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Health culture and the clinical encounter: Vietnamese refugees' responses to preventive drug treatment of inactive tuberculosis.

A majority of Vietnamese refugees entering the United States test positive for inactive tuberculosis (TB). In asymptomatic conditions like inactive TB, it is often difficult to obtain compliance with medical treatment. The clinical encounter has been analyzed as a form of symbolic action between doctor and patient critical to patient trust and compliance. However, it is equally, if not more, important to understand the health culture of patients, that is, the broader sociocultural context of the patient within which his or her illness is interpreted and understood. In this article I look at health culture elements that influence compliance and noncompliance by Vietnamese American clients with courses of preventive drug therapy for inactive TB. Key factors in compliance are: (1) cultural interpretations of the therapy's side effects as "hot"; (2) the role of family members and peers; and (3) community perceptions of the drug treatment. Culturally incongruent elements of the clinical encounter and the funding of community-based organizations for health education also are examined.