Explanatory Cognitive Diagnosis Models Incorporating Item Features.

Item quality is crucial to psychometric analyses for cognitive diagnosis. In cognitive diagnosis models (CDMs), item quality is often quantified in terms of item parameters (e.g., guessing and slipping parameters). Calibrating the item parameters with only item response data, as a common practice, could result in challenges in identifying the cause of low-quality items (e.g., the correct answer is easy to be guessed) or devising an effective plan to improve the item quality. To resolve these challenges, we propose the item explanatory CDMs where the CDM item parameters are explained with item features such that item features can serve as an additional source of information for item parameters. The utility of the proposed models is demonstrated with the Trends in International Mathematics and Science Study (TIMSS)-released items and response data: around 20 item linguistic features were extracted from the item stem with natural language processing techniques, and the item feature engineering process is elaborated in the paper. The proposed models are used to examine the relationships between the guessing/slipping item parameters of the higher-order DINA model and eight of the item features. The findings from a follow-up simulation study are presented, which corroborate the validity of the inferences drawn from the empirical data analysis. Finally, future research directions are discussed.

Statistical explanation of the protective effect of four COVID-19 vaccine doses in the general population.

Objectives: To assess the effectiveness of four doses of the vaccine against SARS-CoV-2 in the general population and the impact of this on the severity of the disease by age group. Methods: By using data from the health authority public data base, we build statistical models using R and the GAMLSS library to explain the behavior of new SARS-CoV-2 infections, active COVID-19 cases, ICU bed requirement total and by age group, and deaths at the national level. Results: The four doses of vaccine and at least the interaction between the first and second doses were important explanatory factors for the protective effect against COVID-19. The R2 for new cases per day was 0.5644 and for occupied ICU beds the R2 is 0.9487. For occupied ICU beds for >70 years R2 is 0.9195 and with the interaction between 4 doses as the main factor. Conclusions: Although the increase in the number of vaccine doses did not adequately explain the decrease in the number of COVID-19 cases, it explained the decrease in ICU admissions and deaths nationwide and by age group.

Influence of Family Social Support and Diabetes Self-Efficacy on the Emotional Wellbeing of Children and Adolescents with Type 1 Diabetes: A Longitudinal Study.

Type 1 diabetes (T1D) is a chronic disease that is usually diagnosed in childhood, underscoring the importance of early disease control for overall wellbeing. Our aim was to design an explanatory model of subjective emotional wellbeing in children and adolescents with T1D. A longitudinal study was conducted at the Reina Sofia University Hospital in Cordoba (Spain). A total of 151 patients (mean age = 14.50, SD = 2.67; 41.1% girls) participated at T1, while 97 participated at T2 (mean age = 14.93, SD = 2.56; 39.2% girls). Participants completed a self-report questionnaire. Descriptive, reliability, correlation, path, and mediation analyses were performed. The explanatory model showed excellent fit indices [χ2 (10) = 8.62, p = 0.57, RMSEA = 0.00, 95% [0.00, 0.10], CFI = 1.00, GFI = 0.98, AGFI = 0.93, and TLI = 1.01]. The results showed significant and positive relationships between family social support and subjective emotional wellbeing and improved self-care skills. Self-efficacy presented a mediating role between family social support and subjective emotional wellbeing. Given that self-efficacy is a self-regulatory mechanism and a determinant of health, it is argued that future psychoeducational interventions could aim to improve self-efficacy to manage chronic diseases, to achieve greater emotional wellbeing in children and adolescents with T1D.

The role of culture on the phenomenology of hallucinations and delusions, explanatory models, and help-seeking attitudes: A narrative review.

AIM: Culture has been posited to be involved in the formation and maintenance of delusions and hallucinations. The extent of these differences and how they affect explanatory models of psychosis and help-seeking attitudes remains to be understood. This review aims to present a cultural formulation to account for psychosis onset, symptom maintenance, and help-seeking attitudes. METHODS: A narrative review was conducted to summarize the existing evidence base regarding cross-cultural differences in hallucinatory and delusional prevalence, explanatory models, and help-seeking attitudes in First Episode Psychosis (FEP) and Non-FEP Schizophrenia samples. RESULTS: Sixteen studies were eligible for inclusion. In terms of positive symptom specificity, cross-cultural differences were found. Specifically, auditory and visual hallucinations occurred most frequently in African patients, persecutory and grandiose delusions occurred at higher rates in African, Pakistani, and Latino patients, while delusions of reference were most prevalent in White-British groups. Three explanatory models were identified. Westerners tended to endorse a bio-psychosocial explanation, which was associated with increased help-seeking, engagement, and positive medication attitudes. Asian, Latino, Polish, and Maori patients endorsed religious-spiritual explanatory models, while African patients opted for a bewitchment model. The religious-spiritual and bewitchment models were associated with a longer duration of untreated psychosis (DUP) and poorer engagement with mental health services. CONCLUSIONS: These findings highlight the important influence of culture in the formation and maintenance of positive symptoms of psychosis, engagement, and help-seeking attitudes across different ethnic groups. The incorporation of cultural beliefs in formulation development could facilitate enriched CBTp practices and improved engagement amongst different cultural groups with Early Intervention Services.

Explanatory model of the psychosocial variables related to the social acceptance of a uranium mine project in northwest Spain.

Introduction: The demographic growth and the development of the welfare system have been accompanied by an important social dilemma between preserving nature or promoting energy development by assuming the benefits and risks of both proposals. This research attempts to address this social dilemma by analyzing the psychosocial factors that influence the acceptance or rejection of a new uranium mining development and exploitation project. The main objective was to test an explanatory theoretical model of uranium mining project acceptance, based on the interrelation of sociodemographic variables (e.g., age, gender, economic and educational situation, and level of knowledge about uranium energy) and cognitive variables (e.g., environmental beliefs, risk, and benefit perceptions), along with the activation of an emotional balance in response to the proposal of constructing a uranium mine. Method: Three hundred seventy-one individuals responded to the questionnaire about the variables included in the model. Results: The results showed that older participants showed lower levels of agreement with the mining proposal people, while women and those with greater knowledge of nuclear energy perceived greater risks and had a more negative emotional balance. The proposed explanatory model based on sociodemographic, cognitive, and affective variables showed good fit indices for explaining the assessment of the uranium mine. Thus, age, level of knowledge, risks and benefits, and emotional balance had a direct effect on the acceptance of the mine. Likewise, emotional balance showed a partial mediation effect between the relationships existing between the perception of benefits and risks and the acceptance of the mining proposal. Discussion: The results are discussed based on the consideration of analyzing sociodemographic, cognitive, and affective variables to understand potential conflicts in communities affected by energy projects.

Helpful explanatory models for persistent somatic symptoms (HERMES): Results of a three-arm randomized-controlled pilot trial.

OBJECTIVE: This three-arm randomized controlled trial aimed to test the efficacy of an etiological model for persistent somatic symptoms (PSS) translated into video-animated explanatory models in comparison to a control group, and to examine additional value of personalization of the explanatory models (i.e. possibility to choose information based on mechanisms of symptom persistence). METHODS: Outpatients with PSS were shown one of three 15-min video animations: a) explanatory model without personalization, b) explanatory model with personalization, c) no explanatory model control group. Changes in somatic symptom severity (PHQ-15) and psychological burden related to somatic symptoms or associated health concerns (SSD-12) from baseline to one-month follow-up were the primary outcome. Health-related quality of life (SF-12) and perceived usefulness (USE) were also assessed. RESULTS: Seventy-five patients with PSS were allocated to the study arms (Mage = 44.2 ± 13.3 years, 56% female). The study arms did not differ significantly on the primary outcomes. However, no explanatory model participants reported significantly greater mental quality of life improvements than explanatory model without personalization participants (Mdiff = 7.50 [0.43; 14.56]). Further, explanatory model with personalization participants rated the individual fit of the intervention significantly higher than no explanatory model participants (Mdiff = 2.05 [0.17; 3.93]). All groups rated credibility of the intervention as very high. CONCLUSION: The HERMES materials seemed to have been too brief to improve symptom related outcomes. However, all three interventions were positively evaluated regarding their usefulness, particularly in case of additional personalization. Future studies should investigate potential effects of an increased intervention dose. TRIAL REGISTRATION: DRKS00018803.

Patients' acceptance of explanatory models for persistent somatic symptoms: A qualitative analysis within the HERMES study.

OBJECTIVE: The aim of this qualitative study was to provide an in-depth analysis of participants' experiences with video-animated explanatory models developed within the three-arm randomized controlled HERMES study ('Helpful explanatory models for somatic symptoms') and suggestions for further intervention improvement. METHODS: Semi-structured qualitative interviews were conducted with psychosomatic outpatients with persistent somatic symptoms (PSS) after they were randomized to view one of three psychoeducational videos on a tablet computer: a) an explanatory model without personalization or b) an explanatory model with personalization in the two experimental groups or c) PSS guidelines without an explanatory model in the control group. Qualitative interviews were audiotaped, transcribed and analyzed applying thematic analysis. RESULTS: Seventy-five patients with PSS were allocated to the study arms, mean duration of interviews was 8.19 min (SD = 3.19, range 4.02-19.49 min). Although all participants gave positive feedback regardless of their allocated study arm, those in the explanatory model without and with personalization groups were especially likely to rate the psychoeducational interventions as helpful. Results highlighted previous illness course, symptom perceptions and patient characteristics as key factors related to patients' response to the video interventions and optimal personalization of the explanatory model. CONCLUSION: The present study not only demonstrated the acceptance of all three psychoeducational interventions developed within the HERMES study, but also provided valuable insights into potential key factors that may increase their impact and potential starting points for tailored psychoeducation in patients with PSS.

Which interventions with youths counter ageism toward older adults? Results from a realist review.

Age-related social biases - ageism - are developed at an early age. Interventions to counter ageism have been identified but little is known about their mechanisms, particularly in children. This study aimed to provide a comprehensive understanding of which interventions in youths are most effective, under which circumstances, how, and with what outcomes. Using 46 keywords in 6 databases, a realist review identified 24 studies published between 2000 and 2022 targeting youths under 18. A content analysis of these studies led to the construction of a Context-Mechanisms-Outcomes explanatory model. Contextual facilitators triggering mechanisms for changing stereotypes, prejudices and discrimination were: 1) enhancing knowledge about aging and older adults by providing nuanced information, 2) improving the quality of intergenerational contacts, 3) increasing opportunities to apply previously acquired knowledge in intergenerational interactions, and 4) promoting reflective thinking about experiences with older adults. However, stereotypes and prejudices appeared to be resistant and changes difficult to generalize. Insufficiently advanced cognitive development in children or viewing healthy and socially engaged older adults as unrepresentative of their age group were obstacles that reduced intervention effectiveness. Future studies should explore how advancing age influences interventions as well as the characteristics of older adults involved.

Explanatory Models and their Relationship with Drug Attitude in Patients with Depression in South India.

Background: The patient's understanding of the illness may mediate beliefs towards its treatment. There is a paucity of studies examining the relationships between these variables in depression. This study was conducted to know the relationships between explanatory models and attitude to medication in depression. Methods: 494 patients with depression in remission were assessed with sociodemographic proforma, Drug Attitude Inventory, and Mental Distress Explanatory Model Questionnaire. Results: A favorable attitude toward medication was observed in 57.49% of participants. Mean scores on MDEMQ subscales Stress, Western Physiology, Non-Western Physiology, and Supernatural were 32.96, 21.87, 10.06, and 47.55, respectively. Statistically significant associations were found between attitude towards medication and the patient's marital status (more negative attitude with single status, χ2 = 11.72, df = 3, P = 0.008) and occupation (more negative attitude among unemployed patients, χ2 = 4.17, df = 1, P = 0.041). The scores of explanatory models did not differ based on positive or negative drug attitude. Conclusion: Though explanatory models are not linked to patient attitudes toward medication, patients who are single or unemployed have a negative attitude toward medications. Such negative attitude may impair compliance and worsen patient outcomes.

Neuropathic pain, cognitive fusion, and alexithymia in patients with multiple sclerosis: Cross-sectional evidence for an explanatory model of anxiety symptoms.

Multiple sclerosis (MS) presents a high prevalence, a marked increase worldwide, and a relevant impact on patients, public health, and society. Anxiety often cooccurs with MS and can contribute to the worsening of MS symptoms. However, knowledge about predictors of anxiety in Patients with MS (PwMS) is scarce. OBJECTIVE: This preliminary study explored a novel model for anxiety symptoms in PwMS, including neuropathic pain (NeP), cognitive fusion (CF), experiential avoidance (EA), and alexithymia as explanatory factors. METHOD: This cross-sectional study integrated two independent convenience samples: 107 PwMS recruited from the Portuguese Society for Multiple Sclerosis and 97 age- and gender-matched participants without the MS diagnosis (no-MS sample) recruited from the Portuguese general population. Self-report questionnaires that measured the constructs included in the model were administered to both groups. RESULTS: PwMS showed significantly higher values regarding anxiety symptoms and their explanatory variables (NeP, CF, EA, alexithymia) in comparison to non-MS participants. In the MS sample, no correlations were found between anxiety symptoms and sociodemographic and clinical characteristics. NeP, CF, and alexithymia showed significant correlations with anxiety symptoms and significantly explained this symptomatology in simple linear regression models. Thus, these variables were retained in the multiple linear regression model and emerged as significant regressors that together explained 38% of the variance in anxious symptomatology in PwMS. CONCLUSIONS: This preliminary study provides novel evidence on NeP and some maladaptive emotion regulation strategies related to EA/psychological inflexibility, as vulnerability to anxiety in PwMS can be considerably increased by CF and alexithymia. Clinical implications were discussed.

Explanatory models, illness, and treatment experiences of patients with psychosis using the services of traditional and faith healers in three African countries: Similarities and discontinuities.

As part of formative studies to design a program of collaborative care for persons with psychosis, we explored personal experience and lay attributions of illness as well as treatment among persons who had recently received care at traditional and faith healers' (TFHs) facilities in three cultural groups in Sub-Saharan Africa. A purposive sample of 85 individuals in Ibadan (Nigeria), Kumasi (Ghana), and Nairobi (Kenya) were interviewed. Data was inductively explored for themes and analysis was informed by the Framework Method. Across the three sites, illness experiences featured suffering and disability in different life domains. Predominant causal attribution was supernatural, even when biological causation was also acknowledged. Prayer and rituals, steeped in traditional spiritual beliefs, were prominent both in traditional faith healing settings as well as those of Christianity and Islam. Concurrent or consecutive use of TFHs and conventional medical services was common. TFHs provided services that appear to meet the therapeutic goals of their patients even when harmful treatment practices were employed. Cultural and linguistic differences did not obscure the commonality of a core set of beliefs and practices across these three groups. This similarity of core worldviews across diverse cultural settings means that a collaborative approach designed in one cultural group would, with adaptations to reflect differences in context, be applicable in another cultural group. Studies of patients' experience of illness and care are useful in designing and implementing collaborations between biomedical and TFH services as a way of scaling up services and improving the outcome of psychosis.

Understandings of depression among community members and primary healthcare attendees in rural Ethiopia: A qualitative study.

Available evidence in Africa suggests that the prevalence of depression in primary care settings is high but it often goes unrecognized. In this study, we explored how depression is conceptualized and communicated among community members and primary care attendees diagnosed with depression in rural Ethiopia with the view to informing the development of interventions to improve detection. We conducted individual interviews with purposively selected primary care attendees with depression (n = 28; 16 females and 12 males) and focus group discussions (FGDs) with males, females, and priests (n = 21) selected based on their knowledge of their community. Data were analyzed using thematic analysis. None of the community members identified depression as a mental illness. They considered depressive symptoms presented in a vignette as part of a normal reaction to the stresses of life. They considered medical intervention only when the woman's condition in the vignette deteriorated and "affected her mind." In contrast, participants with depression talked about their condition as illness. Symptoms spontaneously reported by these participants only partially matched symptoms listed in the current diagnostic criteria for depressive disorders. In all participants' accounts, spiritual explanations and traditional healing were prominent. The severity of symptoms mediates the decision to seek medical help. Improved detection may require an understanding of local conceptualizations in order to negotiate an intervention that is acceptable to affected people.

'The day you start lifting is the day you become forever small': Bodybuilders explain muscle dysmorphia.

Muscle dysmorphia (MD) is a pathological preoccupation with muscularity characterised by negative body image, compulsive behaviours, and obsessive thoughts. Since its first identification academics have suggested that it is caused by sociocultural factors. Despite this there has been very little research exploring the role of sociocultural factors in the development and maintenance of MD, and no research that examines MD from within its cultural context. Instead the medical model of MD has dominated understanding. This model presents professionals as the experts on this disorder, and sufferers as pathological individuals in need of expert treatment. This renders cultural context largely irrelevant to understandings of MD. In this paper we present a different kind of expertise with regards MD. We describe the expertise of those most likely to suffer from MD, and upon whom medical descriptions of MD are based: bodybuilders. Specifically, we describe how bodybuilders explain MD (their definition, theory of aetiology and experience of MD, as well as their suggested management strategies), and compare these explanations to the dominant medical model. Through a consideration of the expertise of bodybuilders we break the tunnel vision of medicine, and suggest ways we can move beyond our current under-developed understanding of MD. This paper examines MD from within its cultural context, and in so doing it lays the foundation for a sociocultural explanatory model of MD. If we are to significantly reduce the harms of this disorder we cannot rely solely on treating the few individuals who present to clinicians. Rather we must develop ways to help sufferers to manage their disorder, and to prevent the development of this disorder among those at risk in the first place. To do this we must understand the sociocultural dimensions of MD, and collaborate with bodybuilding communities.

A planned behavior theory-based explanatory model of protective behavior against COVID-19, with an age perspective.

In this study, an explanatory model of protective behaviors against COVID-19 transmission based on the theory of planned behavior is tested using a sample of 904 individuals by adding two relevant variables in the COVID-19 context: skepticism and responsibility toward COVID-19 transmission. Responsibility and the intention to behave in a protective way act as mediators in predicting protective behaviors. The model is invariant between younger and older people, although some path differences were found: the perception that individuals have about the extent to which their reference group adopts protective behaviors directly influences individual protective behavior for younger but not older people, for whom subjective social norms were only indirect predictors of such behavior. Additionally, the rates in all the variables showed that the group under 35 took more risks in the context of protective behaviors against COVID-19: they exhibited more skepticism, lower behavioral control, perceived fewer positive social norms regarding protective behaviors, felt less responsible for spreading the disease, had less intention to behave in a protective way, and finally adopted fewer protective behaviors. Developers of intervention strategies and campaigns should contemplate such variables and focus on differences according to age.

Integral definition and conceptual model of mental health: Proposal from a systematic review of different paradigms.

Global society presents a mental health scenario characterized by the prevalence of mental disorders and the limited existence of formal care services. Faced with such a context, it is necessary to review what is understood and done in favor of mental health. This implies, in the first instance, analyzing the concept of mental health from a comprehensive approach that takes into account different perspectives from the social and natural sciences, related factors, and care options. Therefore, the present work aimed to propose an integral definition and a conceptual model of mental health based on the Systematic Literature Review, with the PRISMA approach, of the theoretical frameworks of 52 articles related to mental health published up to February 2022. A qualitative approach was used, with a Grounded Theory design, which allowed comparing different paradigms and identifying gaps in conceptual notions to build an explanatory model of mental health. The results showed three dominant paradigms that circumscribe the concept of mental health. Mental health is understood as the absence of illness, positive mental health, and a state of equilibrium. In addition, the need to propose a definition that integrates these dominant paradigms was mainly identified, and that would allow a broader understanding of the state of equilibrium as the basic process through which the individual must pass in the search for personal recovery. From the comparative analysis of the categories designated according to the Grounded Theory approach, an explanatory model was proposed to define mental health as the internal process of self-care, centered on the self-awareness and self-regulation of the human being, in which the person seeks to balance their feelings, thoughts, and behaviors, intrapersonal and interpersonal ones, to approach an optimal state of wellbeing and absence of mental disorders according to universal values and symptoms, and biological, social, psychological, and environmental factors.

Explanatory Models of Depression in a Rural Community of Coastal Karnataka, India: A Cross-Sectional Survey.

Background: Depression is a major public health problem but there is a huge treatment gap in India. Cultural beliefs influence conception of illness, personal meaning, help-seeking behaviors, and adherence to treatment. Research on explanatory models of depression attempt to explore these unique characteristics in an individual and the community. We set out to examine explanatory models of depression in a rural community of coastal Karnataka and explore the association between sociodemographic variables and explanatory models of depression. Methods: A cross-sectional household survey in the rural community of Harekala village, Mangaluru taluk, Dakshina Kannada district, Karnataka, was done using Kish tables. A total of 200 individuals were interviewed with an adaptation of the Short Explanatory Model Interview in a local language using a case vignette of depression. Results: Around 40% of the individuals perceived the problem as tension/stress/excessive worrying and did not perceive it as mental illness. A scant 10% of the participants recognized some mental illness. Around one-fifth of the individuals attributed the problem to evil spirits and black magic; female participants were more likely to endorse consulting a doctor (P = 0.003**) or a psychiatrist (P = 0.012*). In addition, participants belonging to Islam were less likely to consult a doctor (P = 0.028*) and psychiatrist (P = 0.021*). Also, participants belonging to lower social class were less likely to endorse psychiatric consultation (P = 0.018*). Conclusions: A vast majority of the study subjects failed to identify depression as an illness or acknowledge biomedical causation. Gender, religion, and socioeconomic class may influence help-seeking behavior.

"If They Give Their Mind to HIV, They Don't Last as Long": An Explanatory Model of HIV Infection in a Limited-Resource Setting Informs Person-Centered Care.

Explanatory models describe individuals' perceptions of their illness experiences, which can guide culturally relevant care. We constructed an explanatory model of the experience of living with human immunodeficiency virus (HIV) in the Dominican Republic. Following qualitative descriptive methodology, we conducted interviews in Spanish using a semi-structured interview guide developed using Kleinman's explanatory model framework. Two bilingual researchers coded interview transcripts following conventional content analysis. We used deductive codes from Kleinman's framework and inductive codes external to the framework to construct the codebook. We arranged codes by shared meaning into categories and constructed themes that reflected shared findings from inductive categories and deductive codes. Twenty-six persons living with HIV participated. They provided rich descriptions of their experiences represented by four cross-cutting themes, which informed the explanatory model. By incorporating this in-depth understanding of patients' illness experiences into care delivery, nurses can cultivate culturally meaningful and trusting patient-centered partnerships that improve health.

Los modelos explicativos describen las percepciones personales de las experiencias de vivir con una enfermedad, lo cual puede guiar una atención médica culturalmente relevante. Hemos construido un modelo explicativo a partir de la experiencia de vivir con el virus de inmunodeficiencia humana (VIH) en la República Dominicana. Siguiendo una metodología descriptiva cualitativa, realizamos entrevistas en idioma español basándonos en una guía de entrevista semiestructurada desarrollada dentro del marco del modelo explicativo de Kleinman. Dos investigadores bilingües codificaron las transcripciones de las entrevistas siguiendo un análisis de contenido convencional. Empleamos códigos deductivos del marco de Kleinman y códigos inductivos ajenos al marco para crear el libro de códigos. Organizamos los códigos por significado compartido en categorías; construimos los temas a fin de reflejar los hallazgos compartidos de las categorías inductivas y los códigos deductivos. Participaron veintiséis personas que viven con VIH. Brindaron descripciones abundantes de sus experiencias representadas por cuatro temas transversales, los cuales informaron el modelo explicativo. Al incorporar en la atención médica este entendimiento profundo de las experiencias de los pacientes de vivir con una enfermedad, el personal de enfermería puede desarrollar relaciones centradas en el paciente culturalmente significativas y de confianza que mejoran la salud.

A Rapid Ethnographic Assessment of Cultural and Social Perceptions and Practices About COVID-19 in Bangladesh: What the Policy Makers and Program Planners Should Know.

Anthropological literature on health beliefs and practices related to COVID-19 is scarce, particularly in low and middle-income countries. We conducted a qualitative research on perceptions of COVID-19 among slum residents of Dhaka, Bangladesh from November 2020 through January, 2021. Methods included in-depth interviews and photo elicitation with community residents. Interviews were transcribed and analyzed thematically. Results show scientific explanations of COVID-19 conflicted with interviewees' cultural and spiritual beliefs such as: coronavirus is a disease of rich, sinful people; the virus is a curse from Allah to punish sinners. Interviewees rejected going to hospitals in favor of home remedies, and eschewed measures such as mask-wearing or social distancing instead preferring to follow local beliefs. We have highlighted a gap between community beliefs about the pandemic and science-led interventions proposed by health professionals. For public health policy to be more effective it requires a deeper understanding of and response to community perceptions.

"Just Hemorrhoids, Not Cancer": Perceptions of Colorectal Cancer Among Thai Colorectal Cancer Patients.

Colorectal cancer is the leading cause of mortality among Thais. Understanding patients' perceptions of colorectal cancer can help in the design of educational programs to enhance awareness of colorectal cancer among Thais. This study aims to elucidate illness explanatory models of colorectal cancer and their perceptions of colorectal cancer through the explanatory model. In-depth interviews with 30 patients about their perceptions and experiences of colorectal cancer were subjected to thematic analysis. The findings show that the patients were unaware of colorectal cancer, had misconceptions regarding colorectal cancer detection and screening; they considered the symptoms to be the result of hemorrhoids, karma, and heredity. Their explanatory model underlies the body of knowledge grounded in the lay explanation which results in perception, beliefs, relative experiences, and approaches to illness management. There is a need for further information about colorectal cancer symptoms to assist symptom recognition through cancer education and screening programs.