| dc.description.abstract | The burden of asthma is increasing globally, even where relevant knowledge and effective therapy are available. It is assumed this is partly attributable to high rates of nonadherence, estimated at an average 50%. The patient-physician-relationship has been identified as a major factor for adherence. Despite developments apparently to the contrary, mainstream medicine s response to the challenge still seems to be influenced by a reductionist approach whereby a plethora of barriers are to be removed through improved doctor-to-patient communication, to allow for precise and standardized yet individually tailored interventions. In contrast, anthropological insight would claim that such an approach is insufficient, since many of these "barriers" are essential behavioural compasses in the life worlds of humans that by nature are not only biological but also meaning-seeking cultural beings. In my study, I challenge mainstream views on adherence by applying a strategy proposed by Kleinman et al in 1978 to my own data from Cuba in the mid-1990s. The strategy regards illness and disease as complementary explanatory models, and introduces the concept of the cultural construction of clinical reality. The authors claim its systematic application would improve low compliance rates and even solve the deep crisis in the health care sector. I argue that their analysis and solutions might be as valid today. In my interpretation, the proposed physician-facilitated interaction with patients leading to a clinical reality with common models and goals enveloping both illness and disease dimensions resonates well with the perspective of concordance, which I find a useful development from the currently preferred concept of adherence to therapy. | eng |