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.