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A Model for Translating Ethnography and Theory into Culturally Constructed Clinical Practices

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Abstract

This article describes the development of a dynamic culturally constructed clinical practice model for HIV/STI prevention, the Narrative Intervention Model (NIM), and illustrates its application in practice, within the context of a 6-year transdisciplinary research program in Mumbai, India. Theory and research from anthropology, psychology, and public health, and mixed-method ethnographic research with practitioners, patients, and community members, contributed to the articulation of the NIM for HIV/STI risk reduction and prevention among married men living in low-income communities. The NIM involves a process of negotiation of patient narratives regarding their sexual health problems and related risk factors to facilitate risk reduction. The goal of the NIM is to facilitate cognitive-behavioral change through a three-stage process of co-construction (eliciting patient narrative), deconstruction (articulating discrepancies between current and desired narrative), and reconstruction (proposing alternative narratives that facilitate risk reduction). The NIM process extends the traditional clinical approach through the integration of biological, psychological, interpersonal, and cultural factors as depicted in the patient narrative. Our work demonstrates the use of a recursive integration of research and practice to address limitations of current evidence-based intervention approaches that fail to address the diversity of cultural constructions across populations and contexts.

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Notes

  1. The research and intervention program known as RISHTA (meaning ‘relationship’ in Hindi/Urdu and an acronym for Research and Intervention on Sexual Health: Theory to Action), has included three NIH-funded projects, spanning 12 years (2001–2013): (a) Men’s Sexual Concerns and Prevention of HIV/STI (RO1MH64875; PI, S. Schensul; Co-PIs, B. Nastasi, R. Verma, 2001–2007); (b) supplement, Assessing Women’s Risk of HIV/STI Transmission within Marriage in India, funded by the US Office of AIDS Research of NIH (2002–2006); and (c) Prevention of HIV/STI among Married Women in Urban India (PI, S.Schensul, Co-PIs, R.Verma, B. Nastasi, N.Saggurti, S.Maitra, R.Aras, A. Pandey, J.Schensul, 1R01 MH075678, 2007–2013). This manuscript focuses on our work in the initial project focused on men.

  2. We bring professional development into our discussion as it relates to our training of medical practitioners within the context of our project; that is, implementing NIM for medical practice required reconstruction of providers’ schemas related to treatment of men’s sexual health concerns. We address this in a subsequent section related to program implementation.

  3. A full articulation of these foundations can be found in the following publications: Kostick et al. 2010; Schensul et al. 2007; Schensul et al. 2006a, b, c; Schensul et al. 2009a, b; Schensul et al. 2004; Nastasi et al. 2007.

  4. At the Urban Health Center, the fee for an initial visit was Rs. 10 (US $0.20) with no additional fees for follow-up visits within 15 days. Typical fees for private AYUSH providers were Rs. 30–40 (US $0.60–0.80) per visit.

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Authors and Affiliations

  1. Department of Psychology, Tulane University, 2007 Percival Stern Hall, 6400 Freret Street, New Orleans, LA, 70130, USA

    Bonnie Kaul Nastasi

  2. Institute for Community Research, Hartford, CT, USA

    Jean J. Schensul

  3. University of Connecticut School of Medicine, Farmington, CT, USA

    Stephen L. Schensul

  4. Universite Laval, Quebec, QC, Canada

    Abelwahed Mekki-Berrada

  5. Tata Institute of Social Sciences, Mumbai, India

    Shubhada Maitra

  6. International Center for Research on Women, New Delhi, India

    Ravi Verma

  7. Population Council, New Delhi, India

    Niranjan Saggurti

  8. University of Connecticut, Storrs, CT, USA

    Pertti J. Pelto

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  1. Bonnie Kaul Nastasi
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  2. Jean J. Schensul
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Correspondence to Bonnie Kaul Nastasi.

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This manuscript is being submitted for consideration in the category, Illness Narrative. The manuscript represents original work that has not been submitted or published elsewhere.

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Nastasi, B.K., Schensul, J.J., Schensul, S.L. et al. A Model for Translating Ethnography and Theory into Culturally Constructed Clinical Practices. Cult Med Psychiatry 39, 92–120 (2015). https://doi.org/10.1007/s11013-014-9404-9

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