Health Behavior and Communication in Pharmacy (พฤติกรรมสุขภาพและการสื่อสาร ทางเภสัชกรรม) Good afternoon, my teachers and my dear colleagues. Today I am very proud to present my study, it is the Analysis of Explanatory models and Therapeutic Choices under Patient-Provider Relation Context. Before going to the very interesting findings, I would like to remind all of you about the theme of the study and the methodology that the study used to collect the data. ดร.กรแก้ว จันทภาษา ภาควิชาเภสัชศาสตร์สังคมและบริหาร คณะเภสัชศาตร์ มหาวิทยาลัยขอนแก่น

Contents 1. Overview of Health System 2. Concept of Disease, Illness, Health and The Explanatory Model Good afternoon, my teachers and my dear colleagues. Today I am very proud to present my study, it is the Analysis of Explanatory models and Therapeutic Choices under Patient-Provider Relation Context. Before going to the very interesting findings, I would like to remind all of you about the theme of the study and the methodology that the study used to collect the data.

Behavior Outcome Determinants Good afternoon, my teachers and my dear colleagues. Today I am very proud to present my study, it is the Analysis of Explanatory models and Therapeutic Choices under Patient-Provider Relation Context. Before going to the very interesting findings, I would like to remind all of you about the theme of the study and the methodology that the study used to collect the data. Outcome 6-7 June 05

Outcome Determinants Health Behavior Good afternoon, my teachers and my dear colleagues. Today I am very proud to present my study, it is the Analysis of Explanatory models and Therapeutic Choices under Patient-Provider Relation Context. Before going to the very interesting findings, I would like to remind all of you about the theme of the study and the methodology that the study used to collect the data. 6-7 June 05

Health Behavior Illness Behavior Sick Role Behavior Preventive Health Behavior 6-7 June 05

Determinants Personal Determinants Family Determinants Personal Characteristic and Life Style Family Determinants Social Determinants Social Structure and Networks Social Roles Institutional Determinants Cultural Determinant 6-7 June 05

Outcome * Positive * Negative Treatment outcomes Short-term and intermediate outcomes Type and quantities of drugs Patient satisfaction Long-term outcomes Compliance /adherence to treatment Health status 6-7 June 05

Pluralistic Medical System (ระบบการแพทย์พหุลักษณ์) Professional sector Popular sector Folk sector 6-7 June 05

Popular sector Professional sector Folk sector 6-7 June 05

Pluralistic Medical System Popular sector Professional sector Folk sector Pluralistic Medical System 6-7 June 05

Biomedical Model Dentist Nurse Doctor Pharmacist Professional sector 6-7 June 05

ลักษณะของการแพทย์แผนปัจจุบัน Biomedical Model ลักษณะของการแพทย์แผนปัจจุบัน แบ่งเป็นแผนกต่างๆ สูติ ศัลย์ Med เด็ก ฯลฯ ห้องตรวจ Lab ห้องยา เครื่องมือ High tech 6-7 June 05

รากฐานของวิทยาศาสตร์สมัยใหม่ Biomedical Model รากฐานของวิทยาศาสตร์สมัยใหม่ กลไก แยกส่วน ลดส่วน สิ่งทีมีอยู่จริง ดำรงอยู่จริง จะต้องตรวจวัดได้ 6-7 June 05

Biomedical Model Disease (Helman,2000) Disease is the basic concept of biomedical knowledge, ruled on scientific rationality, and universally valid; clinical fact must be counted, tested, and tangible. 6-7 June 05

Popular sector เครือข่าย ชุมชน ผู้ป่วย ครอบครัว 6-7 June 05

Biomedical Model Illness (Helman,2000) Illness is the concept of lay knowledge on ill health, generates from the pattern of activities reinforced by the ways of life. Illness is the subjective response of an individual for sickly being, results of culture and social structure. Disease and illness are very different premises using different systems of evaluation on causes, efficacy of treatment, and others. 6-7 June 05

Illness Disease Outcome 6-7 June 05 This evidence presented that the physicians and patients hardly communicated with one another. The physicians did not concern on the patient’s illness, they did not hear the patient’s compliant, while the patients did not understand the physician’s diagnosis. Astonishingly, both parties felt satisfied about the consultation, which always ended in a prescription. Then, the prescriptions were the good way out of any problems that occurred in the consultations. 6-7 June 05

Illness Disease ตัวแบบการอธิบายความเจ็บป่วย 6-7 June 05 This evidence presented that the physicians and patients hardly communicated with one another. The physicians did not concern on the patient’s illness, they did not hear the patient’s compliant, while the patients did not understand the physician’s diagnosis. Astonishingly, both parties felt satisfied about the consultation, which always ended in a prescription. Then, the prescriptions were the good way out of any problems that occurred in the consultations. ตัวแบบการอธิบายความเจ็บป่วย 6-7 June 05

Explanatory Model (EM) ตัวแบบการอธิบายความเจ็บป่วย Explanatory Model (EM) Illness Disease วิธีการได้มาซึ่งความรู้ This evidence presented that the physicians and patients hardly communicated with one another. The physicians did not concern on the patient’s illness, they did not hear the patient’s compliant, while the patients did not understand the physician’s diagnosis. Astonishingly, both parties felt satisfied about the consultation, which always ended in a prescription. Then, the prescriptions were the good way out of any problems that occurred in the consultations. โรงเรียน ประสบการณ์ 6-7 June 05

activities reinforced Explanatory Model (EM) Disease Illness วิธีการได้มาซึ่งความรู้ Biomedical Sciences The pattern of activities reinforced by the ways of life This evidence presented that the physicians and patients hardly communicated with one another. The physicians did not concern on the patient’s illness, they did not hear the patient’s compliant, while the patients did not understand the physician’s diagnosis. Astonishingly, both parties felt satisfied about the consultation, which always ended in a prescription. Then, the prescriptions were the good way out of any problems that occurred in the consultations. 6-7 June 05

Different System of Thinking Kleinman (1980) Both physicians and patients have their own explanatory model Explanatory Model is “the notion about an episode of sickness and its treatment that is employed by all those engaged in the clinical process” 6-7 June 05

The Explanatory Model Both doctor and patient have their own explanatory models but different on five aspects of illness: etiology of the condition onset of symptoms pathophysiological processes involved natural and severity of the illness appropriate treatments for the conditions 6-7 June 05

The Explanatory model explanations of sickness and treatment guide choices among available therapies and therapists 6-7 June 05

The Explanatory Model Cobb & Hamera (1986) ideas of causation recognition of symptoms course of the illness experience therapies, including professional, popular, and folk evaluation of therapies 6-7 June 05

The Explanatory Model - Reeler (1996) Nichter (1980) and Reeler (1996) For therapies component, besides the type of health care providers, therapies will include the therapy expectation: etiquette, treatment style, and therapeutic objectives. Nichter (1980) and Reeler (1996) The perception of medicine must be considered, since it indicates direct effect on behavior and the use of multiple therapy sources especially on lay persons. 6-7 June 05

Definition of The Explanatory Model for Health Care Provider Six Significant Components 1.ideas of causation 2.recognition of symptoms 3.course of the illness experience 6-7 June 05

Six Significant Components 4. Therapies type of therapist (professional, popular and folk) therapy expectation manner such as formal, polite, etc. treatment style: medical equipment or technology therapeutic objectives: recovery, biomedical cure, patient satisfaction 6-7 June 05

Six Significant Components 5. evaluation of therapies 6. perception of medicines physical characteristics value 6-7 June 05

หนังสืออ่านประกอบ โกมาตร จึงเสถียรทรัพย์, นงลักษณ์ ตรงศีลสัตย์, และ พจน์ กริช-ไกรวรรณ บรรณาธิการ (2545). มิติสุขภาพ: กระบวนทัศน์ใหม่เพื่อสร้างสังคมแห่งสุขภาวะ. นนทบุรี: สถาบันวิจัยระบบสาธารณสุข. ประเวศ วะสี (2547) ทฤษฎีใหม่ทางการแพทย์. กรุงเทพฯ : หมอชาวบ้าน. ประเวศ วะสี (2538) รักษาโรคหรือรักษาคน. กรุงเทพฯ : หมอชาวบ้าน. 6-7 June 05

หนังสืออ่านประกอบ ประเวศ วะสี (2538) สาธารณทุกข์หรือสาธารณสุข. กรุงเทพฯ : หมอชาวบ้าน. David S. Gochman (1988) Health behavior : emerging research perspectives. New York : Plenum Pr. Kornkaew Chanthapasa (2004) Analysis of Explanatory Models and Therapeutic Choices under Patient-Provider Power Relation Context. Dissertation (Ph.D.), Social and Administrative Pharmacy. Faculty of Pharmaceutical Sciences. Chulalongkorn University. 6-7 June 05

Any Questions?? 6-7 June 05