Health care professional support for self-care management in chronic illness: insights from …

Author Keywords: Self-care; Support; Patient education; Self-management; Chronic illness

While it has long been recognized that health care professionals play an important role in supporting self-care management in chronic illness, the nature of that support is not well understood. This paper represents an analysis of findings drawn from qualitative research into the development of self-care decision-making expertise in adults with longstanding Type I diabetes, specifically addressing ways in which health professionals’ interactions support or fail to support such processes. These findings highlight issues associated with the disease trajectory, the assumptions about intended outcome, and the complex contexts in which individuals live with chronic disease, illustrating the manner in which varying kinds of support may be required at different points within the learning process. They further challenge notions of standardized communication and informational strategies, demonstrating the complexities inherent in the support needs of chronically ill persons as they change over time and context.

Medical sociology, chronic illness and the body

The sociological conceptualisation of chronic illness requires a sociology which indicates the physicality of the body theoretically. The aim of this paper is to demonstrate how the body might be integrated into sociological accounts of the experience of chronic illness in a way that acknowledges biological and social facts. Central to our argument is the connection between bodily aspects of self and identity. Self and identity are core aspects of everyday experience and of the everyday experience of illness. With the onset of illness bodily functioning alters and self-conceptions and identity may also change. The body, which in many social situations is a taken for granted aspect of the person, ceases to be taken for granted once it malfunctions. The bodily basis of chronic illness has to be attended to because it limits or interferes with other physical and social activities. The connection between biological and social facts is explored using the concepts of self and identity.

Implementing evidence based medicine in general practice: audit and qualitative study of …

Objective: To determine the extent to which implementation of an evidence based treatment, antithrombotic treatment in atrial fibrillation, is possible in general practice.
Design: Audit and qualitative study of patients with atrial fibrillation and an educational intervention for patients judged eligible for antithrombotic treatment.
Setting: South east England.
Subjects: 56 patients with a history of atrial fibrillation.
Interventions: Assessment and interview to ascertain patients' views on antithrombotic treatment.
Main outcome measures: Number of patients receiving antithrombotic treatment.
Results: Out of 13 239 patients, 132 had a history of atrial fibrillation of which 100 were at risk of thromboembolism. After the study, 52 patients were taking warfarin. Of the remaining 48 patients (of whom 41 were taking aspirin), eight were too ill to participate, 16 were unable to consent, four refused the interview, and 20 declined warfarin. Patients declining warfarin were inclined to seek a higher level of benefit than those taking it, as measured by the minimal clinically important difference. Qualitative data obtained during the interviews suggested that patients' health beliefs were important factors in determining their choice of treatment.
Conclusion: Patients' unwillingness to take warfarin seemed to be a major factor in limiting the number who would eventually take it.

The context of health care communication in chronic illness

Keywords: health care communication, patient-centred care, chronic illness experience

Patient–professional communication is a critically important element of effective chronic illness care. However, the dynamics of health
care communication in supporting self-care management and effective coping with various chronic diseases is not well understood. The
present study examined health care communication from the perspective of 38 patients with four distinct chronic conditions: end-stage renal
disease (ESRD), non-insulin dependent diabetes mellitus (NIDDM), multiple sclerosis (MS), and fibromyalgia (FM). Analysis revealed the
dimensions of courtesy, respect, and engagement to be inherent in communication priorities across conditions. However, distinct “disease
worlds” among and between these chronic conditions illuminated salient differences within these dimensions, thereby illustrating the way
in which relevant variables such as legitimacy, the availability of conventional treatments, and lifestyle implications shape the meaning
of health care communication. The findings enlarge upon patient-centered approaches to health care communication and inform further
analysis of the interactional dynamics associated with chronic conditions.