Mohan Dutta: Culture-Centered Approach

Grounded theory is the premiere choice in culture-centered approach research. I write this as a statement because this is how I understand it, but I desperately want to end it with a question mark. If it is true, then I desire a confirmation as to why this may be the case. My assumption is because the existing theories that incorporate culture (such as theory of reasoned action and the health belief model, which are both referenced in Mohan’s article) were created under the auspices of institutions holding power and access. Therefore, to build a theoretical framework using these existing theories would be like instantly giving the upper hand to the hegemonic powers that be, rather than those who are the primary concern for the research: the marginalized communities. But, such pondering leads me to the next statement/question… How do you effectively use a grounded theory approach and still maintain a strong sense of credibility and buy-in from institutional peers? It is one thing to

The marriage of Comparative Effectiveness Research (CER) with the Culture-Centered Approach (CCA) seems to be one that was destined to happen...the synergies between these approaches to the uses of clinical information are incredible. This brings me to the core point about CCA, the one about Structure, and one that puts it in opposition to postmodern approaches to critical theory that often get reduced to the feel-good elements of identity politics in multiculturalism. In foregrounding the localized voices of the margins, the approach continually seeks to engage with entry points for making truth claims in relationship to social structures. That hunger is a truth in the most salient rendition of it is something that is continually brought to the forefront in multiple CCA studies. If CCA is positioned in the quest for truth that is grounded in material evidence, the value of CER to CCA precisely lies in the quest for clinical evidence base for medical decision-making that is grounded

I am in the process of reviewing a proposal for a large scale project that frames itself in terms of addressing healthcare disparities. After giving us sermons about how disparities are bad, and so on and so forth, the proposal goes on to talk about some silly and outdated concept of "external locus of control" and makes the claim that addressing external locus of control would change behaviors. The behavior in question, my favorite, eating fruits and vegetables. So the evaluation measures of the project that is asking for a large sum of money to address health disparities is played out in getting the target community to eat more fruits and vegetables. Silly, silly, silly...and more importantly, one might suggest, wastage of tax payer dollars. Nowhere in the proposal does the researcher show awareness of the prices that the poor have to pay for securing fruits and vegetables, or of the fact that fruits and vegetables are typically out of the reach of the common person. Most i

Reading Dutta’s chapter on marginalization reinforced my views about the disenfranchisement of those living in particular rural communities and forced me to probe my understanding of the nature of their health disparity further than what I had before. In discussing the mechanisms that lead to marginalization, I was left questioning, in what ways are rural individuals cast towards the margins? Is the marginalized based on access to health information resources? Equitable health care? Resources for engaging in positive health behaviors (such as farmer’s markets or exercise facilities)? Educational avenues for furthering one’s ability to be employed and out of poverty? Or, is the marginalization more closely related to the inability of the rural citizen to participate in the discursive space where policy decisions are made? Ultimately, all of these questions could be answer with the affirmative. Disentangling their individual impact, however, would be exponentially difficult. Broadly, man

After reading this week’s articles on pain, a central question that continues to resonate on my mind is: should the lived experience of patients or expert’s explanation serve as the basis for the design of therapy for pain. I consider the above question as intriguing, because our understanding or the values we attach to a problem serve as a basis for the design of a therapy for the ailment. I use us to refer to the public. My question about which view should take precedence over the other is based on the accounts in this week’s readings. Of particular interest to me is how the MPQ became a tool to legitimize the concept of pain, consequently impacting the terminologies and tools used for pain management. So I ask, could such articulation of terminologies be representative? Can it accurately reflect what the patients feel? I believe that the patient should be allowed to spontaneously generate words that accurately reflect or capture their experiences; otherwise we could be robbing the

If you got a chronic pain that lasts more than three months, what’s your reaction to it? Paper by Bates: “Control, Culture and Chronic pain.” tried to explain that the “ locus of control” beliefs influence people’s responses to the chronic pain experiences. Furthermore, the LOC style has this intimate relationship with the ethnic or cultural background. Form comparing the research data from New England and Puerto Rico patients, Bates etc concluded that after one years of emergency reaction of the chronic pain, then they would developed in two directions: positive adaptation and negative adaptation which depends on the individual internal LOC or External LOC style, that the definition as in the paper: “ An internal LOC style involves a reported cognitive perception or expectation that life events and circumstances are the result of one’s own actions. By comparison, an external LOC style includes the perception or expectation that life events and circumstances are beyond on

What is pain? I personally asked myself this question time and again as I read the articles (specifically the Raheim, Crawford and Mowat articles). Of course, it is subjective. On a day when I have an excruciating headache, how does that compare to an individual who suffers from migraines? If we were both to rank our intensity of pain on a scale from 1-10, would an 8 mean the same thing for both of us? Seems relative to me. Last summer I began intensely looking for answers, and hopefully subsequent relief, for chronic neck and back pain. A sports doctor, a pain management specialist, a deep-tissue massage therapist, a chiropractor/acupuncturist… Each of them asked me to fill out a packet (some a couple pages, other nearly 15). I became very familiar with the multi-view body illustration within the forms, on which I was asked to shade the areas of the body where I was feeling pain. I’m pretty sure each diagram (while a few key areas were always shaded) looked differently, depending on

In thinking about the notion of pain as private verses intersubjective (as put forward in scholarly dialogue between Crawford and Mowat), I recalled my last trip to the emergency room (about 2 ½ years ago) with what I would describe as serious pain that later resulted in an appendectomy. In my entrance interview, I was asked to rate my pain on a scale from 1 to 10, where 1 equaled fleeting and dull and 10 equaled the most pain I’ve ever experienced. I can’t remember what my response was, but in conceptualizing the experience of pain as private and personal, it seems as though it was the need for the biomedical system to place my pain in the context of a shared language for the experience (such that the appropriate treatment could be prescribed, in the form of medication or further physical evaluation) that ultimately left me feeling disheartened and poorly served. I’m left questioning, was I really able to describe my pain? Did the measure truly capture my experience? It seems as thoug

“ Cultural Studies of Biomedicine: An Agenda For Research.” From Good etc (1995) brought out a term “ clinical narratives” specifically refers to clinical context between patients and physicians which is very interesting concept for me. In my opinion, the physicians of course hold the power of accessing the newly treatment method and they are the person will determine the language of diagnosis, disease progression, treatment and outcome, and professional obligations to patients. Besides this seems almost ideal professional power, it is very challenging for me to think of that they work under the frame of international information and also try to fit their language within the local culture and still under the influence of the “political economy of hope”. Influenced by all these, doctors from different area no matter the economic development level occupy different “clinical narratives”. When talking about the statistics in clinical narratives, the author gave an example of how a oncology

Comparative Effectiveness Research is guided by the goal of creating information capacities regarding the best comparative evidence base on treatment effectiveness, side effects, and benefits of different treatment options. The CER process is one that attempts to de-center the shroud of secrecy and scientific legitimacy that the medical industry (pharmaceuticals, physicians etc.) rely on. What is most important about the CER process is the implicit acknowledgement that is built into it: that the culture of medicine operates often under a great deal of uncertainty, misinformation, and lack of solid information. The CER process therefore seeks to a) foster a scientific evidence base for comparing different treatments, and b) de-center the blindfolded legitimacy patients put in physicians by seeking to put information in the hands of patients. It is precisely in this backdrop that I have witnessed resistance from physicians about CER in one-on-one interactions with them. That the tran

I have chosen this reading for comment as I could instantly relate this approach to the medical encounter scenrio in India and how tough it would be for the medical personnel to adopt this in their daily exeriences. In a country like India with the kind of diversity in culture and populations of the people, where there is minimal efficient medical infrastructure available ( cant get more optimistic than this), I do not hope that this approach would be relevant. More specifically if we ponder over the rural health and medical settings it becomes almost impossible for the physcians and other medical practitioners to employ such a method considering the meager faclities that are available in the government administered health centres. Even with the available facilities there would be very few practitioners who would at least lend an ear for such an approach (the kind of impressions people have towards the medical personal). I donot aim to generalise these statements for all the people an