In addition to our From the Archive series, where we highlight past articles in the journal’s history, the CMP blog features selected previews and sneak peeks into our latest issue. This week, we gain a glimpse into an article from the March issue: the first installment of 2015’s Volume 39 of Culture, Medicine & Psychiatry.
A Model for Translating Ethnography and Theory into Culturally Constructed Clinical Practices
Bonnie Kaul Nastasi, et al. Pages 92-120. Link to article: http://link.springer.com/article/10.1007/s11013-014-9404-9
In this article, Nastasi and colleagues have developed a new model for preventative care of HIV and STIs over the course of a 6-year research project in Mumbai, India. This clinical approach, called the Narrative Intervention Model (NIM), implores married men in Mumbai to construct narratives around their sexual health and related problems. With the clinician, patients then deconstruct the narrative to locate discrepancies between their accounts of sexual health and their desired health status. The last stage of the preventative approach entails clinicians coaching patients on how to minimize risk while meeting patient expectations surrounding sexual health. In this way, health counseling becomes a more dynamic process than medical history taking alone.
The NIM model in this initial study was employed by both allopathic physicians and traditional Indian medical practitioners. By analyzing patients’ accounts and creating models for health behavior that minimized risks of HIV or STIs, caregivers were able to blend an anthropological and public health approach to preventative medicine. Likewise, the model drew on principles of cognitive behavioral psychology: inquiring about patients’ logic in rationalizing health choices, and intervening in this narrative to display where risks might be prevalent.
In the NIM model, the clinician’s interview with the patient takes on a semi-structured form (which the authors assert is “ethnographic” in nature.) Rather than traditional history-taking, which is an elicitation of information from the patient rather than a more fluid conversation, the NIM encourages patients to make connections between their cultural beliefs, behaviors, and their health.
Given the widespread interest in both medicine and anthropology on patient-clinician communication, this case presents an informative glance into how caregivers might draw on ethnographic practices to improve patient health. NIM offers one methodology for meaningful exchanges between clinicians and patients, and unites the aims of medicine and anthropology in illuminating culturally specific health behaviors, beliefs, and practices for the direct benefit of patients.