Taking the MINI to Mustang, Nepal: methodological and epistemological translations of an illness narrative interview tool

Abstract

Illness narratives and explanatory models have been a research focus for the discipline of medical anthropology for decades. In recent years, standardized qualitative research tools have been developed to elicit illness narratives as a means of conducting socio-cultural analysis and as a springboard for health-related interventions – particularly with reference to communities experiencing rapid socioeconomic transition or those in which trauma has been experienced. Nevertheless, gaps persist in terms of the latent methodological and epistemological challenges of translating and transplanting such research tools to new contexts. This paper chronicles the adaptation of the McGill Illness Narrative Interview (MINI) for use in the culturally Tibetan region of Mustang, Nepal. This analysis is based on 44 in-depth interviews using an adapted version of the MINI to elicit narratives about experiences of illness. The MINI proved to be a compelling research tool, particularly in terms of engaging research assistants in the field. Yet its deployment in a context where distinctions between individual and social suffering can be blurred, where the dichotomization of ‘religion’ and ‘medicine’ makes little sense, and where understandings of causality are rooted in the concept of karma, revealed the extent to which the MINI – and, by extension other such qualitative research tools – emerges from particular models of narrative construction and assumptions about the relationships between self and other, cause and effect. Concluding recommendations are made regarding the adaptation of this tool to other settings.

Keywords:

• explanatory models
• illness meaning
• medical anthropology
• narratives
• Nepal
• Tibet

Acknowledgements

The authors would like to thank Rob Whitley and three anonymous reviewers for their helpful comments on this manuscript. The authors also thank their friends, interviewees, and hosts in Mustang. Funding for this research was provided through Faculty Research Grants from the Rockefeller Center and the Claire Garber Goodman Fund of the Department of Anthropology, both at Dartmouth College. Student research support was granted through Dartmouth's First Year Research Program. The study received ethics clearance from the Dartmouth IRB.

Declaration of interest: none.

Notes

1. For example, the World Health Organization's Probe Flow Chart of the Composite International Diagnostic Interview has been criticized for its lack of adaptability, and the broad assumptions it makes which do not hold true in many cultures (Van Ommeren et al. 2000). The Illness Perception Questionnaire (IPQ) (Weinman et al. 1996) has also been linked to cultural bias (Bhui and Bhugra 2002, 7). The more recent publication of the Revised Illness Perception Questionnaire (IPQ-R) (Moss-Morris et al. 2002), has addressed some of these concerns, but this instrument, like its predecessor, still assumes a biomedical model and has not directly addressed issues of cultural bias.

2. A special issue of Anthropology & Medicine (Vol. 8, No. 1, 2001) was devoted to EMIC-based research. Several studies have also applied the EMIC alongside standard, quantitative epidemiological tools such as the Structured Clinical Interview for the DSM-III-R (SCID), the Revised Clinical Interview Scale (CISR), and the Hamilton Depression Rating Scale (Weiss et al. 1995; Henningsen et al. 2005; Patel et al. 1995; Raguram et al. 1996; Weiss et al. 1992).

3. An example of such a question in the original MINI reads ‘Have you considered that you might have [INTRODUCE POPULAR SYMPTOM OR ILLNESS LABEL]?’

4. The authors thank one anonymous reviewer for the note that, from a methodological perspective, such data could be productively analyzed through a conversation analysis, to examine how each person's account is influenced by others and how a consensus story emerges.