LEARN Model¹

• L - Listen with empathy and understanding to the patient’s perception of the problem. Try questions like: What do you think may be causing your problem? How do you think the illness is affecting you? What do you think might be beneficial?
• E - Explain your thoughts and perceptions about the problem.
• A - Acknowledge, discuss, and incorporate the differences and similarities between your patient’s beliefs and your own professional understanding of treatment options.
• R - Recommend treatment. Suggest a treatment plan that is developed with the patient’s involvement, including culturally appropriate aspects.
• N - Negotiate agreement. The final treatment plan should be determined as mutually agreeable by both the care provider and patient.

Kleinman’s Explanatory Model²

• What do you think caused your problem? What name does it have?
• Why do you think it started when it did?
• What do you think your illness does to you? How does it work?
• How severe is it? Will it have a short or long course?
• What are the chief problems your illness has caused you?
• What do you fear most about your illness?
• What kind of treatment do you think you should receive?
• What are the most important results you hope to receive?

Social Context of Patients³

Control over environment

• How do you usually pay for your medication? Are you ever short of food or clothing?
• How do you keep track of appointments? Are you more concerned about how your health affects you right now or how it might affect you in the future?

Change in environment

• Where are you from?
• What made you decide to come to this country [city, town]? When did you come?
• How have you found life here compared to life in your country [city, town]?
• What was medical care like there, compared with here? How did you get your medication?

Social stressors and support network

• What is causing the most difficulty or stress in your life? How do you deal with this?
• Do you have friends or relatives that you can call on for help? Who are they? Do they live close to you?
• Are you very involved in a religious or social group? Do you feel that God [or a higher power] provides a strong source of support in your life?

Literacy and language

• Do you have trouble reading your medication bottles or appointment slips?
• What language do you speak at home? Do you ever feel that you have a hard time talking about your medicine with the doctor or pharmacist?

Negotiating Across Cultures for Management Options^{3, 4}

1. Describe specific medication information in easy-to-understand words
2. Prioritize medication management options
3. Determine patient’s priorities
4. Present a reasonable medication management plan that reflects both patient and pharmacist priorities
5. Ask patient directly about their level of acceptance of this plan
6. If conflict remains, focus negotiation on highest priorities