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Sanders T, Fryer K, Greco M, Mooney C, Deary V, Burton C. Explanation for symptoms and biographical repair in a clinic for persistent physical symptoms. SSM. QUALITATIVE RESEARCH IN HEALTH 2024; 5:100438. [PMID: 38915733 PMCID: PMC11195018 DOI: 10.1016/j.ssmqr.2024.100438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 06/26/2024]
Abstract
Introduction Biographical disruption describes the process by which illness impacts not just on a person's body and their participation in activities, but also on their sense of self. Biographical disruption is often followed by a process of biographical repair in which identity is reconstructed and a new normality is restored. People with persistent physical symptoms (sometimes referred to as medically unexplained symptoms) experience biographical disruption. This can be complicated by lack of explanation and the implication that if the problem is not medical, then it might be the person/psychological. We aimed to examine this tension in people attending a novel "Symptoms Clinic" for people with persistent physical symptoms. Methods This study reports an embedded qualitative study in a UK based randomised controlled trial. Data were collected by audio recordings of consultations and semi-structured interviews with patients. We used theoretically informed thematic analysis with regular coding and discussion meetings of the analysis team. This analysis explores the role of intervention components in facilitating biographical repair. Results The lack of acceptable explanation for persistent symptoms acted as a block to biographical repair. In the clinic, multi-layered explanations were offered and negotiated that viewed persistent symptoms as understandable entities rather than as indicators of something still hidden. These explanations allowed study participants to make sense of their symptoms and in turn opened new opportunities for self-management. The result was that participants were able to reframe their symptoms in a way that enabled them to see themselves differently. Even if symptoms had not yet improved, there was a sense of being better. This can be understood as a process of biographical repair. Conclusion Explaining persistent physical symptoms enables biographical repair.
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Affiliation(s)
- Tom Sanders
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Northumbria Building, Newcastle upon Tyne, NE1 8ST, UK
| | - Kate Fryer
- Division of Population Health, Sam Fox House, Northern General Hospital, University of Sheffield, Sheffield, S5 7AU, UK
| | - Monica Greco
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, BA2 7AY
| | - Cara Mooney
- Clinical Trials Research Unit, School for Health & Related Research, University of Sheffield, Innovation Centre, Sheffield, S1 4DA, UK
| | - Vincent Deary
- Department of Psychology, Northumbria University, Northumbria Building, Newcastle upon Tyne, NE1 8ST, UK
| | - Christopher Burton
- Division of Population Health, Sam Fox House, Northern General Hospital, University of Sheffield, Sheffield, S5 7AU, UK
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Samant P, Tawde P, Tawde DN. Understanding How Patients With Lumbar Radiculopathy Make Sense of and Cope With Their Symptoms. Cureus 2024; 16:e56987. [PMID: 38665744 PMCID: PMC11045257 DOI: 10.7759/cureus.56987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Lumbar radiculopathy, characterized by pain radiating along a nerve root, significantly diminishes the quality of life due to its neuropathic nature. Patients' understanding of their illness and the coping strategies they employ directly influence how they manage their condition. Understanding these illness representations from the patient's perspective is crucial for healthcare providers seeking to optimize treatment outcomes. This study adopted a qualitative interpretive/constructive paradigm to explore this dynamic. A qualitative evidence synthesis approach, utilizing best-fit framework synthesis for data extraction, was applied to analyze primary qualitative studies focused on patient experiences with lumbar radiculopathy. Using SPiDER (Sample, Phenomenon of interest, Design, Evaluation, Research type) to guide the search strategy, extracted data was mapped against the Common-Sense Model of Self-Regulation (CSM) framework. Sixteen studies, with moderate to minor methodological quality concerns, were included in the analysis. Data mapping across CSM domains generated 14 key review findings. Results suggest that patients with high-threat illness representations often exhibit maladaptive coping behaviors (e.g., activity avoidance) driven by emotional responses. In contrast, problem-solving techniques appear to contribute to positive outcomes (e.g., exercise adherence and effective self-management) in patients who perceive their condition as less threatening. These findings highlight the potential benefits of interventions designed to reduce perceived threat levels and enhance self-efficacy in patients with lumbar radiculopathy, leading to improved self-management and ultimately better health outcomes.
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Affiliation(s)
- Pooja Samant
- Physical Therapy, Cardiff University, Cardiff, GBR
| | - Poonam Tawde
- Medicine, Avalon University School of Medicine, Willemstad, CUW
- Medicine, Chandler Regional Medical Center, Chandler, USA
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Disrupted everyday life in the trajectory of low back pain: A longitudinal qualitative study of the cross-sectorial pathways of individuals with low back pain over time. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Reddington M, Baxter S, Walters SJ. A qualitative exploration of patient experiences of medication for sciatica. Musculoskelet Sci Pract 2021; 55:102419. [PMID: 34186473 DOI: 10.1016/j.msksp.2021.102419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sciatica is often a painful and disabling condition, with medication routinely the first line of management. It is important to describe patients experiences of taking medication for sciatica, the reasons for commencing and reasons for cessation, the effects of the medication in symptom management and any other potential positive or deleterious effects. OBJECTIVES To describe patient experiences of medication for the relief of symptoms of sciatica. STUDY DESIGN Qualitative analysis of data from a mixed-methods randomised controlled pilot study. METHODS A total of 46 semi-structured interviews were conducted with 33 consenting participants (19 female) recruited from 14 GP practices. A purposive sampling strategy ensured a range of age, severity of pain and disability. Interviews were recorded and transcribed verbatim prior to thematic analysis, which aimed to identify the important, interesting or divergent views within the data. FINDINGS Participant experiences of pain were often severe with significant disability and fear. The use of a combination of medications was common, including the use of opioids and other medication inconsistent with national (NICE) guidance. Most participants found medication ineffective and reported significant side-effects, often necessitating cessation of the drugs or the use of alternatives. Despite the regularity of participants stopping all medication for sciatica, their pain levels still significantly eased over the 6-month period of the study. CONCLUSIONS The study highlighted a lack of perceived effectiveness for prescribed medication, often with concomitant side-effects. Clinicians should be cognisant of the fears that patients hold in terms of the cause and severity of sciatica, as well as fears of prescribed medication.
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Affiliation(s)
- Michael Reddington
- Therapy Services Outpatient Department Northern General Hospital Herries Road Sheffield, S5 7AU, UK.
| | - Susan Baxter
- Section of Public Health ScHARR, University of Sheffield 30 Regents Court Sheffield, S1 4DA, UK.
| | - Stephen J Walters
- Designs, Trials and Statistics, ScHARR, University of Sheffield, 30 Regents Court, Sheffield, S1 4DA, UK.
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Igwesi-Chidobe CN, Bishop A, Humphreys K, Hughes E, Protheroe J, Maddison J, Bartlam B. Implementing patient direct access to musculoskeletal physiotherapy in primary care: views of patients, general practitioners, physiotherapists and clinical commissioners in England. Physiotherapy 2021; 111:31-39. [PMID: 33316866 PMCID: PMC8120843 DOI: 10.1016/j.physio.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE Musculoskeletal problems are the leading cause of chronic disability. Most patients in the UK seek initial care from general practitioners (GPs), who are struggling to meet demand. Patient direct access to National Health Service physiotherapy is one possible solution. The purpose of this study was to understand the experiences of patients, GPs, physiotherapists and clinical commissioners on direct access in a region in England with it commissioned. METHODS The study was informed by Normalisation Process Theory (NTP). Data collection was via semi-structured individual face-to-face and telephone interviews with 22 patients and 20 health care professionals (HCPs). Data were analysed thematically using NPT. RESULTS Three themes emerged: understanding physiotherapy and the direct access pathway; negotiating the pathway; making the pathway viable. HCPs saw direct access as acceptable. Whilst patients found the concept of direct access, those with complex conditions continued to see their GP as first point of contact. Some GPs and patients reported a lack of clarity around the pathway, reflected in ambiguous paperwork and inconsistent promotion. Operational challenges emerged in cross-disciplinary communication and between HCPs and patients, and lack of adequate resources. CONCLUSION Direct access to NHS musculoskeletal physiotherapy is acceptable to patients and HCPs. There is need to ensure: effective communication between HCPs and with patients, clarity on the scope of physiotherapy and the direct access pathway, and sufficient resources to meet demand. Patient direct access can free GPs to focus on those patients with more complex health conditions who are most in need of their care.
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Affiliation(s)
- Chinonso N Igwesi-Chidobe
- Primary Care Centre Versus Arthritis, Faulty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom; Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Nigeria
| | - Annette Bishop
- Primary Care Centre Versus Arthritis, Faulty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Katrina Humphreys
- Central Cheshire Integrated Care Partnership, Leighton Hospital, Middlewich Road, Crewe, Cheshire, United Kingdom; The North West Coast Clinical Research Network, United Kingdom
| | - Emily Hughes
- Primary Care Centre Versus Arthritis, Faulty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Joanne Protheroe
- Primary Care Centre Versus Arthritis, Faulty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - John Maddison
- Primary Care Centre Versus Arthritis, Faulty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Bernadette Bartlam
- Primary Care Centre Versus Arthritis, Faulty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom.
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Foster NE, Konstantinou K, Lewis M, Ogollah R, Saunders B, Kigozi J, Jowett S, Bartlam B, Artus M, Hill JC, Hughes G, Mallen CD, Hay EM, van der Windt DA, Robinson M, Dunn KM. Stratified versus usual care for the management of primary care patients with sciatica: the SCOPiC RCT. Health Technol Assess 2020; 24:1-130. [PMID: 33043881 DOI: 10.3310/hta24490] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Sciatica has a substantial impact on patients and society. Current care is 'stepped', comprising an initial period of simple measures of advice and analgesia, for most patients, commonly followed by physiotherapy, and then by more intensive interventions if symptoms fail to resolve. No study has yet tested a model of stratified care in which patients are subgrouped and matched to different care pathways based on their prognosis and clinical characteristics. OBJECTIVES The objectives were to investigate the clinical effectiveness and cost-effectiveness of a stratified care model compared with usual, non-stratified care. DESIGN This was a two-parallel group, multicentre, pragmatic, 1 : 1 randomised controlled trial. SETTING Participants were recruited from primary care (42 general practices) in North Staffordshire, North Shropshire/Wales and Cheshire in the UK. PARTICIPANTS Eligible patients were aged ≥ 18 years, had suspected sciatica, had access to a mobile phone/landline, were not pregnant, were not receiving treatment for the same problem and had not had previous spinal surgery. INTERVENTIONS In stratified care, a combination of prognostic and clinical criteria associated with referral to spinal specialist services was used to allocate patients to one of three groups for matched care pathways. Group 1 received advice and up to two sessions of physiotherapy, group 2 received up to six sessions of physiotherapy, and group 3 was fast-tracked to magnetic resonance imaging and spinal specialist opinion. Usual care was based on the stepped-care approach without the use of any stratification tools/algorithms. Patients were randomised using a remote web-based randomisation service. MAIN OUTCOME MEASURES The primary outcome was time to first resolution of sciatica symptoms (six point ordinal scale, collected via text messages). Secondary outcomes (at 4 and 12 months) included pain, function, psychological health, days lost from work, work productivity, satisfaction with care and health-care use. A cost-utility analysis was undertaken over 12 months. A qualitative study explored patients' and clinicians' views of the fast-track care pathway to a spinal specialist. RESULTS A total of 476 patients were randomised (238 in each arm). For the primary outcome, the overall response rate was 89.3% (88.3% and 90.3% in the stratified and usual care arms, respectively). Relief from symptoms was slightly faster (2 weeks median difference) in the stratified care arm, but this difference was not statistically significant (hazard ratio 1.14, 95% confidence interval 0.89 to 1.46; p = 0.288). On average, participants in both arms reported good improvement from baseline, on most outcomes, over time. Following the assessment at the research clinic, most participants in the usual care arm were referred to physiotherapy. CONCLUSIONS The stratified care model tested in this trial was not more clinically effective than usual care, and was not likely to be a cost-effective option. The fast-track pathway was felt to be acceptable to both patients and clinicians; however, clinicians expressed reluctance to consider invasive procedures if symptoms were of short duration. LIMITATIONS Participants in the usual care arm, on average, reported good outcomes, making it challenging to demonstrate superiority of stratified care. The performance of the algorithm used to allocate patients to treatment pathways may have influenced results. FUTURE WORK Other approaches to stratified care may provide superior outcomes for sciatica. TRIAL REGISTRATION Current Controlled Trials ISRCTN75449581. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 49. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK.,Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Kika Konstantinou
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK.,Haywood Hospital, Midlands Partnership Foundation NHS Trust, Stoke-on-Trent, UK
| | - Martyn Lewis
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK.,Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Reuben Ogollah
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK.,Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Benjamin Saunders
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Jesse Kigozi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK.,Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Bernadette Bartlam
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK.,Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Majid Artus
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Jonathan C Hill
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Gemma Hughes
- Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Elaine M Hay
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Danielle A van der Windt
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK
| | | | - Kate M Dunn
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK
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Saunders B, Konstantinou K, Artus M, Foster NE, Bartlam B. Patients' and clinicians' perspectives on a 'fast-track' pathway for patients with sciatica in primary care: qualitative findings from the SCOPiC stratified care trial. BMC Musculoskelet Disord 2020; 21:469. [PMID: 32680487 PMCID: PMC7367249 DOI: 10.1186/s12891-020-03483-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sciatica is common and associated with significant impacts for the individual and society. The SCOPiC randomised controlled trial (RCT) (trial registration: ISRCTN75449581 ) tested stratified primary care for sciatica by subgrouping patients into one of three groups based on prognostic and clinical indicators. Patients in one group were 'fast-tracked' for a magnetic resonance imaging (MRI) scan and spinal specialist opinion. This paper reports qualitative research exploring patients' and clinicians' perspectives on the acceptability of this 'fast-track' pathway. METHODS Semi-structured interviews were conducted with 20 patients and 20 clinicians (general practitioners, spinal specialist physiotherapists, spinal surgeons). Data were analysed thematically and findings explored using Normalisation Process Theory (NPT) and 'boundary objects' concept. RESULTS Whilst the 'fast-track' pathway achieved a degree of 'coherence' (i.e. made sense) to both patients and clinicians, particularly in relation to providing early reassurance based on MRI scan findings, it was less 'meaningful' to some clinicians for managing patients with acute symptoms, reflecting a reluctance to move away from the usual 'stepped care' approach. Both groups felt a key limitation of the pathway was that it did not shorten patient waiting times between their spinal specialist consultation and further treatments. CONCLUSION Findings contribute new knowledge about patients' and clinicians' perspectives on the role of imaging and spinal specialist opinion in the management of sciatica, and provide important insights for understanding the 'fast-track' pathway, as part of the stratified care model tested in the RCT. Future research into the early referral of patients with sciatica for investigation and specialist opinion should include strategies to support clinician behaviour change; as well as take into account the role of imaging in providing reassurance to patients with severe symptoms in cases where imaging reveals a clear explanation for the patient's pain, and where this is accompanied by a thorough explanation from a trusted clinical expert.
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Affiliation(s)
- Benjamin Saunders
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK.
| | - Kika Konstantinou
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK
- Haywood Hospital, Midlands Partnership Foundation NHS Trust, Staffordshire, UK
| | - Majid Artus
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK
- Keele Clinical Trials Unit (CTU), David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK
| | - Bernadette Bartlam
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK
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Painful lives: Chronic pain experience among people who use illicit drugs in Montreal (Canada). Soc Sci Med 2020; 246:112734. [DOI: 10.1016/j.socscimed.2019.112734] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/05/2019] [Accepted: 12/12/2019] [Indexed: 01/03/2023]
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Polidano K, Chew-Graham CA, Bartlam B, Farmer AD, Saunders B. Embracing a 'new normal': the construction of biographical renewal in young adults' narratives of living with a stoma. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:342-358. [PMID: 31562644 DOI: 10.1111/1467-9566.13005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Stoma surgery can be a life-changing procedure due to bodily changes and related psychological responses. Despite previous literature identifying unique challenges for young adults living with a long-term condition, no studies have explored the biographical implications of stoma formation. Drawing on interviews with 13 young adults, aged 18-29 years, with a stoma resulting from inflammatory bowel disease, this article aims to generate new theoretical insights in understanding the process of biographical (re)construction and the wider implications of stoma formation among this group. Data analysis combined constructivist grounded theory and narrative analysis. Whilst two narratives display 'biographical suspension' characterised by a distancing of self from their stoma, the majority of narratives highlight positive transformations in the young adults' conceptions of self; which we explain through the concept of 'biographical renewal'. The liberating effects of stoma surgery allowed young adults to reclaim aspects of their pre-illness selves, yet also reconfigure a new, altered sense of self, culminating in a 'new normal'. However, psychological distress also co-existed alongside these positive representations, revealing a tension that young adults attempt to reconcile through narrativising their experiences. Our findings have implications for the identification and management of the psychological needs of young people with a stoma.
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Affiliation(s)
- Kay Polidano
- School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- School of Primary, Community and Social Care, Keele University, Keele, UK
- Midlands Partnership Foundation Trust, Stafford, UK
- West Midlands Collaboration for Leadership in Applied Health Research and Care, Staffordshire, UK
| | - Bernadette Bartlam
- School of Primary, Community and Social Care, Keele University, Keele, UK
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technical University, Singapore City, Singapore
| | - Adam D Farmer
- School of Primary, Community and Social Care, Keele University, Keele, UK
- Department of Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Benjamin Saunders
- School of Primary, Community and Social Care, Keele University, Keele, UK
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Le Hénaff Y, Héas S. Engagement in leisure and physical activities: analysing the biographical disruptions of a rare chronic disease in France. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:65-79. [PMID: 31498461 DOI: 10.1111/1467-9566.12987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Using the biographical disruption literature, this article examines how the experience of illness - in this case, pemphigus - reconfigures engagement in leisure activities, and how these activities are integrated into the biographies of persons with a rare chronic illness. Among the changes imposed by the illness, leisure activities are especially enlightening, as they primarily depend on the body. The article is based on a study of 50 interviews of persons with pemphigus, a rare and chronic dermatological disorder. The ways in which they relate to leisure activities give a new perspective on biographical disruption. The first striking observation is how diverse they are: illness does not level social differences or lived experience, and can even further consolidate commitment to engagements. We identified four types of engagement in leisure activities: disengagement, which reveals biographical disruption; adapted engagement, leading individuals toward low-risk physical activities; engagement in medicalised normalisation; and salutary engagement.
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Sanders T, Elliott J, Norman P, Johnson B, Heller S. Disruptive illness contexts and liminality in the accounts of young people with type 1 diabetes. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:1289-1304. [PMID: 30968432 DOI: 10.1111/1467-9566.12906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We utilise Bury's (1982) biographical disruption to examine young people's experiences of type 1 diabetes. Our findings show that young adults adopted various 'subject positions' across different illness contexts. The subject positions deployed are intended to produce a particular kind of normal embodied identity unaffected by diabetes. First, participants concealed their illness in public spaces and challenged cultural stereotypes of diabetes to maintain a normal illness biography. Disruption was ever present and required careful negotiation to avoid exposure of illness in public. Young adults upheld a 'normal public presentation'. Second, they resisted the medical system's pressure to adhere to glucose targets asserting and maintaining a subject position of 'independent and autonomous young adults'. Here, disruption was transient and temporary, present in the clinic but not always beyond. It remained in the background for much of the time until it was reinforced by parents or at meal times. Third, young adults acquired a 'pragmatic subject position' with diabetes viewed as complex but manageable, no longer a target for resistance. Frank's (1995) 'narrative restitution' is adopted to describe the transition to life with 'normal' illness. We argue that illness experience was 'liminal' and reflected the subject positions adopted by young adults.
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Affiliation(s)
- Tom Sanders
- Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Jackie Elliott
- Academic Unit of Diabetes, Endocrinology and Metabolism, Department of Oncology & Metabolism, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Barbara Johnson
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Simon Heller
- Academic Unit of Diabetes, Endocrinology and Metabolism, Department of Oncology & Metabolism, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK
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