Cultural models of diarrheal illness: conceptual framework and review

Health planning for diarrheal diseases must be responsive to both epidemiological patterns and local perceptions of health, illness and need. A conceptual framework that relates patterns of distress, explanatory models, help seeking and treatment practices to knowledge and use of oral rehydration therapy (ORT), dietary management, other specific treatments and health policy issues provides the basis for our review of research on diarrheal illness-related beliefs and practices. The ethnomedical model asserts that efforts to secure the compliance of target populations are likely to be inadequate without an alliance between health professionals and communities to identify and address mutually comprehensible objectives that are perceived locally as meaningful and relevant. An appreciation of local cultural models and the diversity of cultural contexts enables health professionals to (1) recognize the significance of local perceptions of diarrheal illness with respect to pertinent outcomes and perceived needs, (2) develop ways to introduce recommendations that communities will accept, and (3) make appropriate use of existing community resources representing local traditions. An agenda for needed research concludes the review.