1
|
Roikjær SG, Skou ST, Walløe S, Tang LH, Beck M, Simonÿ C, Asgari N. Experiences of integrating and sustaining physical activity in life with multiple sclerosis, Alzheimer's disease, and ischaemic heart disease: a scoping review. Disabil Rehabil 2024; 46:2979-2988. [PMID: 37584422 DOI: 10.1080/09638288.2023.2244424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 07/03/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE The effects of physical activity on health are well-established for chronic diseases such as multiple sclerosis (MS), Alzheimer's disease (AD), and ischaemic heart disease (IHD). However, sustaining physical activity in everyday life is difficult. Lifeworld knowledge can help qualify interventions aimed at resolving this public health issue, but there is a gap in regard to synthesized research on peoples' experiences with integrating and sustaining physical activity. Hence, the purpose of this review is to explore and present the available evidence on experiences with integrating and sustaining physical activity in a lived life with MS, AD, and IHD. METHODS We conducted a scoping review with qualitative analysis and narrative syntheses in accordance with PRISMA-ScR. Based on SPIDER we ran a systematic search in Cinahl, Embase, Medline, and PsychInfo for primary qualitative research papers published until December 2022. RESULTS 43 papers were included. A thematic content analysis found that individuals who have MS, AD or IHD find integrating and sustaining physical activity in everyday life meaningful on several levels: Physical activity can facilitate meaningful movement with outcomes of physical, psychosocial, and existential importance. CONCLUSION The research literature presents a meaning to physical activity that extends the idea of physical fitness to one of existential movement and personal growth. In addition, our review finds that people are more likely to integrate and sustain physical activity if they feel acknowledged, supported and believe that physical activity has a meaningful purpose reflecting their sense of self. Taking a more person-centred approach in rehabilitative care might help qualify the content of physical activity in terms of integration into everyday life, but more research is needed on how to implement a person-centred approach in practice.
Collapse
Affiliation(s)
- Stine G Roikjær
- Department of Neurology Næstved, Slagelse and Ringsted Hospitals, CNF, the Center for Neurological Research, Slagelse, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Sisse Walløe
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
- The Research Unit OPEN, Open Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Lars H Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Malene Beck
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Charlotte Simonÿ
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Nasrin Asgari
- Department of Neurology Næstved, Slagelse and Ringsted Hospitals, CNF, the Center for Neurological Research, Slagelse, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
2
|
Delaney S, Huntley-Moore S, Cronin P. Exercising power in the self-management of COPD: A narrative inquiry. Patient and user perspectives. PATIENT EDUCATION AND COUNSELING 2024; 118:107990. [PMID: 37847990 DOI: 10.1016/j.pec.2023.107990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE To develop an in-depth understanding of how people with COPD exercise power in the self-management of their illness. METHODS This was a narrative inquiry using Foucault's concepts of power, knowledge and agency as a conceptual framework. Up to three unstructured interviews were conducted with 31 people with COPD in the Republic of Ireland. Thematic template analysis was used to analyse the data. The COREQ checklist was used to report this qualitative study. RESULTS The findings of the study show that participants exercised power through mobilising agency in two main ways. They resisted the imposition of power by leveraging different types of knowledge. They also engaged in practices designed to operate on the self and the body in order to achieve happiness and health. However, this agency was constrained by the imposition of power by health care professionals. CONCLUSION The findings expand the understanding of self-management as a complex and multi-dimensional concept that is negotiated and constructed by people with COPD, using their own knowledge and agency. PRACTICE IMPLICATIONS Honouring the considerable skills and resources that people with COPD mobilise to self-manage should form the heart of person-centred self-management support.
Collapse
Affiliation(s)
- Sarah Delaney
- School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland.
| | | | - Patricia Cronin
- School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland
| |
Collapse
|
3
|
Wang R, Zhou C, Parry M. Health locus of control and self-management behaviours among individuals with ischaemic heart disease: protocol for a scoping review. BMJ Open 2023; 13:e075277. [PMID: 37848304 PMCID: PMC10582856 DOI: 10.1136/bmjopen-2023-075277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/20/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION Ischaemic heart disease is a significant cause of morbidity and mortality worldwide. Self-management is a way to reduce the risk associated with ischaemic heart disease; however, some individuals may not have the ability or willingness to engage in self-management behaviours. One approach to identify an individual's readiness and capacity to engage in self-management behaviours is to assess their health locus of control. Based on the Individual and Family Self-Management Theory, this review's objectives are to describe: (1) how health locus of control affects the process of engaging in self-management behaviours, (2) impacts of health locus of control on outcomes associated with self-management behaviours and (3) potential contextual variations in the relationship between health locus of control and self-management behaviours. METHODS AND ANALYSIS The scoping review will be guided by the Joanna Briggs Institute methodological framework. A comprehensive search will encompass seven electronic databases (Ovid Medline, CINAHL, EMBASE, APA PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus) and grey literature sources (ProQuest Dissertations, ClinicalTrials.gov). Collaborative efforts with library experts will inform our search strategies, building on insights from previous reviews centred on self-management and ischaemic heart disease. Two review authors will independently conduct the screening and data extraction processes; discrepancies will be resolved through consensus or discussion with a third review author. The review will include English studies from database inception, focusing on the health locus of control among adults with ischaemic heart disease. Findings will be presented graphically and tabularly, together with a narrative description. ETHICS AND DISSEMINATION We will collect data from published and grey literature, meaning ethical approval is not necessary. Findings will be published in peer-reviewed journals and presented at academic conferences. REGISTRATION DETAILS Open Science Framework (https://doi.org/10.17605/OSF.IO/B4A6F).
Collapse
Affiliation(s)
- Run Wang
- Department of Nursing, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Chunlan Zhou
- Department of Nursing, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Monica Parry
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Ukoha-Kalu BO, Adibe MO, Ukwe CV. A qualitative study of patients' and carers' perspectives on factors influencing access to hypertension care and compliance with treatment in Nigeria. J Hypertens 2023; 41:845-851. [PMID: 36883455 DOI: 10.1097/hjh.0000000000003409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE We explored patients' and carers' perspectives on factors influencing access to hypertension care and compliance with treatment. METHODS This was a qualitative study using in-depth interviews with hypertensive patients and/or family carers receiving care at a government-owned hospital in north-central Nigeria. Eligible participants were patients who had hypertension, receiving care in the study setting, were aged 55 years and over and had given their written/thumbprint consent to participate in the study. An interview topic guide was developed from the literature and through pretesting. All the interviews were held face-to-face by a member of the research team. This study was conducted between December 2019 and February 2020. NVivo version 12 was used to analyse the data. RESULTS A total of 25 patients and 13 family carers participated in this study. To understand the barriers to compliance with hypertension self-management practices, three themes were explored, namely: personal factors, family/societal factors and clinic/organization factors. Support was the key enabling factor for self-management practices, which were categorized to emerge from three sources namely: family members, community and government. Participants reported that they do not receive lifestyle management advice from healthcare professionals, and do not know the importance of eating low-salt diets/engaging in physical activities. CONCLUSION Our findings show that study participants had little or no awareness of hypertension self-management practices. Providing financial support, free educational seminars, free blood pressure checks, and free medical care for the elderly could improve hypertension self-management practices among patients living with hypertension.
Collapse
Affiliation(s)
- Blessing O Ukoha-Kalu
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Enugu State, Nigeria
- Hull York Medical School, The University of Hull, England, United Kingdom
| | - Maxwell O Adibe
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Enugu State, Nigeria
| | - Chinwe V Ukwe
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Enugu State, Nigeria
| |
Collapse
|
5
|
Hallqvist J. The making of a professional digital caregiver: personalisation and friendliness as practices of humanisation. MEDICAL HUMANITIES 2022; 48:347-356. [PMID: 34417320 PMCID: PMC9411891 DOI: 10.1136/medhum-2020-011975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
The aim of this paper is to explore how a digital caregiver, developed within a Swedish interdisciplinary research project, is humanised through health-enhancing practices of personalisation and friendliness. The digital caregiver is developed for being used in older patients' homes to enhance their health. The paper explores how the participants (researchers and user study participants) of the research project navigate through the humanisation of technology in relation to practices of personalisation and friendliness. The participants were involved in a balancing act between making the digital caregiver person-like and friend-like enough to ensure the health of the patient. Simultaneously, trying to make the patients feel like as if they were interacting with someone rather than something-while at the same time not making the digital caregiver seem like a real person or a real friend. This illustrates the participants' discursive negotiations of the degree of humanisation the digital caregiver needs in order to promote the health of the patient. A discursive conflict was identified between a patient discourse of self-determination versus a healthcare professional discourse of authority and medical responsibility: whether the digital caregiver should follow the patient's health-related preferences or follow the healthcare professionals' health rules. Hence, a possible conflict between the patient and the digital caregiver might arise due to different understandings of friendliness and health; between friendliness (humanisation) as a health-enhancing practice governed by the patient or by the healthcare professionals (healthcare professionalism).
Collapse
Affiliation(s)
- Johan Hallqvist
- Department of Culture and Media Studies & Umeå Centre for Gender Studies, Umeå University, Umeå, Sweden
| |
Collapse
|
6
|
Alqahtani J, Alqahtani I. Self-care in the older adult population with chronic disease: concept analysis. Heliyon 2022; 8:e09991. [PMID: 35874086 PMCID: PMC9304718 DOI: 10.1016/j.heliyon.2022.e09991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/12/2022] [Accepted: 07/13/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Chronic disease care is considered a challenging dilemma for health organizations’ sustainability and patient health. Self-care is key to chronic disease management and is substantially important in all aspects of health and levels of care. In the past years, research regarding self-care in the context of chronic disease has evolved, yet this complex concept continues to be ambiguous as there are differences in the way self-care is clearly conceptualized in the literature. A discussion of an in-depth concept analysis of self-care in the older adult population with chronic disease and an outline of its defining common attributes, referents, antecedents, consequences, and related concepts. Design Qualitative concept analysis concerning the concept of self-care in the older adult population with chronic disease. Methods An extensive review of the literature concerning the concept of self-care in the older adult population with chronic disease was conducted using different databases. Literature from nursing and other disciplines was selected to differentiate this concept from other related concepts. Rodgers's evolutionary methodology of concept analysis was used to investigate the concept of self-care in detail to better understand its meanings in the context of chronic disease. Results Multiple definitions of self-care exist, and a consensus definition was not shown to have been achieved across disciplines. The common attributes, referents, antecedents, consequences, and related concepts were identified, and a model case was constructed by the authors to clarify the concept of self-care in the context of the older adult population living with chronic disease. This concept analysis provides a theoretical definition of self-care of the older adult population living with chronic disease to offer nurses and others insight into the concept, which will ultimately provide a foundation for further research needed in the areas of clinical practice, policy, and education. Identification of the core of the self-care concept affords professionals and researchers the ability to identify appropriate practice priorities, enhance current practices, and develop theories and guidelines regarding self-care, leading to improvements in patient care and outcomes. Self-care is supported in the literature as an approach toward the attainment and sustainment of optimal health. The common attributes, referents, antecedents, consequences, and related concepts were identified. A clearer conceptual understanding was established of how self-care will support nursing research and clinical leadership.
Collapse
Affiliation(s)
- Jawhrah Alqahtani
- Medical-Surgical Nursing Department, King Saud University-College of Nursing, Riyadh, Saudi Arabia
- Corresponding author.
| | - Ibtesam Alqahtani
- Community and Mental Health Nursing Department, King Saud University-College of Nursing, Riyadh, Saudi Arabia
| |
Collapse
|
7
|
Nguyen TNM, Whitehead L, Saunders R, Dermody G. Systematic review of perception of barriers and facilitators to chronic disease self-management among older adults: Implications for evidence-based practice. Worldviews Evid Based Nurs 2022; 19:191-200. [PMID: 35032152 DOI: 10.1111/wvn.12563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/16/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND An aging population has contributed to an increased prevalence in chronic disease. To empower patients, healthcare systems are shifting toward chronic disease self-management. However, no review on how older adults self-manage chronic disease and the barriers and facilitators they experience has been published. AIMS To explore barriers and facilitators perceived by older adults during the process of self-managing chronic disease. METHODS A systematic review of qualitative literature was performed using the Joanna Briggs Institute methodology. The literature search was conducted using Ovid databases (MEDLINE, CINAHL with full text, and PsycINFO) for the period of 1988-2020. All records were screened using predetermined eligibility criteria. The critical appraisal instrument QARI (Qualitative Assessment and Review Instrument) was employed to assess the quality of the included studies. Data from the included papers were extracted using the QARI data extraction tool. Extracted data were then synthesized to produce final sets of themes and sub-themes relating to the review question. RESULTS A total of 267 abstracts were screened, and 13 studies reporting barriers and facilitators perceived by older adults during the process of managing chronic diseases were included in the review. Physical and cognitive decline, low-health literacy, culture, and relationships with healthcare professionals were described as barriers. Facilitators were described as resources that supported disease self-management and included family, social networks, healthcare professionals, and religious beliefs. LINKING EVIDENCE TO ACTION This study highlights the importance of understanding the patients' perspectives of the barriers and enablers of self-management of chronic illness for health professionals across settings. Understanding barriers and facilitators to chronic disease self-management will support health professionals to identify strength-based approaches to self-management that meet the needs of individual older adults.
Collapse
Affiliation(s)
- Thi Ngoc Minh Nguyen
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia.,School of Nursing, Eastern International University, Binh Duong, Vietnam
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Rosemary Saunders
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Gordana Dermody
- School of Nursing Midwifery and Paramedicine, Sunshine Coast University, Sunshine Coast, Queensland, Australia
| |
Collapse
|
8
|
Turnbull S, Lucas PJ, Hay AD, Cabral C. Digital Health Interventions for People With Type 2 Diabetes to Develop Self-Care Expertise, Adapt to Identity Changes, and Influence Other's Perception: Qualitative Study. J Med Internet Res 2020; 22:e21328. [PMID: 33346733 PMCID: PMC7781797 DOI: 10.2196/21328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/28/2020] [Accepted: 11/17/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND A diagnosis of type 2 diabetes (T2D) results in widespread changes to a person's life and can be experienced as an assault on their sense of self. The resources available to an individual influence how the individual adapts to their diabetic identity and subsequently engages in self-care. Digital interventions can be viewed as a resource that people can draw on to adapt to the diagnosis. However, there is an indication that people from disadvantaged groups find digital health technologies more challenging to access and use, which may increase health inequalities. OBJECTIVE This study aims to gain insights into how and why people with T2D use digital self-care technology and how experiences vary between individuals and social groups. METHODS A purposive sample of people who had used a digital intervention to help them self-care for their T2D were recruited for the study. Semistructured interviews were conducted, and data were analyzed thematically. RESULTS A diverse sample of 21 participants were interviewed. Participants used digital interventions to help them to understand and feel more in control of their bodies. Digital interventions were used by participants to project their chosen identity to others. Participants selected technology that allowed them to confirm and enact their preferred positive identities, both by avoiding stigma and by becoming experts in their disease or treatment. Participants preferred using digital interventions that helped them conceal their diabetes, including by buying discrete blood glucose monitors. Some participants used technology to increase their sense of power in their interaction with clinicians, whereas others used technology to demonstrate their goodness. CONCLUSIONS The technology that people with T2D have access to shapes the way they are able to understand and control their bodies and support preferred social identities.
Collapse
Affiliation(s)
- Sophie Turnbull
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Patricia J Lucas
- School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Alastair D Hay
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Christie Cabral
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
9
|
Hudson N, Law C, Culley L, Mitchell H, Denny E, Norton W, Raine-Fenning N. Men, chronic illness and healthwork: accounts from male partners of women with endometriosis. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1532-1547. [PMID: 32589324 DOI: 10.1111/1467-9566.13144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 04/03/2020] [Accepted: 05/12/2020] [Indexed: 06/11/2023]
Abstract
Currently dominant in medical discourse, the concept of self-management sees the responsibility for health and illness shift from the state to the individual. However, while this emphasis on individual responsibility and management has burgeoned, the role and status of partners and other family members in the management of chronic illness remains under-theorised. While self-management privileges individual responsibility for the management of chronic illness, the role of partners remains unclear. This paper utilises data from a study of heterosexual couples' experiences of living with the chronic gynaecological condition endometriosis to explore how male partners engage in its day-to-day management. In all, 22 couples participated in in-depth, semi-structured interviews with each partner interviewed separately (n = 44). Data were analysed thematically and dyadically, informed by an interpretivist relational approach. The paper utilises the concept of healthwork to describe the illness work, everyday life work, biographical work and emotion work men engaged in. The paper demonstrates how the conceptual value of healthwork is enhanced by incorporating an analysis of the emotional effort required in managing chronic illness. The paper illustrates the value of investigating the role of partners in managing chronic illness to provide a fuller account of the distributed and relational nature of healthwork.
Collapse
Affiliation(s)
- Nicky Hudson
- Centre for Reproduction Research, De Montfort University, Leicester, UK
| | - Caroline Law
- Centre for Reproduction Research, De Montfort University, Leicester, UK
| | - Lorraine Culley
- Centre for Reproduction Research, De Montfort University, Leicester, UK
| | - Helene Mitchell
- Centre for Reproduction Research, De Montfort University, Leicester, UK
| | - Elaine Denny
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Wendy Norton
- Centre for Reproduction Research, De Montfort University, Leicester, UK
| | | |
Collapse
|
10
|
Coorey G, Peiris D, Neubeck L, Redfern J. A realist evaluation approach to explaining the role of context in the impact of a complex eHealth intervention for improving prevention of cardiovascular disease. BMC Health Serv Res 2020; 20:764. [PMID: 32811480 PMCID: PMC7433103 DOI: 10.1186/s12913-020-05597-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 07/29/2020] [Indexed: 01/05/2023] Open
Abstract
Background Reduction of cardiovascular disease (CVD) is a worldwide health priority and innovative uses of technology-based interventions may assist patients with improving prevention behaviours. Targeting these interventions to recipients most likely to benefit requires understanding how contexts of use influence responsiveness to the intervention, and how this interaction favours or discourages health behaviour. Using a realist evaluation approach, the aim of this study was to examine the contextual factors influencing behaviour change within a multi-feature eHealth intervention with personalised data integration from the primary care electronic health record (EHR). Methods Realist evaluation of qualitative data from the Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) randomised trial (N = 934). Thirty-six participants from the intervention group (N = 486) who had completed 12 months of study follow-up were interviewed. Coding of transcripts was structured around configurations of contexts, mechanisms, and outcomes of intervention use. Contextual narratives were derived from thematic analysis of the interviews. Results Mechanisms favouring positive health behaviour occurred when participants responded to four interactive features of the intervention. Facilitating mechanisms included greater cognitive engagement whereby participants perceived value and benefit, and felt motivated, confident and incentivised. Participants moved from being unconcerned (or unaware) to more task-oriented engagement with personal CVD risk profile and prevention. Increased personalisation occurred when modifiable CVD risk factors became relatable to lifestyle behaviour; and experiences of feeling greater agency/self-efficacy emerged. Use and non-use of the intervention were influenced by four overarching narratives within the individual’s micro-level and meso-level environments: illness experiences; receptiveness to risk and prevention information; history of the doctor-patient relationship; and relationship with technology. Conclusions Intervention-context interactions are central to understanding how change mechanisms activate within complex interventions to exert their impact on recipients. Intervention use and non-use were context-dependent, underscoring the need for further research to target eHealth innovations to those most likely to benefit.
Collapse
Affiliation(s)
- Genevieve Coorey
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia. .,The George Institute for Global Health, Sydney, New South Wales, Australia.
| | - David Peiris
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Julie Redfern
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
11
|
Yin K, Jung J, Coiera E, Laranjo L, Blandford A, Khoja A, Tai WT, Phillips DP, Lau AYS. Patient Work and Their Contexts: Scoping Review. J Med Internet Res 2020; 22:e16656. [PMID: 32484449 PMCID: PMC7298639 DOI: 10.2196/16656] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/04/2020] [Accepted: 03/29/2020] [Indexed: 12/19/2022] Open
Abstract
Background Having patients self-manage their health conditions is a widely promoted concept, but many patients struggle to practice it effectively. Moreover, few studies have analyzed the nature of work required from patients and how such work fits into the context of their daily life. Objective This study aimed to review the characteristics of patient work in adult patients. Patient work refers to tasks that health conditions impose on patients (eg, taking medications) within a system of contextual factors. Methods A systematic scoping review was conducted using narrative synthesis. Data were extracted from PubMed, Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO, including studies from August 2013 to August 2018. The included studies focused on adult patients and assessed one or more of the following: (1) physical health–related tasks, (2) cognitive health–related tasks, or (3) contextual factors affecting these tasks. Tasks were categorized according to the themes that emerged: (1) if the task is always visible to others or can be cognitive, (2) if the task must be conducted collaboratively or can be conducted alone, and (3) if the task was done with the purpose of creating resources. Contextual factors were grouped according to the level at which they exert influence (micro, meso, or macro) and where they fit in the patient work system (the macroergonomic layer of physical, social, and organizational factors; the mesoergonomic layer of household and community; and the microergonomic triad of person-task-tools). Results In total, 67 publications were included, with 58 original research articles and 9 review articles. A variety of patient work tasks were observed, ranging from physical and tangible tasks (such as taking medications and visiting health care professionals) to psychological and social tasks (such as creating coping strategies). Patient work was affected by a range of contextual factors on the micro, meso, or macro levels. Our results indicate that most patient work was done alone, in private, and often imposing cognitive burden with low amounts of support. Conclusions This review sought to provide insight into the work burden of health management from a patient perspective and how patient context influences such work. For many patients, health-related work is ever present, invisible, and overwhelming. When researchers and clinicians design and implement patient-facing interventions, it is important to understand how the extra work impacts one’s internal state and coping strategy, how such work fits into daily routines, and if these changes could be maintained in the long term.
Collapse
Affiliation(s)
- Kathleen Yin
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Joshua Jung
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Liliana Laranjo
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Ann Blandford
- UCL Interaction Centre, University College London, London, United Kingdom
| | - Adeel Khoja
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Wan-Tien Tai
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Daniel Psillakis Phillips
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia.,UCL Interaction Centre, University College London, London, United Kingdom
| |
Collapse
|
12
|
Nevedal AL, Ayalon L, Briller SH. A Qualitative Evidence Synthesis Review of Longitudinal Qualitative Research in Gerontology. THE GERONTOLOGIST 2020; 59:e791-e801. [PMID: 30395232 DOI: 10.1093/geront/gny134] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Gerontologists have long been interested in longitudinal qualitative research (LQR), yet ambiguity remains about best practices. The purpose of this review was to conduct a qualitative evidence synthesis to identify strengths and limitations in existing gerontological LQR. RESEARCH DESIGN AND METHODS We searched for studies published in English before September 2017, using longitudinal qualitative methods and focusing on gerontology. We searched the following databases: PubMed and ProQuest. This was followed up by a snowball search to identify additional LQR articles that were not gerontologically focused but provided conceptual or methodological information to enhance gerontological LQR. Article titles and abstracts were reviewed, and selected articles were independently evaluated by all authors and summarized in a descriptive matrix based on design, analysis, and strengths and limitations. RESULTS Our literature search resulted in 225 articles, which was then narrowed to 71 articles from 47 different journals based on our inclusion/exclusion criteria. LQR in gerontology varies considerably by study design and analysis approach. LQR design considerations involve number of time points and duration; rapport and retention; and consistent or different sampling, data collection, and measures. LQR analysis considerations involve synchronic and diachronic approaches, consistent or evolving coding, and individual- or group-level analysis. Gerontological LQR articles vary in the extent to which they address special aging considerations. DISCUSSION AND IMPLICATIONS This review indicates that there are areas where gerontological LQR can be strengthened going forward. We provide researchers with strategies to improve LQR rigor in our field and beyond.
Collapse
Affiliation(s)
- Andrea L Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California
| | - Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Faculty of Social Sciences, Bar-ILan University, Ramat-Gan, Israel
| | | |
Collapse
|
13
|
Cardiovascular Risks Associated with Gender and Aging. J Cardiovasc Dev Dis 2019; 6:jcdd6020019. [PMID: 31035613 PMCID: PMC6616540 DOI: 10.3390/jcdd6020019] [Citation(s) in RCA: 380] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/19/2019] [Accepted: 04/23/2019] [Indexed: 12/12/2022] Open
Abstract
The aging and elderly population are particularly susceptible to cardiovascular disease. Age is an independent risk factor for cardiovascular disease (CVD) in adults, but these risks are compounded by additional factors, including frailty, obesity, and diabetes. These factors are known to complicate and enhance cardiac risk factors that are associated with the onset of advanced age. Sex is another potential risk factor in aging adults, given that older females are reported to be at a greater risk for CVD than age-matched men. However, in both men and women, the risks associated with CVD increase with age, and these correspond to an overall decline in sex hormones, primarily of estrogen and testosterone. Despite this, hormone replacement therapies are largely shown to not improve outcomes in older patients and may also increase the risks of cardiac events in older adults. This review discusses current findings regarding the impacts of age and gender on heart disease.
Collapse
|
14
|
Vassilev I, Rogers A, Kennedy A, Oatley C, James E. Identifying the processes of change and engagement from using a social network intervention for people with long-term conditions. A qualitative study. Health Expect 2018; 22:173-182. [PMID: 30318769 PMCID: PMC6433331 DOI: 10.1111/hex.12839] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/02/2018] [Accepted: 09/04/2018] [Indexed: 12/23/2022] Open
Abstract
Background Personal and community networks are recognized as influencing and shaping self‐management activities and practices. An acceptable intervention which facilitates self‐management by mobilizing network support and improves network engagement has a positive impact on health and quality of life. This study aims to identify the processes through which such changes and engagement take place. Methods The study was conducted in the south of England in 2016‐2017 and adopted a longitudinal case study of networks design. Purposive sample of respondents with long‐term conditions (n = 15) was recruited from local groups. Barriers and facilitators to implementation were explored in interviews with key stakeholders (5). Results Intervention engagement leads to a deepening of relationships within networks, adding new links and achieving personal objectives relevant for improving the health and well‐being of users and network members. Such changes are supported through two pathways: the mobilization of network capabilities and by acting as a nudge. The first is a gradual process where potentially relevant changes are further contemplated by forefronting immediate concerns and negotiating acceptable means for achieving change, prioritizing objective over subjective valuations of support provided by network members and rehearsing justifications for keeping the status quo or adopting change. The second pathway changes are enacted through the availability of a potential fit between individual, network and environmental conditions of readiness. Conclusions The two pathways of network mobilization identified in this study illuminate the individual, network and environmental level processes involved in moving from cognitive engagement with the intervention to adopting changes in existing practice.
Collapse
Affiliation(s)
- Ivaylo Vassilev
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Anne Rogers
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Anne Kennedy
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Chad Oatley
- School for Sport, Health and Social Sciences, Solent University, Southampton, UK
| | - Elizabeth James
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| |
Collapse
|
15
|
Malcolm D, Pullen E. 'Everything I enjoy doing I just couldn't do': Biographical disruption for sport-related injury. Health (London) 2018; 24:366-383. [PMID: 30253661 DOI: 10.1177/1363459318800142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article draws on interview data with a population of non-elite sport/exercise participants (n = 20) to illustrate the interrelationship between biographical disruption and sport-related injury. It argues that contrary to the significance implied by their lack of prominence on current public health agendas, sport-related injuries can have a devastating personal impact, comparable to the more extreme variants of biographical disruption depicted in the literature on chronic illness. It seeks to explain the apparent incongruence between biophysical severity and subjective assessment of impact, by invoking notions of community normalisation and imagined futures, and identifying the unavailability of what subjects evaluate as effective medical support. These factors combine to problematise the attainment of biographical repair. It further highlights how biographical contingencies such as youthfulness, distinction through exhibiting responsible citizenship and the sense of failure to exert bodily self-management through exercise, perpetuate and escalate both biographical disruption and chronic illness. The paper thus illustrates the aetiological interdependence of biographical disruption and chronic illness as exercisers exacerbate relatively minor ailments due to their reluctance to modify habitual routines.
Collapse
|
16
|
Smith R, Frazer K, Hyde A, O'Connor L, Davidson P. “Heart disease never entered my head”: Women's understanding of coronary heart disease risk factors. J Clin Nurs 2018; 27:3953-3967. [DOI: 10.1111/jocn.14589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/23/2018] [Accepted: 06/24/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Rita Smith
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Dublin 4 Ireland
| | - Kate Frazer
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Dublin 4 Ireland
| | - Abbey Hyde
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Dublin 4 Ireland
| | - Laserina O'Connor
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Dublin 4 Ireland
| | | |
Collapse
|
17
|
Wilson L, Crowe M, Scott A, Lacey C. Psychoeducation for bipolar disorder: A discourse analysis. Int J Ment Health Nurs 2018; 27:349-357. [PMID: 28299858 DOI: 10.1111/inm.12328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2017] [Indexed: 12/20/2022]
Abstract
Psychoeducation has become a common intervention within mental health settings. It aims to increase people's ability to manage a life with a long-term illness. For people with bipolar disorder, psychoeducation is one of a range of psychosocial interventions now considered part of contemporary mental health practice. It has taken on a 'common sense' status that results in little critique of psychoeducation practices. Using a published manual on psychoeducation and bipolar disorder as its data, Foucauldian discourse analysis was used in the present study for a critical perspective on psychoeducation in order to explore the taken-for-granted assumptions on which it is based. It identifies that the text produces three key subject positions for people with bipolar disorder. To practice self-management, a person must: (i) accept and recognize the authority of psychiatry to know them; (ii) come to see that they can moderate themselves; and (iii) see themselves as able to undertake a reflexive process of self-examination and change. These findings highlight the circular and discursive quality to the construct of insight that is central to how psychoeducation is practiced. Using Foucault's construct of pastoral power, it also draws attention to the asymmetrical nature of power relations between the clinician and the person with bipolar disorder. An effect of the use of medical discourse in psychoeducation is to limit its ability to work with ambivalence and contradiction. A critical approach to psychotherapy and education offers an alternate paradigm on which to basis psychoeducation practices.
Collapse
Affiliation(s)
- Lynere Wilson
- Department of Psychological Medicine and Māori, University of Otago, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine and Māori, University of Otago, Christchurch, New Zealand
| | - Anne Scott
- Department of Social and Political Sciences, University of Canterbury, Christchurch, New Zealand
| | - Cameron Lacey
- Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| |
Collapse
|
18
|
Wilson L, Crowe M, Scott A, Lacey C. Self-management for bipolar disorder and the construction of the ethical self. Nurs Inq 2018; 25:e12232. [DOI: 10.1111/nin.12232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Lynere Wilson
- Department of Psychological Medicine; University of Otago-Christchurch; Christchurch New Zealand
| | - Marie Crowe
- Department of Psychological Medicine; University of Otago-Christchurch; Christchurch New Zealand
| | - Anne Scott
- Department of Sociology and Anthropology; University of Canterbury; Christchurch New Zealand
| | - Cameron Lacey
- Māori/Indigenous Health Institute; University of Otago-Christchurch; Christchurch New Zealand
| |
Collapse
|
19
|
Potter CM, Kelly L, Hunter C, Fitzpatrick R, Peters M. The context of coping: a qualitative exploration of underlying inequalities that influence health services support for people living with long-term conditions. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:130-145. [PMID: 29023822 PMCID: PMC5846884 DOI: 10.1111/1467-9566.12624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Coping with chronic illness encapsulates both practical and emotional aspects of living life in relation to one's long-term health condition(s). Dominant health psychology approaches for understanding coping, which underpin a more recent policy discourse on 'self-management', focus sharply on the person affected by illness and potentially mask the influence of overarching social structure. In this paper we draw on qualitative interviews with 48 people living with long-term conditions (LTCs), in order to highlight the role that structural configurations such as healthcare systems may play in either helping or hindering people's efforts to cope with chronic illness. We argue that coping is a social process in which health and related services, situated within their wider political-economic contexts, play an active role in shaping people's attempts to live well with LTCs. More specifically, health systems are sites of social and cultural capital exchange that can differentially mobilise coping resources through access, continuity of care, and coordination across services. Whilst it is essential to recognise the personal agency of people living with chronic illness, it is also vital to acknowledge the underlying inequalities that affect the ways in which services can support such resourcefulness.
Collapse
Affiliation(s)
- Caroline M. Potter
- Health Services Research Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) OxfordOxfordUK
| | - Laura Kelly
- Health Services Research Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) OxfordOxfordUK
| | - Cheryl Hunter
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Department of Health EnglandQORU: Quality and Outcomes of Person‐centred Care Policy Research UnitUK
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) OxfordOxfordUK
| | - Michele Peters
- Health Services Research Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Department of Health EnglandQORU: Quality and Outcomes of Person‐centred Care Policy Research UnitUK
| |
Collapse
|
20
|
‘Independence’ among older people receiving support at home: the meaning of daily care practices. AGEING & SOCIETY 2017. [DOI: 10.1017/s0144686x17001039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACTLater life care practices are closely entangled with the ideals of independence and dependence. Based on an interpretive analysis of qualitative interviews with 34 people aged 65–100 receiving home care in Ontario, Canada, this article explores older people's subjective interpretations of caring for themselves (i.e. independence) and receiving support from others (i.e. dependence). Findings suggest that individuals construct subjective meanings of independence in relation to their changing physical capacities, and in the context of their relationships with family members, friends and formal care providers. First, participants considered their care activities to be a way of maintaining independence when they undertook certain practices with the intention of staving off dependency and future decline. Second, when they accepted assistance, many engaged in care relations that allowed them to preserve an independent identity in the face of limits to physical self-sufficiency. Third, participants reached the limits of independence when they lacked adequate assistance, and were unable to care for themselves in desirable ways. Findings illustrate how objective circumstances related to social and financial resources as well as access to formal services shape subjective interpretations, allowing some older people to hold on to independent identities while exacerbating feelings of dependency among others.
Collapse
|
21
|
Ekman I, Wolf A, Vaughan Dickson V, Bosworth HB, Granger BB. Unmet expectations of medications and care providers among patients with heart failure assessed to be poorly adherent: results from the Chronic Heart Failure Intervention to Improve MEdication Adherence (CHIME) study. Eur J Cardiovasc Nurs 2017; 16:646-654. [DOI: 10.1177/1474515117707669] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Axel Wolf
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | | | - Hayden B Bosworth
- Center for Health Services Research in Primary Care and Research, VA Medical Center, USA
- Duke University School of Nursing, Durham, NC, USA
- Department of Medicine, Duke University, USA
| | - Bradi B Granger
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Duke University School of Nursing, Durham, NC, USA
- Duke University Health Systems, Durham, NC, USA
| |
Collapse
|
22
|
van de Bovenkamp HM, Dwarswaard J. The complexity of shaping self-management in daily practice. Health Expect 2017; 20:952-960. [PMID: 28152248 PMCID: PMC5600231 DOI: 10.1111/hex.12536] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 11/26/2022] Open
Abstract
Background and context Many countries are giving patients a more active role in health care, on both the individual and collective level. This study focuses on one aspect of the participation agenda on the individual level: self‐management. The study explores self‐management in practice, including the implications of the difficulties encountered. Objective To gain insight into the complexity of self‐management practice. This is crucial for developing both self‐management interventions and the participation policy agenda. Methods Qualitative semi‐structured interviews with experts (n=6) and patients with a chronic condition (n=20). Results In terms of level of involvement and type of activity, shaping self‐management in practice depends on personal and social dynamics, patients’ ideas of the good life and their interactions with care professionals. Clashes can arise when patients and professionals hold differing ideas, based on different values, about the level and type of patient involvement. Discussion The discussion on self‐management should account for the fact that how we define self‐management is very much a normative issue. It depends on the norms and values of patients, professionals and underlying health‐care policies. Differing ideas present professionals with ethical dilemmas which they should reflect on. However, professional reflection alone is not enough to deal with these dilemmas. The participation agenda needs far wider ranging reflection on how participation relates to other values in health care.
Collapse
Affiliation(s)
| | - Jolanda Dwarswaard
- Research Centre Innovations of Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| |
Collapse
|
23
|
Hughes ND, Closs SJ, Flemming K, Bennett MI. Supporting self-management of pain by patients with advanced cancer: views of palliative care professionals. Support Care Cancer 2016; 24:5049-5057. [PMID: 27557834 DOI: 10.1007/s00520-016-3372-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/04/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the study is to ascertain the views of specialist palliative care professionals on patient self-management of cancer pain in order to inform the development of a new educational intervention to support self-management. METHODS This is a qualitative research study using focus group interviews. RESULTS Participants viewed self-management of cancer pain as desirable and achievable but also as something that could be problematic. Challenges to self-management were perceived in patient attitudes and behaviours, professionals' own beliefs and actions and the wider social system. Practitioners showed awareness of potential tension between their espoused views (the desirability that patients manage pain autonomously) and their tacit views (the undesirability of patients managing pain in ways which conflict with professionals' knowledge and identity). CONCLUSIONS Practitioners espoused patient-centred professional practice which inclined them towards supporting self-management. They showed awareness of factors which might inhibit them from effectively incorporating education and support for self-management into routine practice.
Collapse
Affiliation(s)
- Nicholas D Hughes
- School of Healthcare, Baines Wing, University of Leeds, Leeds, LS2 9UT, UK.
| | - S José Closs
- School of Healthcare, Baines Wing, University of Leeds, Leeds, LS2 9UT, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, School of Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
24
|
Britten N, Maguire K. Lay knowledge, social movements and the use of medicines: Personal reflections. Health (London) 2015; 20:77-93. [PMID: 26621264 DOI: 10.1177/1363459315619021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article consists of two personal reflections about the changing status of lay knowledge over the last 20 years. The first reflection is by Nicky Britten from the perspective of a sociologist working in medical schools whose interest in this topic was motivated by my own personal experience of health care and of teaching general practitioners. Starting with the problematic deficit model of 'ignorant patients', I trace the literature on patient-centredness, shared decision-making, lay knowledge, public involvement in research and social movements. Looking at medicines use in particular, I deplore the continued hegemony of the concept of compliance in the face of extensively documented problems with the licensing, regulation, prescribing and monitoring of medicines. I argue that lay knowledge is now taken more seriously, not so much because of advocacy by clinicians and academics, but because of social movements and social action. We may have moved from 'anecdotes' to 'lived experience' but there is still a way to go, particularly when it comes to medicines use. I end with a possible future scenario. The second reflection is by Kath Maguire and is a response from the perspective of someone who came to work in this field with the express purpose of improving engagement with lay knowledge. It questions my own 'layness' and explores the issues raised by Nicky Britten using the lens of lived experience. Finally, it questions the paradigm of social movements and highlights the importance of developing different ways of listening.
Collapse
|