Introduction
It has been suggested that although health professionals are generally cognisant that minority ethnic groups do not constitute monolithic entities, a powerful assumption has been that cultural differences within the UK population significantly affect health-related behaviour. In this paper, I will explore the contrasting explanations offered by health professionals and lay people for the 'problem' of compliance with therapy amongst Pakistani people living in the UK with a diagnosis of type 2 diabetes. The relevance of these findings to promoting 'concordance' are discussed.

Methods
A qualitative approach was adopted given the small amount of research that has been conducted in this area and the expressed desire to explore the complex constructions of both groups in a sensitive, contextually aware and in-depth manner (Mason 1996). Twenty-one patients identifying themselves as of Pakistani origin were interviewed, recruited from a hospital based diabetic centre and two GP surgeries. Twenty health professionals involved in the care of people with diabetes were interviewed. All interviews were tape recorded, transcribed and searched for repeated themes. The approach to analysis has been described in more depth by Mason (1996).

Themes in the data
Patients' explanations for non-compliance focused on the difficulties they faced integrating the diabetic regimen in the face of competing demands from the social context of their everyday lives. For example, patients talked about caring for family, social obligations and the demands of employment and their impact on compliance. They also emphasised the difficulties involved in prioritising 'health' in the face of these demands and in the context of living in an environment of poverty and material deprivation.

By contrast, health professionals focussed on 'Asian' cultural practices (a diet high in fats, oils and sugar, an emphasis on the relationship between body size and health, and the social significance of food and eating) in explaining non-compliance. In addition, they emphasised the role of the Muslim religion and its putative link with 'fatalistic' attitudes in shaping patients' ability to take responsibility for health.

Discussion
It is clear that there were marked discrepancies between the two sets of accounts. Lambert and Sevak (1996) have suggested that pathologising and reifying 'culture' and religion in the way described by health professionals represents a form of victim blaming which has the effect of ignoring other (often socio-economic) determinants of health status. We suggest that the 'concordance' model may represent one way of moving beyond this approach in terms of sharing and mutually respecting the differing perspectives of health professionals and patients.

References

1. Lambert H, Sevak L (1996). Is the 'cultural' difference a useful concept? In Hillier S & Kelleher D (Eds) Researching cultural differences in Health. Routledge.
2. Mason J. (1996). Qualitative researching. Sage