applied medical anthropologists with a substantial literature that is currently used in successful grant writing and the development of high impact applied projects.
Examples of Midrange Theory in Application
Many applied medical anthropology projects deliberately and appropriately utilize a diverse set of mid-range anthropological theories which allow them to (1) describe the cultural models of health and illness which provide a framework for understanding individual and group knowledge and beliefs; (2) monitor both the stability and the change in behavior; (3) identify the key social contexts in which cultural beliefs and values are turned into action; (4) establish the intervening conditions that either allow for change (protective forces) or prevent change (barriers); (5) understand the cultural–environmental and the political economy of health; (6) provide a theoretical framework for determining the decision making and sustainable actions of the group and identify the conditions that are necessary for sustained maintenance of behavioral change for individuals; (7) identify the symbolic and communication conditions imposed by cultural systems that relate to health behavior and behavioral change; and (8) either initiate or restructure culturally competent and effective interventions at the individual and group level. The following sections provide some examples of these approaches and their link to larger theoretical models.
Connections between the Internal and the External (Cognitive and Psychological Approaches)
The research on aspects of the internal–external connections between thought and behavior has developed predominantly within psychological anthropology and cognitive anthropology, although other approaches have also played a part in this area of midrange theory development. The midrange theories that appear to be in the most common use include Cultural Models, Cultural Beliefs Systematic Comparison, and Cultural Cognition (domain analysis). Some specific examples of the use of a cultural models or cultural health beliefs models include research on building culturally congruent prevention systems which are more than models; they are actual structural programs that test the models and their gender sensitivity for use in intervention programs (Weeks et al. 1996).
Cultural Domain Analysis provides an arena within which midrange theories have been successfully applied to both research questions and the development of HIV and drug interventions among other applied efforts. These approaches can provide excellent models for providing culturally competent, and locally motivated information prevention information, as in the case of a Puerto Rican study of what individuals wanted to know about substance abuse and AIDS education from risk reduction programs. They can also provide key information for qualitative–quantitative bridges to find predictors of risk perception, as seen in the work of Singer et al. (1996) among women drug users.
Systematic explorations of mental health and other illness domains have been pursued through the use of three interlocked cognitive anthropology methods. These are techniques for (1) exploring the content and limit of cultural domains (e.g., freelistings, sentence frame completion, contrast sets); (2) techniques for establishing the structural and cognitive relationships among the elements of cultural domains (e.g., pile sorts, dyad and triad tests, Q sorting, matrix profile analysis); and (3) techniques for establishing the cultural consensual framework for these systems of knowledge and belief (Trotter 1991, 1995). These techniques are amenable to being used in a standard pre-test/post-test design to analyze changes in cultural models or cognition over time as a result of intervention or culture change. Many of these techniques provide a format for systematic ethnographic rapid assessment. They also provide a methodological basis for bridging between ethnographic and standard survey or experimental (quantitative) research designs, since they are typically analyzed using both qualitative (description of meaning) and quantitative (cluster analysis, multidimensional scaling, correspondence analysis) algorithms. As an example, Trotter and Potter (1993) conducted an HIV risk pile sort with Navajo teenagers, using a list of risks that had been generated in focus groups and ethnographic interviews with Navajo cultural consultants. The project was offered as a service component of the Flagstaff Multicultural AIDS Prevention Program, and it explored the ways that the teenagers related the risks in their lives (including alcohol, drug, and HIV-related risks) to other risks (violence, school problems, sexuality). The results of the project demonstrated that the students were linking risks within bounded risk areas (e.g., drug risks, school risks, violence risks, etc.), and that the linkages between those areas were weakly associated. The models of risk for the teenagers were then valuable in constructing HIV and other risk prevention programs which improved the students understanding of the need to link among risks in order to prevent negative outcomes, and the need to strengthen boundaries between risks to avoid them.
Social Organization and Structure: Cultural Contexts Research
The bulk of health-related research in other disciplines has either focused on individuals and their attributes, or on population samples collected through probabilistic sampling procedures. While this approach has a number of strengths, its weaknesses are twofold. First, the cultural context of health problems is all too often ignored by individually centered approaches. Second, people spend a significant portion of their lives within small interactive groups, where their behavior may be impacted as much or more strongly by the group than by any individual characteristic that they bring to the group. Anthropological midrange theory has been highly productive in establishing the importance of cultural contexts and the organization and structure of human systems. These approaches derive from theories of kinship and social network analysis and the impact of cultural structures on human behavior.
Ethnographic network mapping allows applied anthropologists to describe the participants, the behaviors, the kinship and friendship ties, and the consequences of small “bounded groups” in a community. It is accomplished through extensive qualitative interviewing at the community level. In the drug field, the composite ethnographic characteristics of the networks have subsequently been used to create a “drug network” typology or classification system that describes the individual and group context of drug use (such as crack houses, local manufacturing, and distribution). Trotter et al. (1995) and Williams and Johnson (1993) have demonstrated that this type of data is extremely useful for targeting intervention and education activities for the highest risk groups, based on multiple risk criteria. The data can also provide important information about the sub-epidemics that are likely to be part of drug use in network groups (Trotter et al. 1993). In HIV and drug risk prevention, several projects have tested very useful midrange theory to identify network structural elements. These findings provide public health measures of HIV and drug risk conditions (Trotter et al. 1995; Weeks et al. 2001, 2006) as well as epidemiological comparisons of HIV risks within their personal network context in cities around the United States (Williams et al. 1995).
More recently, social network paradigms, combined with community-based participatory principles (CBPR) have provided an important theoretical foundation for understanding infectious disease carriage and transmission through the confluence of Staphylococcus aureus genomics and network analytics. The project has focused on health disparities in Staphylococcus aureus transmission and carriage in a border Region of the United States based on cultural differences in social Relationships (Pearson et al. 2019), providing an example of the potential confluence between biology, social organization, culture, and communication. The epidemiological aspects of genomics are a strong fit with paradigms that include organized social relationships.
Cultural Ecology, Critical Medical Anthropology, and Cultural Epidemiology Theories
The midrange theories related to cultural ecology, critical anthropology, and cultural ecology that have been successfully tested include Barriers to Change research (Environmental Factors Research), Cultural Congruency Models (Conflicts in Belief and Process), Human-Biological Interactions Research, Comparative Cultural Models Research, Deconstructionist Models, Critical Theory approaches, and studies of the political economy of health and illness (cf. Hill 1991; Singer and Baer 1995). These theories have provided
