“If you listen to the doctor, you still have to die”

Abstract

Background: Little is known about the processes underlying cultural differences in health behaviour. Leventhal’s (2011) CSM was adopted as a theoretical framework to investigate differences in illness perceptions between the UK (individualistic culture) and Pakistan (collectivistic culture). Methods: Participants were recruited in Pakistan (N = 71) and the UK (N = 68). A 2 (culture) x 5(illnesses) mixed design was used with culture as a between group and illness as a repeated measure factor. Five illnesses were included, two with higher prevalence in Pakistan (malaria, tuberculosis), two with higher prevalence in the UK (diabetes, lung cancer) and one with equal prevalence (flu), to control for relative prevalence across the two countries. Participants completed a booklet in their native language. For each of the five illnesses participants responded to open ended questions concerning their beliefs about symptoms, cause, consequences, cure and prevention. Responses were coded according to domains (e.g. the dimension cause was coded according to 6 categories such as environmental, biological, long and short term behaviour, chance/faith and stress) for subsequent statistical analysis. Findings: Analysis confirmed that participant’s perceptions of illness prevalence in their home countries mapped on to the WHO prevalence data. A series of culture by domain MANOVAs revealed significant cultural X domain interactions. For example, Pakistani participants anticipated more depressive affective responses, more functional consequences and were less likely to anticipate seeking medical treatment. Discussion: Data revealed distinctive patterns of cultural difference that can be interpreted in terms of collectivism and individualism across cultures.