EXPLANATORY MODELS OF DIABETES - PATIENT PRACTITIONER VARIATION

Most cases of diabetes, a complex disorder that requires many lifestyl e changes, can be controlled if persons adhere to their prescribed reg imen. However, compliance is difficult to attain. Differences in expla natory models between client and practitioner have been suggested as o ne reason for non-compliance in several disorders. In this ethnographi c investigation, individual explanatory models were elicited from pers ons with diabetes and from health professionals working with these pat ients. Professionals described models of diabetes in general and their model of a particular patient's diabetes. A composite professional mo del was constructed and compared with each of the patients' models. Th e models were most congruent regarding treatment. Etiology, pathophysi ology, and severity had less congruence, and time and mode of symptom onset were least congruent. The Spearman correlation coefficient showe d a positive but non-significant association of explanatory model cong ruence between professionals and patients with normal glycosylated hem oglobin levels. Patients and professionals seem to emphasize different domains; patients emphasized difficulties in the social domain and th e impact of diabetes on their lives while staff saw diabetes primarily as a pathophysiological problem with impact on patients' physical bod ies. This study's importance rests on its clear articulation of signif icant differences between patients' and staffs' models even when they are similar in demographic characteristics.