Hagey R
Soc Sci Med. 1984;18(3):265-72. doi: 10.1016/0277-9536(84)90089-3.
Type II Diabetes is a growing problem among Indian people in Canada. Ojibway and Cree leaders in Toronto collaborated with the University of Toronto, Faculty of Nursing, to develop the Native Diabetes Program. A key to the success of the program was seen by Natives to be the story 'Nanabush and the Pale Stranger', which seemed to put into perspective the nature of diabetes as a phenomenon. It provided explanations for it and answered numerous questions (non-biological) associated with the disease and indicated appropriate coping strategies. Yet formal methods of analyzing the story would not reveal its benefit as there is no explicit reference to many of the questions it implicitly answers. Metaphoric relationships are illuminated which may provide an underlying rationality to the narrative. Cultural expression is advocated as a source of making meaningful and tolerable that which is feared and avoided; of generating metaphors which make health information understandable and useful, by providing resolution to conflicting systems of belief. Information does not come in discreet ingestible particles of fact. All information is a sort of propaganda in that it is tied to deeper meaning structures. Clinicians are architects of meaning construction. Clinical research and practice requires a knowledge of the folk and professional construction of meaning around so-called factual information.
II型糖尿病在加拿大的印度裔人群中是一个日益严重的问题。多伦多的奥吉布瓦族和克里族领袖与多伦多大学护理学院合作，开展了原住民糖尿病项目。该项目成功的关键在于一个故事“纳纳布什与苍白陌生人”，原住民认为这个故事似乎从某种角度阐释了糖尿病这一现象的本质。它对糖尿病进行了解释，回答了许多与该疾病相关的（非生物学）问题，并指出了适当的应对策略。然而，对这个故事进行形式化分析并不能揭示其益处，因为它隐含回答的许多问题并没有明确提及。隐喻关系得以阐明，这可能为该叙事提供一种潜在的合理性。文化表达被倡导为一种让令人恐惧和回避的事物变得有意义且可容忍的源泉；通过为相互冲突的信仰体系提供解决方案，生成能使健康信息易于理解且有用的隐喻。信息并非以离散的、可摄取的事实颗粒形式呈现。所有信息在某种程度上都是一种宣传，因为它与更深层次的意义结构相关联。临床医生是意义构建的建筑师。临床研究和实践需要了解围绕所谓事实信息的民间和专业意义构建。
