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Transcultural Psychiatry
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Knowledge Structures in Illness Narratives: Development and Reliability of a Coding Scheme

Lara Stern

McGill University lara.stern{at}mail.mcgill.ca

Laurence J. Kirmayer

McGill University laurence.kirmayer{at}mcgill.ca

Illness narratives reflect patients’ underlying illness schemas or models of illness as well as efforts to position themselves vis-à-vis a specific interlocutor and social context. Although the literature on illness narratives in medical anthropology has been dominated by the explanatory model perspective, people may use other types of knowledge structures to frame and construct their conceptions of symptoms. For this study, we developed operational definitions and a coding manual for three types of putative knowledge schemas: prototypes, chain complexes, and explanatory accounts. The operationalized definitions were then applied to coding a sample of illness narratives collected in a study of help-seeking in an urban community population. It was found that all three knowledge structures could be reliably identified in these narratives. This method of analysis provides a way to test hypotheses regarding the role of knowledge structures in illness narratives.

Key Words: attribution • discourse analysis • explanatory models • measures • symptom schemas

Transcultural Psychiatry, Vol. 41, No. 1, 130-142 (2004)
DOI: 10.1177/1363461504041358
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