Why did this happen to me? Causal attributions of illness and cultural health capital

Andrew Gallan*, Anu Helkkula, William R. McConnell

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review


This study examines how conversations between patients and clinicians about the causes of their health conditions relate to patient engagement in care. Leveraging cultural health capital (CHC) theory, we find that patient-physician discussions of health attributions are one mechanism to build patient understanding and activate engagement. We present a qualitative interpretive analysis of data collected in three phases with adult home health care patients: phone interviews (n = 28), field observations (n = 61), and semi-structured field interviews (n = 38). We find that engaging in discussions of causal health attributions with clinicians enables patients to overcome uncertainty, envision preventive actions, and engage in setting future goals. Such discussions must be supported by acknowledgement of the co-responsibility of individual factors and structural factors such as social determinants of health. These discussions are not easy to navigate but they can potentially help patients transition from a mindset of treating the disease (pathogenic approach) to an awareness of their available capabilities to improve health (salutogenic approach). This study contributes to research on attribution theory and cultural health capital theory by demonstrating how discussing causes for poor health can enable patients resolve doubts and accrue instrumental and symbolic resources that facilitate healing.
Original languageEnglish
Article number116923
Peer-reviewed scientific journalSocial Science & Medicine
Publication statusPublished - 28.04.2024
MoE publication typeA1 Journal article - refereed


  • 520 Other social sciences
  • causal attributions
  • health care
  • home care
  • cultural health capital
  • goals
  • illness
  • patient engagement
  • attribution theory
  • goal-setting

Areas of Strength and Areas of High Potential (AoS and AoHP)

  • AoS: Leading for growth and well-being


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