The PhD Abstracts below were published in MSo Volumes 6, 7 & 8.

Chronic illness and self-management in primary care

Dr Lucy Moore, Peninsula School of Medicine and Dentistry


This abstract summarizes a PhD in medical studies entitled, Chronic illness and self-management in primary care: characterising the 'work' of older people with coronary heart disease. Professor Nicky Britten and Dr Charlotte Paterson supervised this research. Three contrasting primary care practice sites where recruited including a town practice with a high deprivation score, a rural practice and a general practice with a low deprivation score.

A review of the literature on self-management employed an iterative process leading to an exploration of the ideology, assumptions and attributes associated with self-management policy.  The analysis for this study drew on features of grounded theory and the work of Schutz and social phenomenology, Foucault, governmentality and the reflexive self and Gidden's modernity and self-identity.
Detailed findings of the study are divided into three areas namely:

Context and complexity: the meaning of self-management for patient participants
The 'occupational' model of self-management, drawing on the metaphor of work
The professional perspective: the successful and unsuccessful self-manager.

In conclusion, the study identified the tension for policy makers and professionals who need to consider how to meet the needs of a diverse group of patients. Some patients had the skills, attributes and understanding to align themselves with self-management policy and improve their outcome. Other patients lacked the skills, attributes and personal circumstances for optimum self-management and were more likely to follow a lifestyle incongruent with an improved outcome for the heart and their health. These patients were either restricted or constrained physically and socially, fatalistic or anxious with a negated sense of self, disengaged or distanced from professionals or distracted by competing priorities in the form of co-morbidities or caring roles. There were a higher number of these patients in areas of high deprivation.

ABSTRACT

Self-management policy has presented opportunities for patients with long-term conditions to improve their health and wellbeing by becoming active agents in their care. However, the ‘work’ of self-management for patients appears to need certain essential and desirable skills and attributes for improved health outcomes. A literature review and mind mapping analysis of policy literature produced a ‘policy’ model identifying 4 concepts described as active, competent, efficacious and responsible. The aim of this research was to characterise the self-management ‘work’ of older patients with coronary heart disease (CHD) in primary care and to identify the skills and attributes required for participation. This study was qualitative in design employing longitudinal diary-interviews with 21 patients, and interviews with 8 professionals, in three contrasting socio-economic general practice areas in the South West of England.

The analysis for this study drew on concepts of governmentality and the reflexive self. It produced an alternative ‘occupational’ model of self-management with 5 dominant occupational roles and 3 levels of occupational status. This occupational model identified the breadth and depth of self-management practices by older patients with CHD. It incorporated the diversity of self-management strategies seen in relation to the everyday management of health problems, life and illness perspectives and challenges associated with bereavement, retirement and parallel responsibilities as carers and sufferers of co-morbidities. It clearly demonstrated where patients have the interest, knowledge and confidence to modify their behaviour for an improved health outcome. It also highlighted the struggles associated with social, physical and emotional circumstances as well as the spectrum of relationships with health care professionals and significant others that improved or impacted upon optimum self-management. This occupational model provides a sociologically sensitive method of describing the older person’s experience of living with CHD. This thesis outlines recommendations for primary care professionals based on this occupational model.

Dr Lucy Moore, Peninsula School of Medicine and Dentistry
lucy.moore@pms.ac.uk


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Abstracts are published here as provided by the author and in the order in which we receive them.