Abstract
BackgroundThe distribution of the roles and responsibilities of long-term condition management (LTCM) outside of formal health services implicates a wide set of relationships and activities of involvement. Yet, compared to studies of professional implementation, patient systems of implementation remain under-investigated. The aim of this paper is to explore the work, meaning and function attributed to ‘weaker’ ties relative to other more bonding relationships in order to identify the place of these within a context of systems of support for long-term conditions.MethodsThis is a mixed methods survey with nested qualitative study. A total of 300 people from deprived areas in the North West of England with chronic illnesses took part in a survey conducted in 2010 to 2011. A concentric circles diagram was used as a research tool with which participants identified 2,544 network members who contributed to illness management. Notions of ‘work’ were used to describe activities associated with chronic illness and to identify how weaker ties are included and perceived to be involved through social network members (SNM) contributions.ResultsThe results provide an articulation of how SNMs are substantially involved in weak tie illness management. Weaker ties constituted 16.1% of network membership involved in illness work. The amount of work undertaken was similar but less than that of stronger ties. Weaker ties appeared more durable and less liable to loss over time than stronger ties. The qualitative accounts suggested that weak ties enabled the moral positioning of the self-managing ‘self’ and acted on the basis of a strong sense of reciprocity.ConclusionsWeak ties act as an acceptable bridge between a sense of personal agency and control and the need for external support because it is possible to construct a sense of moral acceptability through reciprocal exchange. Access to weak tie resources needs to be taken into account when considering the ways in which systems of health implementation for chronic illness are designed and delivered.
Highlights
Professional systems of implementation including those for long-term conditions have drawn on the idea of social networks to make sense of how care is mobilised and delivered to patients [1]
The growth of patient and public involvement and the rise in the importance attributed to self-management for longterm conditionsa supports a shift in analytical focus to patient systems of implementation, which have the potential to act as a complement or alternative to traditional health service provision
We look firstly at how people ranked weak ties relative to others, drawing on empirical data to explore their role and function as elements of chronic illness ‘work’ within whole networks of people with chronic illness management (CIM) [4,29]
Summary
Professional systems of implementation including those for long-term conditions have drawn on the idea of social networks to make sense of how care is mobilised and delivered to patients [1]. The growth of patient and public involvement and the rise in the importance attributed to self-management for longterm conditionsa supports a shift in analytical focus to patient systems of implementation, which have the potential to act as a complement or alternative to traditional health service provision. The rationale for such a focus is reinforced with recognition that patients with long-term conditions spend relatively little time in contact with health professionals in comparison to the activities needed to manage long-term conditions in everyday life [3]. The aim of this paper is to explore the work, meaning and function attributed to ‘weaker’ ties relative to other more bonding relationships in order to identify the place of these within a context of systems of support for long-term conditions
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