Controlled, Constrained, or Flexible? How Self-Management Goals Are Shaped By Patient–Provider Interactions

Franklin, Marika; Lewis, Sophie; Willis, Karen; Rogers, Anne; Venville, Annie; Smith, Lorraine

doi:10.1177/1049732318774324

Cited by 43 publications

(64 citation statements)

References 40 publications

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“…Earlier research has shown that facilitators of group‐based self‐management support often do not explicitly focus on lifestyle change and instead wish to provide group participants with support and help them to achieve a high quality of life . In contrast, it is possible to understand the findings in our study in line with research showing that health professionals revert to define health on a general level in terms of improvement and repair . Health‐promoting support that is not based on medical goals may bring substantial improvements for people with type 2 diabetes, while they simultaneously fail to achieve good health according to the medical definition …”

Section: Discussionsupporting

confidence: 47%

Moving between ideologies in self‐management support—A qualitative study

Bossy

Knutsen

Rogers

et al. 2018

Health Expectations

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BackgroundReforms in current health policy explicitly endorse health promotion through group‐based self‐management support for people with long‐term conditions. Health promotion and traditional medicine are based on different logics. Accordingly, health professionals in health‐promoting settings demand the adoption of new practices and ways of thinking.ObjectivesThe objective of our study was to investigate how health professionals perceive the health‐promoting group‐based self‐management support that is politically initiated for people with long‐term conditions.DesignThis study had a qualitative research design that included focus group interviews and was guided by a social constructivist paradigm in which group‐based self‐management was viewed as a social construction. Different logics at play were analysed through the theoretical lens of institutional logic. Discussions among participants show frames of references seen as logics.Setting and participantsWe recruited health professionals from group‐based health‐promoting measures for people with type 2 diabetes in Norway. Two focus groups comprising four and six participants each were invited to discuss the practices and value of health promotion through group‐based self‐management support.ResultsThe analysis resulted in three themes of discussion among participants that contained reflections of logics in movement. Health professionals’ discussions moved between different logics based on the importance of expert‐based knowledge on compliance and on individual lifestyle choices.Discussion and conclusionThe study indicates that health promotion through self‐management support is still a field “in the making” and that professionals strive to establish new logics and practices that are not considered difficult to manage or do not contain incompatible understandings.

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Section: Discussionsupporting

confidence: 47%

Moving between ideologies in self‐management support—A qualitative study

Bossy

Knutsen

Rogers

et al. 2018

Health Expectations

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“…Indeed, as reported here, the nurses in this study still perceived SSM as being rooted in traditional notions of 'compliance' or 'adherence' with professionally determined goals rather than an approach which is based on working in partnership with stroke survivors to jointly agree on and address the SSM priorities and needs that are important to individuals. Such perspectives constrain the provision of SSM, which aligns with individuals' priorities and capacity and can erode practitioners' confidence in reflecting and challenging the 'status quo' of their practice and provide SSM beyond a medical paradigm [37,38]. These findings mirror and contribute to a growing literature base on professionals' perceptions and conceptualizations of person-centred care in addressing the complexity of long-term condition management [20,[33][34][35][36][37][38][39].…”

Section: Discussionmentioning

confidence: 69%

Implementing Supported Self-Management in Community-Based Stroke Care: A Secondary Analysis of Nurses’ Perspectives

Kidd

Booth

Lawrence

et al. 2020

JCM

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The provision of supported self-management (SSM) is recommended in contemporary guidelines to address the longer-term needs and outcomes of stroke survivors and their families, yet its implementation across stroke pathways has been inconsistent. This paper presents a secondary analysis of qualitative data, which aims to identify and offer insight into the challenges of implementing SSM from the perspectives of community stroke nurses (n = 14). The findings revealed that the implementation of SSM in stroke is influenced by factors operating at multiple levels of the healthcare system. Contextual challenges arise because of different understandings and interpretations of what SSM is, what it comprises and professionals’ perceptions of their roles in its implementation in practice. A professionally controlled, one-size-fits-all model of SSM continues to be reinforced within organizations, offering few opportunities for nurses to deliver contextually tailored and person-centred SSM. In conclusion, there are many professional concerns and organizational tensions that need to be addressed across multiple layers of the healthcare system to achieve the consistent implementation of contextually tailored and person-centred SSM following a stroke. Attempts to address these challenges will help to narrow the gap between policy and practice of implementing SSM, ensuring that stroke survivors and families benefit from SSM in the longer-term.

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“…5. Marika Franklin et al (2018), “Controlled, Constrained, or Flexible? How Self-Management Goals Are Shaped By Patient-Provider Interactions,” Qualitative Health Research (June 2018), p. 1049732318774324.…”

mentioning

confidence: 99%

‘He’s my mate you see’: a critical discourse analysis of the therapeutic role of companion animals in the social networks of people with a diagnosis of severe mental illness

et al. 2019

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There is increasing recognition of the role pets play in the management of mental health conditions. Evidence suggests that pets promote social interaction and provide secure and intimate relationships which support the management of symptoms. This paper aimed to extend this evidence by exploring the phenomenological understanding of relationships and relationality with companion animals as therapeutic agents in the context of people’s wider social networks.A qualitative study was undertaken incorporating 35 interviews with 12 participants with a diagnosis of severe mental illness who identified a pet as being important in the management of mental health. Participants took part in three in-depth interviews centred on ego network mapping over a 12-month period (baseline, 6 and 12 months). A critical discourse analysis examined therapeutic relationships with pets in relation to mental health and compared these to other types of support over time. Summative discourse analyses were combined with a cross-case thematic analysis to look for commonalities and differences across individuals.Compared with interactions with other therapeutic agents, relationships with pets were free from the obligations and complexities associated with other types of network members and provided an extension and reinforcement to an individual’s sense of self which militated against the negative experiences associated with mental illness. Relationships with human network members were more variable in terms of consistency and capacity to manage demands (eg, network members requiring support themselves) and the emotions of others associated with fluctuations in mental health.This study adds weight to research supporting the inclusion of companion animals in the lexicon of mental health self-management through the therapeutic value attributed to them by participants within a wide personal network of support. The findings point to how consideration might usefully be given to how relationships with companion animals can be incorporated into healthcare planning and delivery.

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Controlled, Constrained, or Flexible? How Self-Management Goals Are Shaped By Patient–Provider Interactions

Cited by 43 publications

References 40 publications

Moving between ideologies in self‐management support—A qualitative study

Moving between ideologies in self‐management support—A qualitative study

Implementing Supported Self-Management in Community-Based Stroke Care: A Secondary Analysis of Nurses’ Perspectives

‘He’s my mate you see’: a critical discourse analysis of the therapeutic role of companion animals in the social networks of people with a diagnosis of severe mental illness

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