Abstract
Self-management is a contemporary model of chronic condition care that places expectations on, and roles for, both patients and health professionals. Health professionals are expected to form partnerships with their patients, and patients are expected to be active participants in their own care. In these new roles, control and responsibility for self-management are shared between people with chronic conditions and their health professionals. We still have limited knowledge about how these new roles are enacted in self-management support. In this article, we examine how health professionals perceive the roles of patients and professionals in chronic condition self-management, drawing on Bourdieu's concepts of field, doxa and capital. In this qualitative study, 32 in-depth interviews were conducted with 11 health professionals in Sydney, Australia. Data were analysed thematically. Three themes were derived. First, there was incongruence between how participants characterised and enacted their roles. Second, participants compartmentalised clinical and non-clinical aspects of self-management support. Finally, the roles of health professionals entwined with emotions and judgements of patienthood revealed that the provision of self-management support was linked to a fit between individuals' cultural health capital and the expectations governing the field. We argue that 'taken for granted' assumptions about self-management and self-management support must be challenged to mitigate negative social representations and unrealistic expectations placed on patients and health professionals, particularly those patients with less capital, who are more marginalised within clinical interactions.
Highlights
Self-management support (SMS) – the support that health professionals provide to people to help them manage their chronic conditions – is a key component of chronic condition care in many contemporary healthcare systems (Lawn and Schoo, 2010)
We argue that ‘taken for granted’ assumptions about self-management and self-management support must be challenged to mitigate negative social representations and unrealistic expectations placed on patients and health professionals, those patients with less capital, who are more marginalised within clinical interactions
This reflects a broader shift in the contemporary healthcare policy agenda away from ‘traditional top-down’ approaches, where power and authority are largely within the domain of health professionals, towards more inclusive approaches to care which emphasise the importance of person-centredness, patient empowerment and autonomy and shared decision-making
Summary
Self-management support (SMS) – the support that health professionals provide to people to help them manage their chronic conditions – is a key component of chronic condition care in many contemporary healthcare systems (Lawn and Schoo, 2010). The importance of health professionals working in collaboration or partnership with their patients is emphasised in chronic care guidelines and throughout the chronic care literature (Australian Health Ministers’ Advisory Council, 2017; Bodenheimer et al, 2002; Holman and Lorig, 2000) This reflects a broader shift in the contemporary healthcare policy agenda away from ‘traditional top-down’ approaches, where power and authority are largely within the domain of health professionals, towards more inclusive approaches to care which emphasise the importance of person-centredness, patient empowerment and autonomy and shared decision-making. Health professionals often work within systems set up for acute, rather than chronic care and they are socialised into clinical ways of thinking (Nolte and McKee, 2008) This means they tend to operate with logics which prioritise patient compliance with expert-based knowledge and individual lifestyle choices. This sometimes sits uneasily with the importance of patient autonomy, choice and responsibility (Mol, 2008)
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