Journal of Immigrant and Minority Health

, Volume 13, Issue 2, pp 385–394 | Cite as

Explanatory Models of Health and Disease Among South Asian Immigrants in Chicago

  • Manasi A. Tirodkar
  • David W. Baker
  • Gregory T. Makoul
  • Neerja Khurana
  • Muhammad W. Paracha
  • Namratha R. Kandula
Original Paper


To identify concepts of health and disease as part of a study on designing culturally-targeted heart disease prevention messages for South Asians. We conducted qualitative, semi-structured interviews in English, Hindi and Urdu with 75 respondents from a federally qualified health center and at a community center for South Asian immigrants in Chicago, Illinois. Age ranged from 20 to 70 years; 60% were women; 60% held advanced degrees; 70% migrated to the US in the last 10 years; and 60% of the interviews were in Hindi or Urdu. Concepts of health and disease fell into four domains: behavioral, physical, psycho-social and spiritual. Muslim participants consistently evoked spiritual factors such as faith and prayer. Women more frequently included performing home duties and positive affect in their concept of health. Men more frequently cited behavioral factors such as smoking and drinking as the cause of disease. Many South Asians have a holistic conceptualization of health and disease, incorporating spiritual, physical and psycho-social factors. Health promotion strategies aimed at South Asians in the US should take into account this holistic model of health and disease, while also recognizing that variations exist within South Asians, by gender and religion.


South Asians Immigrant health Concepts of health Concepts of disease 



This study was funded by the National Heart, Lung, and Blood Institute (Career Development Award 5 K23 HL 084177, PI-Dr. Kandula). During the research and writing of this paper Dr. Tirodkar was a post-doctoral research fellow at the Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, supported by an Advanced Rehabilitation Research Training Award from the National Institute on Disability and Rehabilitation Research Grant (H133P980014). The authors thank Asian Human Services Family Health Center and Indo-American Center for assistance with data collection. The authors also thank Jason A. Thompson for statistical support.


  1. 1.
    Jefferys K. U.S. legal permanent residents: 2006. Annual flow report, DHS office of immigration statistics. 2007.Google Scholar
  2. 2.
    Betancourt JR. Cultural competence—marginal or mainstream movement? N Engl J Med. 2004;351(10):953–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Carrillo JE, Green AR, et al. Cross-cultural primary care: a patient-based approach. Ann Intern Med. 1999;130(10):829–34.PubMedGoogle Scholar
  4. 4.
    Chachkes E, Christ G. Cross cultural issues in patient education. Patient Educ Couns. 1996;27(1):13–21.PubMedCrossRefGoogle Scholar
  5. 5.
    Charles C, Gafni A, et al. Cultural influences on the physician-patient encounter: the case of shared treatment decision-making. Patient Educ Couns. 2006;63(3):262–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Dimou N. Illness and culture: learning differences. Patient Educ Couns. 1995;26(1–3):153–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Fox RC. Cultural competence and the culture of medicine. N Engl J Med. 2005;353(13):1316–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Herbert CP. The relevance of cultural diversity to patient education. Patient Educ Couns. 1997;31(2):3–4.Google Scholar
  9. 9.
    Meeuwesen L, Tromp F, et al. Cultural differences in managing information during medical interaction: how does the physician get a clue? Patient Educ Couns. 2007;67(1–2):183–90.PubMedCrossRefGoogle Scholar
  10. 10.
    Schouten BC, Meeuwesen L. Cultural differences in medical communication: a review of the literature. Patient Educ Couns. 2006;64(1–3):21–34.PubMedCrossRefGoogle Scholar
  11. 11.
    Schouten BC, Meeuwesen L, et al. Cultural diversity in patient participation: the influence of patients’ characteristics and doctors’ communicative behaviour. Patient Educ Couns. 2007;67(1–2):214–23.PubMedCrossRefGoogle Scholar
  12. 12.
    Kleinman A. Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley: University of California Press; 1980.Google Scholar
  13. 13.
    Engel GL. The biopsychosocial model and the education of health professionals. Ann N Y Acad Sci. 1978;310:169–87.PubMedCrossRefGoogle Scholar
  14. 14.
    Astin J, Sierpina V, et al. Integration of the biopsychosocial model: perspectives of medical students and residents. Acad Med. 2008;83(1):20–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Weiner B. Difficult medical problems: on explanatory models and a pragmatic alternative. Med Hypotheses. 2007;68(3):474–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Blaxter M. The causes of disease. Women talking. Soc Sci Med. 1983;17(2):59–69.PubMedCrossRefGoogle Scholar
  17. 17.
    Karasz A. Cultural differences in conceptual models of depression. Soc Sci Med. 2005;60(7):1625–35.PubMedCrossRefGoogle Scholar
  18. 18.
    Pill R, Stott NC. Choice or chance: further evidence on ideas of illness and responsibility for health. Soc Sci Med. 1985;20(10):981–91.PubMedCrossRefGoogle Scholar
  19. 19.
    Baer RD, Weller SC, et al. A comparison of community and physician explanatory models of AIDS in Mexico and the United States. Med Anthropol Q. 2004;18(1):3–22.PubMedCrossRefGoogle Scholar
  20. 20.
    Loewe R, Freeman J. Interpreting diabetes mellitus: differences between patient and provider models of disease and their implications for clinical practice. Cult Med Psychiatry. 2000;4(24):379–401.CrossRefGoogle Scholar
  21. 21.
    Kreuter MW, McClure SM. The role of culture in health communication. Annu Rev Public Health. 2004;25:439–55.PubMedCrossRefGoogle Scholar
  22. 22.
    Milat AJ, Carroll TE, et al. Culturally and linguistically diverse population health social marketing campaigns in Australia: a consideration of evidence and related evaluation issues. Health Promot J Austr. 2005;16(1):20–5.PubMedGoogle Scholar
  23. 23.
    McGuire MB. Ritual health in suburban America. New Jersey: Rutgers University Press; 1988.Google Scholar
  24. 24.
    Farmer P. AIDS and accusation: Haiti and the geography of blame. Berkeley: University of California Press; 1993.Google Scholar
  25. 25.
    Arcury TA, Skelly AH, et al. Diabetes beliefs among low-income, white residents of a rural North Carolina community. J Rural Health. 2005;21(4):337–45.PubMedCrossRefGoogle Scholar
  26. 26.
    Farooqi A, Nagra D, et al. Attitudes to lifestyle risk factors for coronary heart disease amongst South Asians in Leicester: a focus group study. Fam Pract. 2000;17(4):293–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Netto G, McCloughan L, et al. Effective heart disease prevention: lessons from a qualitative study of user perspectives in Bangladeshi, Indian and Pakistani communities. Public Health. 2007;121(3):177–86.PubMedCrossRefGoogle Scholar
  28. 28.
    Arnold D. Colonizing the body: state medicine and epidemic disease in nineteenth-century India. Berkeley: University of California Press; 1993.Google Scholar
  29. 29.
    Turner V. The forest of symbols: aspects of ndembu ritual Ithaca. NY: Cornell University Press; 1970.Google Scholar
  30. 30.
    Shweder R, Much N, et al. The big three of morality (autonomy, community, divinity) and the big three explanations of suffering. Morality and health. A. Brandt and P. Rozin. New York: Routledge; 1997.Google Scholar
  31. 31.
    Desjarlais R. Body and emotion: the aesthetics of illness and healing in the Nepal Himalayas. Philadelphia: University of Pennsylvania Press; 1992.Google Scholar
  32. 32.
    Kakar S. Shaman, mystics and doctors. Chicago: University of Chicago Press; 1982.Google Scholar
  33. 33.
    Kurtz S. All the mothers are one: Hindu India and the cultural reshaping of psychoanalysis. New York: Columbia University Press; 1992.Google Scholar
  34. 34.
    Lamb S. White saris and sweet mangoes. Berkeley: University of California Press; 2000.Google Scholar
  35. 35.
    Langford J. Fluent bodies: ayurvedic remedies for postcolonial imbalance. Durham: Duke University Press; 2002.Google Scholar
  36. 36.
    Obeyesekere G. Medusa’s hair: an essay on personal symbols and religious experience. Chicago: University of Chicago Press; 1981.Google Scholar
  37. 37.
    Van Hollen C. Birth on the threshold: childbirth and modernity in South India. Berkeley: University of California Press; 2003.Google Scholar
  38. 38.
    Joshi P, Islam S, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. Jama. 2007;297(3):286–94.PubMedCrossRefGoogle Scholar
  39. 39.
    Cohen L. No aging in India: Alzheimer’s, the bad family and other modern things. Berkeley: University of California Press; 1998.Google Scholar
  40. 40.
    Lawton J, Ahmad N, et al. Contextualising accounts of illness: notions of responsibility and blame in white and South Asian respondents accounts of diabetes causation. Sociol Health Illn. 2007;29(6):891–906.PubMedCrossRefGoogle Scholar
  41. 41.
    Johnson JL, Bottorff JL, et al. South Asian women’s views on the causes of breast cancer: images and explanations. Patient Educ Couns. 1999;37(3):243–54.PubMedCrossRefGoogle Scholar
  42. 42.
    King KM, LeBlanc P, et al. Gender-based challenges faced by older Sikh women as immigrants: recognizing and acting on the risk of coronary artery disease. Can J Nurs Res. 2006;38(1):16–40.PubMedGoogle Scholar
  43. 43.
    Institute of Medicine (U.S.). Committee on Communication for Behavior Change in the 21st Century: Improving the Health of Diverse Populations. Speaking of health assessing health communication strategies for diverse populations. Washington: National Academies Press; 2002.Google Scholar
  44. 44.
    Institute of Medicine (U.S.). Committee on Assuring the Health of the Public in the 21st Century. The future of the public’s health in the 21st century. Washington: National Academies Press; 2003.Google Scholar
  45. 45.
    Mensah GA. Eliminating disparities in cardiovascular health: six strategic imperatives and a framework for action. Circulation. 2005;111(10):1332–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Makoul G, Clayman ML, et al. Four concepts of health in America: results of national surveys. J Health Commun. 2009;14(1):3–14.PubMedCrossRefGoogle Scholar
  47. 47.
    Crawford R. Healthism and the medicalization of everyday life. Int J Health Serv. 1980;10:365–88.PubMedCrossRefGoogle Scholar
  48. 48.
    Tirodkar MA. Adaptations of contemporary Ayurvedic medical practice in urban India [unpublished dissertation]. Department of Comparative Human Development. Chicago: University of Chicago; 2005.Google Scholar
  49. 49.
    Miles M, Huberman M. Qualitative data analysis: an expanded sourcebook. 2nd ed. Thousand Oaks: Sage Publications; 1994.Google Scholar
  50. 50.
    Strauss A, Corbin J. Grounded theory in practice. Thousand Oaks: Sage Publications; 1997.Google Scholar
  51. 51.
    Rangaswamy P, Kalayil AL. Making data count: South Asian Americans in the 2000 Census with focus on Illinois. Chicago: South Asian American Policy and Research Institute (SAAPRI); 2005.Google Scholar
  52. 52.
    Tirodkar MA. Cultural conceptions of health and health outcomes: caste and gender differences in Orissa, India [unpublished MA thesis]. Department of Comparative Human Development. Chicago: University of Chicago; 2000.Google Scholar
  53. 53.
    Green G, Bradby H, et al. We are not completely westernised: dual medical systems and pathways to health care among Chinese migrant women in England. Soc Sci Med. 2006;62(6):1498–509.PubMedCrossRefGoogle Scholar
  54. 54.
    Momenzadeh S, Posner N. Iranian migrant’s discourses of health and the implications for using standardized health measures with minority groups. J Immigr Health. 2003;5(4):173–80.PubMedCrossRefGoogle Scholar
  55. 55.
    Bradby H, Varyani M, et al. British Asian families and the use of child and adolescent mental health services: a qualitative study of a hard to reach group. Soc Sci Med. 2007;65(12):2413–24.PubMedCrossRefGoogle Scholar
  56. 56.
    Facey ME. The health effects of taxi driving: the case of visible minority drivers in Toronto. Can J Public Health. 2003;94(4):254–7.PubMedGoogle Scholar
  57. 57.
    Lauderdale DS, Wen M, et al. Immigrant perceptions of discrimination in health care: the California health interview survey 2003. Med Care. 2006;44(10):914–20.PubMedCrossRefGoogle Scholar
  58. 58.
    Viruell-Fuentes EA. Beyond acculturation: immigration, discrimination, and health research among Mexicans in the United States. Soc Sci Med. 2007;65(7):1524–35.PubMedCrossRefGoogle Scholar
  59. 59.
    Ngo-Metzger Q, Massagli MP, et al. Linguistic and cultural barriers to care. J Gen Intern Med. 2003;18(1):44–52.PubMedCrossRefGoogle Scholar
  60. 60.
    Neusner J, Sonn T, et al. Judaism and Islam in practice: a sourcebook. London: Routledge; 1999.Google Scholar
  61. 61.
    Agarwal P. Passage from India: post 1965 immigrants and their children. Palos Verdes: Yuvati Publications; 1991.Google Scholar
  62. 62.
    Bacon J. Life lines: community, family, and assimilation among Asian Indian immigrants. New York: Oxford University Press; 1997.Google Scholar
  63. 63.
    Lessinger J. From the Ganges to the Hudson: Indian immigrants in New York City. Boston: Allyn and Bacon; 1995.Google Scholar
  64. 64.
    Kleinman A, Benson P. Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med. 2006;3(10):e294.PubMedCrossRefGoogle Scholar
  65. 65.
    Mohanty SA, Woolhandler S, et al. Diabetes and cardiovascular disease among Asian Indians in the United States. J Gen Intern Med. 2005;20(5):474–8.PubMedCrossRefGoogle Scholar
  66. 66.
    King KM, Thomlinson E, et al. Men and women managing coronary artery disease risk: urban-rural contrasts. Soc Sci Med. 2006;62(5):1091–102.PubMedCrossRefGoogle Scholar
  67. 67.
    Curlin FA. Commentary: a case for studying the relationship between religion and the practice of medicine. Acad Med. 2008;83(12):1118–20.PubMedCrossRefGoogle Scholar
  68. 68.
    Nagai C. Clinician’s self-assessment of cultural and spiritual competency: working with Asians and Asian Americans. Community Ment Health J. 2008;44(4):303–9.PubMedCrossRefGoogle Scholar
  69. 69.
    Shweder R, LeVine R, editors. Culture theory: essays on mind, self, and emotion. Cambridge: Cambridge University Press; 1984.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Manasi A. Tirodkar
    • 1
  • David W. Baker
    • 2
    • 3
  • Gregory T. Makoul
    • 3
    • 4
  • Neerja Khurana
    • 3
  • Muhammad W. Paracha
    • 5
  • Namratha R. Kandula
    • 2
    • 3
    • 4
  1. 1.National Committee for Quality AssuranceWashingtonUSA
  2. 2.Institute for Healthcare StudiesNorthwestern University Feinberg School of MedicineChicagoUSA
  3. 3.Division of General Internal MedicineNorthwestern University Feinberg School of MedicineChicagoUSA
  4. 4.St. Francis Hospital and Medical CenterHartfordUSA
  5. 5.Asian Human Services Family Health Center, Inc.ChicagoUSA

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