Abstract
BackgroundHealth service policy in the United Kingdom emphasises the importance of self-care by patients with chronic conditions. Written information for patients about their condition is seen as an important aid to help patients look after themselves. From a discourse analysis perspective written texts such as patient information leaflets do not simply describe the reality of a medical condition and its management but by drawing on some sorts of knowledge and evidence rather than others help construct the reality of that condition. This study explored patient information leaflets on osteoarthritis (OA) to see how OA was constructed and to consider the implications for self-care.MethodsSystematic and repeated readings of six patient information leaflets on osteoarthritis to look for similarities and differences across leaflets, contradictions within leaflets and the resources called on to make claims about the nature of OA and its management.ResultsBiomedical discourse of OA as a joint disease dominated. Only one leaflet included an illness discourse albeit limited, and was also the only one to feature patient experiences of living with OA. The leaflets had different views on the causes of OA including the role of lifestyle and ageing. Most emphasised patient responsibility for preventing the progression of OA. Advice about changing behaviour such as diet and exercise was not grounded in lived experience. There were inconsistent messages about using painkillers, exercise and the need to involve professionals when making changes to lifestyle.ConclusionThe nature of the discourse impacted on how OA and the respective roles of patients and professionals were depicted. Limited discourse on illness meant that the complexity of living with OA and its consequences was underestimated. Written information needs to shift from joint biology to helping patients live with osteoarthritis. Written information should incorporate patient experience and value it alongside biomedical knowledge.
Highlights
Health service policy in the United Kingdom emphasises the importance of self-care by patients with chronic conditions
Except for NHS Direct all the leaflets had drawings of joints in cross section showing the loss of cartilage which characterises osteoarthritis as a disease
The significance for self care practice was considered by relating the findings to the literature on lay experiences of living with arthritis
Summary
Health service policy in the United Kingdom emphasises the importance of self-care by patients with chronic conditions. The language of the patient information leaflet is not an intermediary which enables an understanding of the 'truth' about health and disease but helps construct particular understandings of health and disease. This can be seen in a study by Coulter and colleagues which evaluated written patient information [8]. They found a common failing of leaflets was to give an over optimistic view of treatment emphasising the benefits while downplaying the adverse effects, and to hide medical uncertainty. When reviewing one leaflet on back pain some patients liked its positive approach but others disliked its patronising and victim blaming style
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