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People with multimorbidity: forgotten outsiders or dynamic self-managers?

Anneli Hujala (Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland)
Mieke Rijken (NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands)
Sanna Laulainen (Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland)
Helena Taskinen (Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland)
Sari Rissanen (Department of Social Sciences, Department of Health and Social Management, University of Eastern Finland, Kuopio, The Netherlands)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 9 September 2014

398

Abstract

Purpose

The purpose of this paper is to draw attention to the discursive construction of multimorbidity. The study illustrates how the social reality of multimorbidity and the agency of patients are discursively constructed in scientific articles addressing care for people with multiple chronic conditions.

Design/methodology/approach

The study is based on the postmodern assumptions about the power of talk and language in the construction of reality. Totally 20, scientific articles were analysed by critically oriented discourse analysis. The interpretations of the findings draw on the agency theories and principals of critical management studies.

Findings

Four discourses were identified: medical, technical, collaborative and individual. The individual discourse challenges patients to become self-managers of their health. It may, however, go too far in the pursuit of patients’ active agency. The potential restrictions and consequences of a “business-like” orientation must be paid careful attention when dealing with patients with multimorbidity.

Research limitations/implications

The data consisted solely of scientific texts and findings therefore serve as limited illustrations of the discursive construction of multimorbidity. In future, research focusing for example on political documents and practice talk of professionals and patients is needed.

Social implications

The findings highlight the power of talk and importance of ethical considerations in the development of care for challenging patient groups.

Originality/value

By identifying the prevailing discourses the study attempts to cast doubt on the taken-for-granted understandings about the agency of patients with multimorbidity.

Keywords

Acknowledgements

This paper arises from the project Innovating Care for People with Multiple Chronic Conditions in Europe, ICARE4EU (2013-2016), which has received funding from the European Union in the framework of the Health Programme. The paper is based on the conference presentation in the 8th International Critical Management Studies (CMS) Conference, 10-12 July 2013, Manchester, UK. The authors thank the participants of the conference stream Critical Views on Health Care Management for their feedback.

Citation

Hujala, A., Rijken, M., Laulainen, S., Taskinen, H. and Rissanen, S. (2014), "People with multimorbidity: forgotten outsiders or dynamic self-managers?", Journal of Health Organization and Management, Vol. 28 No. 5, pp. 696-712. https://doi.org/10.1108/JHOM-10-2013-0221

Publisher

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Emerald Group Publishing Limited

Copyright © 2014, Emerald Group Publishing Limited

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