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Grue J. The double bind of social legitimacy: On disability, the sick role, and invisible work. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:78-94. [PMID: 37394774 DOI: 10.1111/1467-9566.13692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 06/16/2023] [Indexed: 07/04/2023]
Abstract
During the last few decades, the human rights paradigm has shifted the normative status of disabled people, providing, in principle, the right to full and equal participation. Particularly in neoliberal economies, however, participation in work life is a major constraint on social legitimacy, creating a predicament for people who cannot adhere to the ideal of the 'productive member of society'. In this article, I explore this predicament at the intersection of disability studies and the sociology of health and illness, reviewing literature and discussing key concepts. I argue that in neoliberal societies, two distinct and largely incompatible pathways to social legitimacy depend, respectively, on (a) a version of the classical sick role and (b) a more recently constituted able-disabled role. Of these, the first pathway has mainly been explored and critiqued in the sociology of health and illness, while the second features mainly in disability studies. However, both pathways can be understood (1) as ableist mechanisms for maintaining adherence to values of productivity and by (2) imposing on disabled people an unequal burden of invisible work-a key feature of ableism, driving inequality both within the group of disabled people and for the group as a whole.
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Affiliation(s)
- Jan Grue
- Department of Sociology and Human Geography, University of Oslo, Oslo, Norway
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McKenna G, Rogers A, Walker S, Pope C. The influence of personal communities in understanding avoidable emergency department attendance: qualitative study. BMC Health Serv Res 2020; 20:887. [PMID: 32958065 PMCID: PMC7504825 DOI: 10.1186/s12913-020-05705-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/31/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Use of emergency department (ED) care globally seems to be increasing at a faster rate than population growth (Baker, House of Commons Library. Accident and Emergency Statistics, Demand, Performance, 2017). In the UK there has been a reported 16% rise in emergency admissions over the past 5 years. Estimates that between 11 and 40% of ED attendances are non-urgent, with 11% of patients being discharged from the ED without treatment (NHS Digital 2017), and a further 44% require no follow-up treatment (NHS Digital, Hospital Accident and Emergency Activity 2016-17, 2019) is cited as evidence that these patients did not require this level of care. The solution to not using the most appropriate point in the system has traditionally been seen as a knowledge problem, requiring, improved sign-posting and information to enable people to self-manage or use health care management for minor ailments. However research about help-seeking behaviour suggests that the problem may not be an informational one. A considerable literature points to help seeking as a social process influenced by a range of contingencies and contextual factors including the way in which lay people influence health care utilisation (Giebel et al. BMJ Open 9:1, 2019). Personal communities comprise a variety of active and significant social ties which have potential to influence individual capacity to seek help. Here we extend and unpack further influencing decisions about seeking formal health care with reference to how they are shaped and informed by and within personal social networks. METHODS We undertook a personal network mapping and qualitative interview-based study to look at, problematize and understand attendance for non-urgent problems. We used network analysis and methods to map and characterise the personal communities of people seeking help from ED for minor ailments and semi-structured interviews with 40 people attending a single ED and associated GP hub providing equivalent care. Interviews were built around an ego network mapping activity and a topic guide structured to explore attender's narratives about why they had visited the ED. This ego network activity uses a diagram consisting of three concentric circles (Fiori et al. J Gerontol B-Psychol 62: 322-30, 2007), representing closest social network members (in the centre) and those at further distance. Participants were initially presented with one of these diagrams and asked to write names of people or resources that had played a role in their attendance and the interviewer probed the interviewee to discuss the actions, input and value of the people and services that supported the visit to the ED. RESULTS We analysed number and type of network connections and undertook a thematic analysis to identify how imagined and actual network members and influences were implicated in ED attendance. The network maps created during the interviews were examined and a typology of networks was developed and used to distinguish different types of networks informed by our reading of the data, and a Network Typology Scoring Tool, a measure of frequency of contact and relationship type in networks. CONCLUSIONS Our study suggests that faced with acute minor illness or injury people's networks narrow: they do not (and perhaps cannot) mobilise their imagined care network because the resources or connections may not be there or are difficult to engage. In addition we identified important system drivers of behaviour, notably that these patients are often directed to the ED by 'professional influencers' including health services staff.
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Affiliation(s)
- Gemma McKenna
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, B15 2RT UK
| | - Anne Rogers
- NIHR CLAHRC Wessex, University of Southampton, Southampton, SO17 1BJ UK
| | - Sandra Walker
- NIHR CLAHRC Wessex, University of Southampton, Southampton, SO17 1BJ UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Services, University of Oxford, Oxford, OX2 6GG UK
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Corbière M, Mazaniello-Chézol M, Bastien MF, Wathieu E, Bouchard R, Panaccio A, Guay S, Lecomte T. Stakeholders' Role and Actions in the Return-to-Work Process of Workers on Sick-Leave Due to Common Mental Disorders: A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:381-419. [PMID: 31673934 DOI: 10.1007/s10926-019-09861-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The lack of knowledge regarding the roles and actions of return to work (RTW) stakeholders create confusion and uncertainty about how and when to RTW after experiencing a common mental disorder (CMD). Purpose The purpose of this scoping review is to disentangle the various stakeholders' role and actions in the RTW process of workers on sick-leave due to CMDs. The research question is: What is documented in the existing literature regarding the roles and actions of the identified stakeholders involved in the RTW process of workers on sick-leave due to CMDs? Methods In conducting this scoping review, we followed Arksey and O'Malley's (Int J Soc Res Methodol 8:19-32, 2005) methodology, consisting of different stages (e.g., charting the data by categorizing key results). Results 3709 articles were screened for inclusion, 243 of which were included for qualitative synthesis. Several RTW stakeholders (n=11) were identified (e.g., workers on sick leave due to CMDs, managers, union representatives, rehabilitation professionals, insurers, return to work coordinators). RTW stakeholders' roles and actions inter- and intra-system were recommended, either general (e.g., know and understand the perspectives of all RTW stakeholders) or specific to an actor (e.g., the return to work coordinator needs to create and maintain a working alliance between all RTW stakeholders). Furthermore, close to 200 stakeholders' actions, spread out on different RTW phases, were recommended for facilitating the RTW process. Conclusions Eleven RTW stakeholders from the work, heath and insurance systems have been identified, as well as their respective roles and actions. Thanks to these results, RTW stakeholders and policy makers will be able to build practical relationships and collaboration regarding the RTW of workers on sick leave due to CMDs.
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Affiliation(s)
- Marc Corbière
- Department of Education, Career counselling, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montreal, QC, H3C 3P8, Canada.
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada.
| | - Maud Mazaniello-Chézol
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Marie-France Bastien
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Estelle Wathieu
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Art History, Concordia University, Montreal, QC, Canada
| | | | - Alexandra Panaccio
- John Molson School of Business, Concordia University, Montréal, QC, Canada
| | - Stéphane Guay
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Psychiatry and Addictology, Université de Montreal, Montreal, QC, Canada
| | - Tania Lecomte
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
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Lindsay D, Brennan D, Lindsay D, Holmes C, Smyth W. Conceal or reveal? Patterns of self-disclosure of long-term conditions at work by health professionals in a large regional Australian health service. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2019. [DOI: 10.1108/ijwhm-05-2018-0071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to describe the patterns of self-disclosure of long-term conditions at work by health professionals in a large regional health service. Recent research by the authors has reported on the self-reported long-term conditions of nursing, medical and allied health staff within a large regional hospital and health service in North Queensland, Australia. Data regarding self-disclosure of health information were gathered during those two previous studies, but has yet to be reported. This current study thus offers the opportunity to explore and describe patterns of self-disclosure by a multi-disciplinary cohort of health professionals within that regional health service.Design/methodology/approachThis current study was a component of two larger studies, reported elsewhere, which explored long-term conditions among health professional staff at a large regional health service in North Queensland, Australia. A cross-sectional survey design was used.FindingsDecision-making associated with self-disclosure of long-term conditions by health professional staff in the workplace is multifactorial, and affected by considerations of age, gender, workplace circumstances and nature of the health condition. It also differs according to professional grouping. The medical profession were less likely than nurses and allied health workers to disclose to their work colleagues. Respondents with a mental health condition were more cautious and selective in their disclosures, and alone in being more likely to disclose to their supervisor than to colleagues; they were also most likely to value the sympathy and understanding of their colleagues and managers.Research limitations/implicationsThis study was conducted across only one large regional health service; a fuller picture of patterns of self-disclosure of long-term conditions by health professional staff would be gained by expanding the number of sites to include metropolitan hospitals, smaller rural or remote health services and non-hospital settings.Practical implicationsHealthcare organizations need to develop support strategies and communication processes so that staff with one or more long-term condition, particularly those that have associated stigma, are empowered to disclose information to line managers and colleagues without fear of discrimination, ostracism, incivility or bullying.Originality/valueThere is a paucity of evidence about self-disclosure of long-term conditions by health professionals and this study therefore makes an important contribution to the extant literature. The findings raise important questions about the culture and dynamics of health care organizations in respect to the patterns of self-disclosure of health professional staff.
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Smyth W, Lindsay D, Brennan D, Lindsay D. Medical and allied health staff self-reported long-term conditions. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2017. [DOI: 10.1108/ijwhm-07-2017-0050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to describe the self-reported long-term conditions of medical officers and allied health staff working in a regional public health service in northern Australia and how these conditions are managed.
Design/methodology/approach
A cross-sectional survey design was used. The sample was all medical officers and allied health staff employed in mid-2015.
Findings
Of the 365 respondents, 217 (59.5 per cent) reported having at least one long-term condition. There was a statistically significant association between professional group and the number of long-term conditions reported, χ2=10.24, p<0.05. A greater proportion of medical officers (n=29, 43.9 per cent) reported having only one long-term condition compared with allied health staff (n=36, 24.5 per cent). The top four categories of conditions were respiratory, musculoskeletal, mental health and episodic and paroxysmal, although the patterns varied amongst the professional groups, and across age groups. Respondents usually managed their main long-term conditions with personal strategies, rarely using workplace strategies.
Research limitations/implications
Although somewhat low, the response rate of 32 per cent was similar to previous surveys in this health service. Since this survey, the health service has implemented a broad Health and Wellness Programme to support their qualified workforce. Future evaluations of this programme will be undertaken, including whether the programme has assisted health professionals to manage their long-term conditions.
Practical implications
There is an urgent need for targeted, workplace-based health promotion strategies to support staff with long-term conditions. Such strategies would complement self-management approaches, and also provide an important recruitment and retention initiative.
Originality/value
This study adds empirical evidence regarding the long-term conditions among health professionals and their self-management strategies. Little is known about the long-term conditions among the various health professional groups and the findings thus make an important contribution to the existing literature.
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