In this FIRST award, using dentistry as a model, methods developed in a University of Washington pilot study will be extended to a larger sample to explore acute and chronic pain perceptions among patients and dentists in Scandinavia, China, and United States. Specifically, we seek to determine how verbal descriptors are cognitively organized to reveal cultural influences on pain and coping remedies through a stepwise combination of ethnographic interviews and validations with participant observation and quantitative survey methods. 700 subjects will describe kinds of pains and ways of coping with them, especially acute and chronic orofacial pain. Subject groups will be matched for age, socioeconomic status, gender, and education. In a first interview, questions like 'What kinds of pain are there?' will be asked. Subjects' statements will be recorded verbatim in their native languages with the aim to reveal differences in perceptual context and detail their relevance. From this database, pain and coping remedy terms will be selected by specific criteria and used to construct crosscultural pain survey instruments. In a second interview, subjects will use a card sort instrument to judge the similarity of pain and remedy concepts. Reasons for sorting choices will be recorded to reveal perceptual categories. Grid matrices will also be used to match pains with subjects' descriptors and pain coping strategies. All open-ended data will be analyzed by content and detailed pain narratives written for each culture. Instrument data will be analyzed by multidimensional scaling and hierarchical clustering analyses. Results will be validated by behavioral observations. Reliability of the methods will be assessed by checking specified outcomes of quantitative indices; validity by how these indices relate to the findings of the qualitative phase. Our long-term objective is to understand how cultural influences such as ethnicity and professional socialization shape the perceived meanings of pain and pain coping remedies, with the intent to improve health-care communication in diagnosis and treatment.
