Theorising inequalities in the experience and management of chronic illness: Bringing social networks and social capital back in (critically)

The role of the body in end-stage kidney disease in young adults: Gender, peer and intimate relationships

OBJECTIVES

To understand how the physical body, and changes in the physical body, influence peer and intimate relationships and parenting in young adults on renal replacement therapies (RRT).

METHODS

Qualitative interview data from 40 young adults aged 16-30 years with end-stage kidney disease (ESKD), first diagnosed aged 0-19 years, were analysed using modified grounded theory.

FINDINGS

Alternating modalities of RRT had a 'yo-yo' effect on the bodies of interviewees, repeatedly reconstructing them as either 'transplanted' bodies, often initially obese, or as 'dialysis' bodies', often underweight. Invisible somatic changes had a major impact on gendered social identity, making intimate social relationships and parenthood problematic. Prepubertal onset interviewees were generally less successful in forming partnerships than those with postpubertal onset; and interviewees on dialysis were likely to postpone partnering until they were transplanted. Social networks were essential for finding a partner, but male interviewees had fewer networks than females. Parenthood was particularly challenging for female interviewees.

CONCLUSIONS

In ESKD, life-saving RRT brings major changes to the body. These adversely affect social relationships and family formation during the crucial period of early adulthood. Effects vary according to age of onset, RRT modality, and gender, with those who were ill before puberty and those on dialysis worst affected.

The mediation of social influences on smoking cessation and awareness of the early signs of lung cancer

BACKGROUND

Whilst there has been no clear consensus on the potential for earlier diagnosis of lung cancer, recent research has suggested that the time between symptom onset and consultation can be long enough to plausibly affect prognosis. In this article, we present findings from a qualitative study involving in-depth interviews with patients who had been diagnosed with lung cancer (n = 11), and people who were at heightened risk of developing the disease (n = 14).

METHODS

A grounded theory methodology was drawn upon to conduct thematic and narrative based approaches to analysis.

RESULTS

The paper focuses on three main themes which emerged from the study: i) fatalism and resignation in pathways to help-seeking and the process of diagnosis; ii) Awareness of smoking risk and response to cessation information and advice. iii) The role of social and other networks on help-seeking. Key findings included: poor awareness among participants of the symptoms of lung cancer; ambivalence about the dangers of smoking; the perception of lung cancer as part of a homogenisation of multiple illnesses; close social networks as a key trigger in help-seeking.

CONCLUSIONS

We suggest that future smoking cessation and lung cancer awareness campaigns could usefully capitalise on the influence of close social networks, and would benefit from taking a 'softer' approach.

Exploring the relationship between multi-morbidity, resilience and social connectedness across the lifecourse

Multi-morbidity is receiving considerable attention in public policy, health and social care. From the perspective of the individual, multi-morbidity is a more complex experience than solely having a clinical diagnosis. In this article, we will argue that understanding multi-morbidity can be facilitated by considering the relationship between adversity (in this case multi-morbidity), resilience and social connectedness within a life course framework. This provides an approach that can capture the dynamics of social relationships, social connectedness and the fluctuations in the experience of multi-morbidity. We draw on a qualitative study of 17 people who have multiple conditions, but consider themselves as being able to maintain a sense of identity and self over time and in the face of adversity. From their accounts, a more varied picture emerges of living with multi-morbidity. This then depicts a more realistic representation of how each person shapes their multi-morbidity and resilient responses within their own social context, which can help to formulate more effective ways of supporting them.

Rationality, Rhetoric, and Religiosity in Health Care: The Case of England's Expert Patients Programme

Policymakers have associated the increasing prevalence and incidence of chronic illness with the threat of unsustainable demands for medical services, requiring deployment of effective demand-management strategies. In this article, the authors consider the rise in policy interest in self-management and examine the metaphors, discourse, official statements, policy developments, and goals shaping the field of chronic illness, especially surrounding the promotion and uptake of self-skills training in England's Expert Patients Programme (EPP). They discuss the shift in relationship between individuals and the state since the 1960s and 1970s; the rise in importance of self-management in relation to an aging population; the evidence and rhetoric associated with policy development; and the relationship of self-care to the notion of the “responsible patient,” as seen in policy implementation and EPP course promotion. The authors also draw on qualitative research to examine the transmission of ideology and rhetoric in self-skills training. Self-management policies are part of a shift from patient rights to individual responsibilities, a shift that may be less persuasive than its supporters imagine.

The United Kingdom Expert Patients Programme: results and implications from a national evaluation

The Expert Patients Programme (EPP) is a central element of chronic disease management policy in the United Kingdom. It aims to deliver self-care support by developing peoples' self-care skills, confidence and motivation to take more effective control over their long-term conditions. A large, national randomised controlled trial found that the EPP's lay-led skills training was effective in improving self-efficacy and energy levels among patients with long-term conditions, and was likely to be cost-effective. Key questions remain as to whether existing outcome measures capture the core outcomes that are important to patients with long-term conditions. The development and evaluation of self-care support initiatives should take into account the extent to which self-care support initiatives can be integrated into peoples' everyday lives, and the degree of fit with patients' existing adaptations and strategies. Rather than being concentrated on a single course, central resources for self-management support should be directed at a variety of systems and interventions that are able to meet the wide range of needs of patients with chronic conditions.