Représentations sociales de la maladie : comparaison entre savoirs « experts » et savoirs « profanes »

Abstract

IntroductionThe link between social practices and representations is now well known. But while many studies have focused on the social representation of mental illness, in various populations, few studies have focused on the notion of disease/illness by comparing professionals and non-professionals health workers representations. Indeed, the disease is both a reality described, explained and treated by medicine; for those who are affected by a disease, it is an individual experience with psychological, social and cultural impacts. The social representation is determined by the structure of the social groups in which it develops; therefore, it is a form of knowledge socially shaped and shared by the members of a social group. Several theoretical extensions have been elaborated and particularly, the structural approach and the central core theory. These approaches sustain the arguments of a hierarchical organization of a social representation with a central core surrounded by peripheral zones. The central core is common and shared by the majority of the members of a given group, whereas the peripheral zones provide space for the individualization of the social knowledge. PurposeThe main goal of our study is to highlight the social representations of disease in health professionals (HP) and in non-health professionals (NHP). The group of HP has been differentiated into three subgroups: “medical doctors”, “nurses” and “pharmacists”, while that of NHP in two subgroups: those submitted to a “long period medical treatment” and those “without treatment”. Our aim is to show that there are different social and professional Representations of disease. The professional representations are specific social representations related to professional contexts. We formulate the following assumptions (a) that the social representations of HP and NHP will be articulated around a common central core. Nevertheless, we expect to find specific peripheral elements related to professional status, based on different knowledge and a differentiated “practice”; (b) the HP should refer to more descriptive aspects of the disease and monitoring of patients, while (c) NHP should refer more to the experience of illness around emotional aspects. MethodOur sample is composed of 270 participants (135 HP and 135 HNP). Representations are measured by a free association task based on the target term: disease. The data have been submitted to prototypical and categorical analyses in agreement with the central core theory. Results and discussionThe results confirm that there is a common social representation of disease shared by the two groups, which refers essentially to suffering and pain. The analysis of each group brings to light two different registers: the one of the HP with more descriptive words referring to the nature and the illness's characteristics, and the other ones of the HNP with more words connected to emotions and referring to personal real experience of the illness. As expected, the social representation of the HP is referring to the “professional representations” of the disease, while the one for the HNP is linked to “practices” of an illness. An analysis of intra-group differences shows specificities for each of the questioned subgroups. In the HP, medical doctors focus on the diagnosis and consequences of the disease, pharmacists refer to the treatment of the disease and its management, while nurses focus on the treatment and on the relation while monitoring patients. In the NHP, people submitted to a “long period medical treatment” refer to the emotional aspects and to the consequences of the illness on their live, while those without treatment use more descriptive and formal terms. These results suggest to the PS to expand exchanges related to the disease in order to facilitate communication centered on taking care of the patient, considered in its wholeness and not only as an actual or potential patient. This is an important step in improving the health of the patient.