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S46 F. Napo et al. / European Psychiatry 27 (2012) / supplement n°2 / S44-S49
That means that explanatory models previously held by the
patient and his/her family, those which had been created anew
during therapy as well as those of the professional caregivers
can be communicated by the mediator to the family members
or friends who stayed at home.
In Mali, like in most African countries, the extended family
traditionally includes all members of the families (cousins,
sisters, uncles, ancestors etc.) [17,32]. A family member’s
mediator role can help to demystify illness concepts that can
otherwise lead to stigmatisation, for example the interpretation
of being ‘bewitched by someone’. Thus reintegration is
facilitated and the patient is not isolated from the family. The
isolation of the group (family) and the loss of the subjective
position in the group have often been discussed as factors for
the aetiology and maintenance of negative mood states in
African patients [11]. The therapeutic “Koteba” theatre, which
is a part of the treatment setting and performed weekly by
the patients to enact typical social confl icts, further supports
exchange between patients and relatives. The Koteba has its
origins in the traditional Bambara theatre and was integrated
as a treatment tool in the 1980ies. Koteba has always been
used as an instrument to break taboos and speak about issues
that are otherwise not allowed to be addressed in traditionally
oriented Malian society.
3. Subjects and methods
We interviewed twenty persons (fi fteen patients and fi ve medical
practioners) with semi- structured, problem- centred qualitative
interviews. All patients who volunteered to participate in our study
suffered from psychotic symptoms caused by schizophrenia or
schizoaffective disorder according to DSMIV/ICD10. All interviews
with the patients and experts except one with a traditional Healer
where conducted at the clinic Pont G. in Bamako, Mali. Data were
collected regarding age, sex, date of birth, marital status, ethnicity,
religion and admission status. The interviews were mostly
recorded in “the Toguna” (house) of the “therapeutic village”; the
average duration was 1 hour. We gathered our information with
the assistance of culturally informed translators who were aware
of the socio- cultural matrix. This helped avoid linguistic barriers
and facilitated transcultural understanding for this study.
Methodologically, we applied qualitative content analysis,
i.e. an approach for the methodologically controlled analysis of
texts within the context of communication that follows content
analytical rules and applies step by step models [29]. We selected
this qualitative content analysis approach because the methodology
takes subjective views and social meanings into account,
which allow a better understanding of the social reality of the
patients. The focus of this qualitative approach can be seen as
an attempt to understand the complexity and uniqueness of the
subjects being researched [29].
The semi- structured interview guidelines included questions
about how the patients describe their illness or disease,
which key symptoms of schizophrenia are experienced by
the patients, what they believe is the cause for their problems
and how the patients and their families think they should be
treated. In particular, the last question was constructed and
evaluated in previous research the semi- structured guideline
was fi rst used in 2007, when we examined West African migrants
with psychotic symptoms in the Department of Psychiatry of
Charité, University Medical Centre Berlin, Germany [43]. This
fi rst investigation of the explanatory models of African migrants
gave us an impression how patients of West African descent
deal with psychotic symptoms in the Diaspora. We used the
same questionnaire with some variation for the present study
as a guideline and redefi ned questions in the fi eld according to
the context and situation while taking the interviews. Flexibility
is a main characteristic of the methodology and this was very
important for the research, because some of the Malian patients
started their narratives spontaneously after we introduced
ourselves (or the caregivers introduced us) as researchers from
Germany who intended to explore patients views and beliefs
about their illness. We explained that we also aimed to learn
from the patients as experts of their illness. The introduction
created confi dence, because we explained the purpose of the
interviews and asked for permission.
The semi- structured interview guideline consisted of the
following questions:
1. Why are you in the hospital? Did you have unusual or threatening
experiences or what makes you suffer?
2. How do you explain and integrate your problem/illness/disease
in your lifestory?
3. What things in life make you feel happy and what create fear?
4. How did the family react with regard to your illness?
5. What did the family counsel you to do with regard to your
problem/illness/disease?
6. What is “illness” and what is “healthiness” for you?
7. Which activities or treatments help you to recover?
The interviews were analysed with a computer assisted
content analysis programme, ATLAS.ti, to explore the explanatory
models and concepts of the West African patients and
professional caregivers. The programme ATLAS.ti is an instrument
supporting the analytical work and interpretation of the
data by helping to structure the text and to build and group
categories, which can be found in the transcripts according to our
research questions. Moreover, it supports the visual representation
of interpreted data, because it offers tools which can be
useful to create networks of the explored categories found in
the interviews.
1. In a fi rst step we structured the interview transcripts
and reviewed the texts explicitly with regard to our research
question: How do West African patients and their caregivers
experience and conceptualize illness and disease? We marked
passages in the transcripts, for example”my family brought me
to a traditional healer”, which seemed to be of importance for
the study of explanatory models and therapeutic activities. This
step can be supported with ATLAS. ti by generating so called
“in- vivo codes”, which give specifi c codes for quotations in
the transcripts that were deemed important according to our
research interests.
2. This process of paraphrasing was the basis for creating
categories. In the course of this mostly inductive but also deductive
research process, we defi ned new or redefi ned selected
codes from the fi rst trial, until all important information from
the transcripts was included.
The text interpretation always followed the research
question and was put into categories. The process of fi nding
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