Behaviour change and social blinkers? The role of sociology in trials of self‐management behaviour in chronic conditions

Abstract

Individual-focused self-management interventions are one response to both an ageing society and the purported increase in chronic conditions. They tend to draw on psychological theories in self-management interventions, but over-reliance on these theories can reinforce a narrow focus on specified attitudinal and behavioural processes, omitting aspects of living with a chronic condition. While advances have been made in health behaviour change theory and practice, scant attention has been paid to the social, with the question of social context remaining undertheorised and under-explored empirically. This is particularly noticeable in trials of behaviour change interventions for self-management. The common sociological critique is that these ignore context and thus no explanation can be given as to why, for whom and under what circumstances a treatment works. Conversely, sociologists are criticised for offering no positive suggestions as to how context can be taken into account and for over-emphasising context with the risk of inhibiting innovation. This article provides an overview of these issues and provides examples of how context can be incorporated into the rigid method of trials of self-management for chronic conditions. We discuss modifications to both trial interventions and design that make constructive use of the concept of context.

Building Bridges between healthcare professionals, patients and families: A coproduced and integrated approach to self-management support in stroke

“…Patients can be more motivated to engage in activities that help to maintain or re-shape a coherent identity and everyday life (Ellis-Hill, Payne, & Ward, 2008;Ong et al, 2014). Professionals, however, can dismiss such activities as irrelevant or even problematic, especially when they are not consistent with or contradicting professional agendas (Ong et al, 2014).…”

“…However, it is the concept of compliance models which can be at odds with nurturing and encouraging self-management. Ong et al (2014) supports moving beyond promoting compliance with clinical advice towards a broader concept of self-management which comprises a continued search for meaning and legitimacy of the chronic condition and the negotiation of a new personal and social equilibrium. From this extended viewpoint, these very same activities that professionals may dismiss as hindering the rehabilitation process can become more relevant.…”

“…Professionals may have to relinquish a degree of power in their inter-actions with patients, and critical changes have to be supported by a shared understanding of working to support self-management at organisational level (Norris & Kilbride, 2013;Ong et al, 2014). Our own work now focuses heavily on understanding the organisational processes, which may hinder promoting self-management .…”

“…In addition, success occurs not only if a patient is motivated and engaged, but when a team or organisation has critically reflected on how they need to change their language and processes to emphasise greater partnership working. We believe that those selfmanagement interventions, which are more or less exclusively based on individual behaviour change, can ignore important structural issues as an explanation for behaviour and engagement (Ong et al, 2014).…”

Self-care of young people with long-term physical and mental health conditions

“…Furthermore it has been noted that professionals' understandings of self-care and self-management are based on a model of compliance rather than empowerment (Sawyer and Aroni 2005;Sadler et al 2014;Dwarswaard et al 2015). A common criticism is that self-care and self-management tend to focus on the individual and changing their behaviour; neglecting not only their social context and lay understandings of long-term illness but also the influence and roles played by families and social networks (Rosland and Piette 2010;Audulv 2013;Ong et al 2014;Sadler et al 2014;Dwarswaard et al 2015;Miller et al 2015). This is particularly pertinent in relation to children/young people as parents play an important role in self-management/care and peers exert an influence over beliefs and behaviours.…”