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Table 4 Summary of comparative explanatory models used by patients and health care providers

From: Conceptual models for Mental Distress among HIV-infected and uninfected individuals: A contribution to clinical practice and research in primary-health-care centers in Zambia

Components of explanatory model HIV - HIV + Health care providers Comments
1. Name given to symptoms -Problems of the mind -Problems of the mind -Depression and stress -Depression, stress -problems of the mind -Occasional differences exists in the name given to symptoms between the health professionals and the traditional healers
2. Cause of symptoms -Poverty, marital problems, -witchcraft -Worries about course of disease, worry about future of family - HIV infection -Social-economic problems, intercurrent illnesses - bad spirits Witchcraft was cited as a cause among some the traditional healers. HIV infection was cited as a cause mostly among HIV+ not on ARV's
3.Common symptoms of experience Headache, sleeplessness, poor appetite, worthlessness, crying Worthlessness, loss of hope. Somatic symptoms - Somatic symptoms, - Social withdraw Significant differences noted based on HIV status and (if on) duration on ARVs
4. Greatest fear about their experiences - Worries about future of children, - death, - disability from illness, - not ever getting married - Children's future, - Death, - Stigma from relatives and friends - Course of illness - Future of family, - Death, - Stigma from family and friends, - Short life expectancy - Worries about future of family were the majority. Short life expectancy was next and the newly diagnosed worried more about stigma
5. Severity of experience - Severe but can have a remedy Extremely severe, no way back, hope for the best Severity depends on other circumstances such as poverty and family support Severity depended a lot on level of adjustment to HIV status and severity of circumstances
6. Choice of treatment Clinic, pain killers, majority no treatment Clinic, counselling, - Religion, - no treatment - Counselling, - Exorcism, - Support groups, family involvement, - Antidepressants Choice of treatment depended on what was thought to cause the problem
7. Factors leading to choice of treatment Severe symptoms (headache, tiredness, loss of sleep) Severity of symptoms, - family support, - Disclosure Severity of symptoms, cause of symptoms, previous failed consultations, Family involvement Factors associated with treatment options were, perceived cause of illness, family support.
8. Course of symptoms and alleviating factors - Short course, - Finding cure, - Solution possible (finding a job, improved marital relationships), may have a chronic course Chronic course, - ARVs, - Family support, social support groups, - Prayer - No hope - Can be modified by counselling and medication - Support groups - Traditional medicine - - Course of illness associated with perceived course of illness, ARVs - Alleviation of symptoms dependent on adjustment to illness, medication and counselling