions, the physician is able to identify differentiating beliefs that may hinder the ability to cure a patient’s disease (i.e. understanding of body system structure, germ theory, religious or cultural healing) (1). Through understanding the patient’s needs and expectations, the physician can meet these needs by altering the treatment plan according to the patient’s behavior patterns and belief structure (1).
The Explanatory Model of Illness was developed in 1978 by Arthur Kleinman, published in his paper titled “Culture, Illness, and Care; Clinical Lessons from Anthropologic and Cross-Cultural Research” (1). Kleinman developed the Explanatory Model in response to an unmet need inherent and unavoidable in the current health care system. Patients complained of “dissatisfaction, inequity of access to care, and spiraling costs” which Kleinman deemed unsolvable by the traditional medical approach (1). Kleinman goes on to explain his distinction between illness and disease; illness is flexible across cultures and individuals, while disease has a concrete definition and diagnosis (1). Therefore, the experience of a certain disease may be felt, described, and understood differently according to each patient, causing patients with the same disease to classify themselves with different illnesses. The Explanatory Model was created to identify specific illness characteristics that allow the physician to bridge the gap between physician’s understanding and patient’s experience to provide quality care and satisfaction to the patient.
The following are the eight questions used to decipher patient understanding and expectations surrounding their illness (1).
- 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 tretment do you think you should receive?
- What are the most important results you hope to achieve from this treatment?
- What are the chief problems your sickness has caused for you?
- What do you fear most about your sickness?
For the reasoning behind each question, and the proper technique in utilizing the Explanatory Model of Illness, please see: Achieving Cultural Competency: A Case-Based Approach to Training Health Professionals (2).
Applications to Global Health Planning and Practice:
In Kleinman’s article, he gives multiple case studies in which utilization of the Explanatory Model of Illness would have provided useful information to avoid confusion and missteps in medical treatment. The following outlines one of the cases:
A Chinese Man enters the health facility with clinical signs of depression but complaining of a physical ailment (1). The man is referred to a psychologist but does not have faith in this treatment regimen. The man continues to focus on his belief of physical injury, and seeks traditional healing practices while continuing western treatment. As the man’s illness improves, he is left without understanding which treatment was successful in curing his ailments (1). Western medicine was able to cure this man, but failed to provide him the quality of care he requested to satisfy his needs. Using the Explanatory Model of Illness to create a regimen tailored to his cultural needs and belief system would have better served this patient, and aided him in his healing process.
The Explanatory Model has three potential limitations: translation, interviewer bias, and patronization. In order to conduct the interview effectively both the patient and the physician must understand each other, this may be contingent on the availability and skill level of an interpreter. An interpreter may have difficulties in translating the cultural meaning of the patient correctly and therefore perpetuate confusion. Depending on the comfort level of the patient with the physician, or other personnel conducting the interview, different answers might be elicited from the patient. For instance, a female patient may feel uncomfortable speaking to a male physician about sexual behaviors related to an STI. The last limitation can be found when the physician focuses on aligning the patient’s view with their own view, as opposed to melding the differentiating views together when issuing a treatment to the patient. For instance, altering a patients diet plan to include traditional foods instead of suggesting food sources never consumed by the patient.
(1) Kleinman A, Eisenberg L, Good B. Culture, Illness, and Care; Clinical Lessons from Anthropologic and Cross-Cultural Research. Ann Intern Med. 1978;88:251–8.
(2) Hark L, DeLisser H. Appendix 2: Kleinman’s Explanatory Model of Illness. Achieving Cultural Competency: A Case-Based Approach to Training Health Professionals. Blackwell Publishing Ltd.; 2009. p. Appendix 2.
(3) Lynch E, Medin D. Explanatory models of illness: A study of within-culture variation. Cognit Psychol. 2006;10(285).
(4) Weiss M. Explanatory Model Interview Catalogue (EMIC): Framework for Comparative Study of Illness. Transcult Psychiatry. 1997 Jun 1;34(2):235–63.
Case in which furthers the discussion on the Explanatory Model of Illness:
“Explanatory models of illness: A study of within-culture variation” by Elizabeth Lynch and Douglas Medin
- Lynch E, Medin D. Explanatory models of illness: A study of within-culture variation. Cognit Psychol. 2006;10(285).
Explanatory Model Interview Catalogue (EMIC):
Weiss M. Explanatory Model Interview Catalogue (EMIC): Framework for Comparative Study of Illness. Transcult Psychiatry. 1997 Jun 1;34(2):235–63.