An Analytical Framework for Contrasting Patient and Provider Views of the Process of Chronic Disease Management

Abstract

Medical anthropologists involved in clinical research are often asked to help explain patients' "noncompliance" with treatment recommendations. The clinical literature on "noncompliance" tends to problematize only the patient's perspective, treating the provider's perspective as an uncontroversial point of departure. Explicating the articulation between provider and patient assumptions, expectations, and perceptions in managing chronic illness is an area well suited to the unique perspective of medical anthropologists. In this article we present an analytical framework for contrasting patient and provider goals, strategies, and evaluation criteria in chronic illness management, using examples from research on type 2 diabetes care in South Texas. This approach goes beyond contrasting patient and provider concepts and explanations of the illness itself and examines their contrasting views within the dynamic process of long-term care. This approach may prove especially useful for research aimed at a clinical audience, since it maintains a clinically relevant focus while giving serious consideration to the patient's perspective.

Diabetes Self-care among a Multiethnic Sample of Older Adults

“…(Hunt and Arar 2001;Yeh et al 2002)Specifically, one in four informants (one in two for Mexican-American elders) mentioned ever having used unconventional therapies for diabetes control and during our interviews no informants described unconventional strategies as a significant component of their diabetes self-care. Such limited use of alternative approaches for diabetes control dispels the notion that preference for unconventional modalities undermines conventional self-care activities and glycemic control.…”

“…(Weller et al 1999) Other studies among Mexican Americans in the U.S. and native communities in Canada have also demonstrated how people develop rich diabetes narratives that blend traditional and biomedical perspectives. (Hunt and Arar 2001;Mercado-Martinez and Ramos-Herrera 2002) In this paper, we examine patterns of self-care among four groups at elevated risk from diabetes, focusing on the questions: (1) what are the patterns and frequency of diabetes selfcare practices and (2) what explanations do people give for their self-care behaviors or why do they engage in these patterns? Drawing on cross-cultural comparison rather than an indepth view of one disproportionately affected group allows us to examine how institutions, beliefs, and practices have evolved and speculate on why such traits are shared or distinctive.…”

The experience of thalassemic adults with their treatment

“…For one to learn the similarities and differences among the perspectives of patients in the course of a chronic disease and treatment, one should explore the treatment's objectives, strategies, and evaluation criteria. Because explanations involve multiple and often contradictory processes and meanings, they are seen as situational explanations (13) . (14) .…”

Las enfermedades crónicas desde la mirada de los enfermos y los profesionales de la salud: un estudio cualitativo en México

“…En este contexto, el reconocimiento de posturas diferentes no significa inferioridad, indiferencia o ignorancia, ni lleva a la descalificación, la exclusión o el dominio 16 , como ocurrió en algún momento de la atención a la enfermedad. Al igual que como lo han reportado otros autores 17 , los médicos participantes en este estudio reproducen una concepción biomédica en donde a una entidad mór-bida previamente definida se le asigna un tratamiento convencional. Los sujetos enfermos, por su parte, enfatizan múltiples manifestaciones y dificultades que enfrentan en el marco de su vida diaria.…”