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A study of illness in relation to different cultures

Jeremy Pincus Editor's note: Marketing researchers recognize that emerging markets will provide the engine of pharmaceutical revenue and profit growth in the coming decades. Because global markets vary dramatically in how consumers view illness, health and wellness e. Based on research conducted in a mix of established and emerging countries, we identified a set of seven global truths and implications for global health care-focused marketing research: Biological and medical concepts are converging Global communication is standardizing disease categories and treatment concepts, particularly among urban, educated classes and physicians, many of whom are trained in the West.

Pharmaceutical advertising and government-sponsored PSAs also drive standardization of concepts through widely available media and growing global Internet penetration. This convergence makes global pharmaceutical marketing research possible as it provides a baseline level of thinking about health.

Western medicine is being integrated into treatment regimens Although traditional herbal approaches are generally preferred for minor ailments and prevention, Western medicine now plays a role in health care nearly everywhere, alongside traditional beliefs and practices. Questioning should acknowledge that consumers generally try to avoid treating by use of more extreme phrasing to find differences among consumers, e.

Disease prevention is typically equated with healthier lifestyles i. This desire for healthy lifestyles can be taken to extremes, as in a new condition known as vigorexia exercise mania afflicting young urbanites in Spain.

  • Social and economic factors also play into diagnosis and treatment in many regions;
  • Some doctors may consider these practices to be less self-serving and more of an attempt to minimize patient fear and social disruption;
  • Depending on the market, it can be very important to obtain consumer feedback on the physical characteristics of medications and the connotations of each;
  • This is especially true of new roles developed in situations of socio-cultural change where tradition gives no guidelines for assisting the recently emancipated to adapt and fulfill his new state;
  • Each order he issued was shouted back first by one individual and then gradually by a chorus of all in the ranks.

Conversely, emphasis on improved diet can be a reaction to the loss of indigenous cuisine and corresponding rising rates of obesity. For example, Italy, Southern France and Spain have always been known for the heart-healthy traditional Mediterranean diet of fresh fish, fruits and vegetables, pasta, olive oil and garlic, yet due to the proliferation of processed foods and fast-food outlets, Italy now has a childhood obesity rate of 25 percent.

When designing research, questioning needs to raise the bar on healthy lifestyle attitudes in order to find differences among consumers since there is near universal agreement that diet and exercise are good for you. More extreme statements can effectively differentiate consumers, e. Illness is a family thing In most cultures, illness is viewed as a disruption to the total family system.

In a study of illness in relation to different cultures all cultures, the family constitutes the major source of caregiving in response to the needs of the ill or elderly. When designing research for chronic conditions, it is often useful to include a sample of caregivers as an important source of influence on treatment, a window on patient status and to measure the indirect impact of the disease on others.

Mental illness can carry stigmas In virtually all cultures, mental illness carries significant stigma, which is expressed in culture-specific ways. Spain and Italy, the global hubs of machismo, share the lowest rate of seeking help for mental health problems, especially among men.

Because of the broader risk, mental illness is generally hidden as long as possible and doctors tend to label mental health conditions with remarkable vagueness: Shenjing shuaijo can include any of the following: Similarly, in Central and South America, mental illnesses are often treated as spiritual crises that go by various names e.

Traditional healers called curanderos use religious rituals, ceremonial cleansing and prayers as treatments, which takes mental illness out of the realm of medicine and into the realm of religion, thereby preserving the self-esteem and social standing of the afflicted.

In the West, too, there is a strong preference for treatment by general practitioners, psychologists or neurologists instead of psychiatrists, which tends to be stigmatized as appropriate for the most severe cases.

Cultures as a Causative of Mental Disorder

When conducting research on mental health conditions it is important to convey the procedures that ensure anonymity and confidentiality to reassure potential respondents. Additionally, in cultures that tend to categorize mental illness in different ways, symptom lists can be combined to identify conditions so that patients do not need to admit to the stigmatized condition directly.

Dermatological conditions can carry stigmas In virtually all cultures, skin disorders carry significant stigma because dermatological problems are visible and may be interpreted as contagious or infectious. Because of the fear of stigma, sufferers typically go to great lengths to hide affected skin.

Similar to mental health research and STDs, care must be taken to reassure respondents of privacy and a study of illness in relation to different cultures procedures when attempting to research dermatological conditions globally.

Sharply divergent In contrast to the global truths, health practices can be sharply divergent between markets. Cultural conception of disease. Different cultures can have vastly different ways of thinking about diseases. For example, some diseases are expected as a normal part of development e.

Some diseases are culturally stigmatized e. Other cultural distinctions include minor vs. Different cultures also can hold radically different notions about disease causation. In Western cultures, heredity, lifestyle e. For those conducting a global research project on the GI tract, dermatological conditions, or upper respiratory conditions such as asthma or allergies, it may be important to address inside fever in questioning.

A variety of folk illnesses have been documented. If research pertains to any of the symptoms associated with a folk illness, analysis should go beyond the individual symptoms a study of illness in relation to different cultures incorporate the cultural syndrome.

Fit can be improved by permitting multiple routes to qualification through various culturally-appropriate condition labels and through symptom lists; e. For example, in traditional Chinese medicine, erectile dysfunction is associated with kidney problems.

It also be important to include culture-specific condition triggers to capture align with local ideas regarding disease etiology. Access to physicians is markedly different in various parts of the world, with structural factors determining the quality, quantity and duration of patient-physician interactions.

For many countries with national health services, physician visits typically last a maximum of 10 minutes and may require four-hour wait times.

Health care concepts need to adapt to fit radically different delivery systems, as illustrated with the following four examples: In order to gain access to specialists or prescriptions, patients must build a case for referrals by exaggerating symptoms.

In each market, researchers need to have a firm understanding of what constitutes a doctor, with which type of health care professional patients have relationships, the presence of primary care physicians, gatekeeping functions, etc. Similar to physician access, access to pharmaceuticals is highly variable and the structure of delivery systems determines pharmaceutical usage.

Prescriptions are not required in many emerging markets, such as China, Mexico, Brazil and India. Western notions of pharmaceutical access must also adapt to fit different delivery systems when conducting research.

Sharply divergent

This is illustrated with the following three examples: Local pharmacists chemists make diagnoses and directly dispense medications. When conducting research in these markets it can be more important to discuss pharmacist relationships than to ask about doctor relationships and to be aware of the potential for conflicts of interest. Beliefs about Western medicine. Consequently, it tends to be viewed as too strong for patients in states of weakness such as childhood, pregnancy and old age.

The strength of Western medications is believed to cause habituation, such that larger doses of Western medication are needed over time to get the same effect. The physical characteristics of medications form, color, taste, shape, pill size, etc. In India, white pills are considered mild and safe, whereas black pills are considered powerful and dangerous, which can affect patient compliance.

Depending on the market, it can be very important to obtain consumer feedback on the physical characteristics of medications and the connotations of each. Role of traditional treatments. In many regions, traditional herbal medicines tend to be preferred for health maintenance and disease prevention similar to the vitamin and supplements market in the U.

In China, physicians receive training in traditional Chinese medicine in medical school and some doctors practice traditional Chinese medicine alongside Western medicine.

  • Are culturally-adjacent co-morbidities included?
  • The Journal of Abnormal and Social Psychology;
  • At the least it would call for assessment of etiological theories against a broader background and it should bring to the fore the notion that the etiology of diagnosis in this or that cultural setting is a matter that has to be understood before there can be understanding of the etiology of disorder;
  • It may involve not only feeling and knowing but also the process of thinking;
  • Sex and temperament in three primitive societies.

Similarly, Mexican physicians prescribe traditional herbal medicines alongside prescription medicines as means to control negative side effects. Corruption is also endemic: Unsurprisingly, the Indian upper classes avoid public doctors and hospitals.

How Cultural Factors May Be Thought to Affect Psychiatric Disorder

Cultivating confidence among patients is critical to the success of doctors, particularly in rural areas. Doctors in these markets fear that by immediately diagnosing the full extent of serious conditions or by prescribing uncomfortable or expensive treatments, patients will simply go elsewhere and will tell others of their experience, diminishing their reputation for healing ability.

Some doctors may consider these practices to be less self-serving and more of an attempt to minimize patient fear and social disruption.

There are many examples of diagnostic softening: In addition to mislabeling of health conditions, asymptomatic stages of serious illnesses may be downplayed to patients. Social and economic factors also play into diagnosis and treatment in many regions. Where patients are deemed to be unable to afford proper treatment, expensive medications may be delayed.

When conducting research in these markets, it can be important to use permission phrasing when asking doctors about diagnosis and prescribing to address issues around tendency to soften diagnosis and prescribe suboptimal but affordable treatments.

These challenges may be summarized by posing a set of questions that marketing researchers might ask themselves as they design cross-cultural studies.

Are there local, in-country experts on the research team representing each major region, ethnicity and language? Is cognitive pre-testing of all research instruments conducted in all local languages and dialects? For any stigmatized conditions under study e.

Does the local semantic disease network guide disease language, including both formal and colloquial names for diseases of interest, as well as folk illness syndromes? Are symptom lists provided for non-self identified sufferers?

Are culturally-adjacent co-morbidities included? Is questioning appropriate to local HCP-patient relationships?

Is the local pharmaceutical distribution system accurately reflected e. Is permission-language for physicians included for sensitive subjects e. Are culturally-relevant treatment attributes included e. Is the prescription vs. Is the branded vs.

Are local side effect concepts included e.

  • Normally the family gives little attention to people filling such subservient roles as younger sons and wives without children, but for this illness the family group will finance an elaborate curing rite with attention focussed on the tromba-sufferer;
  • For one thing, description paves the way for assessment of frequency—be this in terms of prevalence or incidence;
  • Notes on the Concept of Sentiment; p.

Are physical characteristics of treatment included? Are local treatments included?