Explanatory models of black lung: Understanding the health-related behavior of Appalachian coal miners

Many retired coal miners who are eligible for care in a black lung treatment enter at little or no cost to themselves do not enter into available programs or discontinue soon after beginning therapy. Reasons for this behavior are related to the prevalent beliefs among Appalachians concerning the course of black lung and the appropriate treatment for it. The miners' health beliefs are clearly at odds with those of the health care providers who work in the centers. Using the concept of explanatory model, popular and professional health cultures are analyzed, focusing on course of disease, sick role, appropriate treatment, and expected outcome. Differences in explanatory models are discussed with regard to implications for the organization and delivery of care to retired coal miners with black lung.