Search results

The purpose of this chapter is to use sociological theory and research to develop an explanation for how chronic illnesses are managed at home and to thereby suggest some ways in which a sociological perspective can be applied to improve health care for persons with chronic illnesses. Self-care illness management is crucial to the prevention of and reduction of morbidity and mortality from chronic illness.

Review and synthesis of research literature.

Sociological research and theory suggest two important insights that should inform health care services aimed at improving self-care; chronic illness care occurs in the context of the household, neighborhood, and community and, therefore, the “patient” (i.e., the object of health services) is really the caregiving social network around the patient, and because the risk of chronic illness and the resources available to deal with it are socially (and unequally) distributed, “health care” interventions need to take account of disparities in risks and resources that will affect the patient’s ability to successfully comply with self-care regimens.

The review does not include an examination of the clinical research literature. It does, however, suggest that sociologists need to explicitly study chronic illness and health care related to it.

The chapter links the long history of research on family caregiving to the concern with the success of self-management of chronic illness. It also links concerns about that success to social disparities in the distribution of social resources and hence to morbidity and mortality disparities.

Social networks have been a central focus of sociological research on inequalities but less has focused specifically on chronic illness and disability despite a policy emphasis on resources necessary to support self-management. In this chapter, we seek to unpack overlaps and distinctions between social network approaches and research on the experience and management of chronic illness. We outline four main areas viewed as central in articulating the potential for future work consistent with a critical realist perspective: (1) body–society connections and realist/relativist tensions; (2) the controversy of ‘variables’ and accounting for social and cultural context in studying networks for chronic illness support; (3) conceptualising social support, network ties and the significance of organizations and technology; and (4) translating theory into method.

The purpose of this paper is to explore illness beliefs among adults with type 2 diabetes (T2DM), studied in a clinical setting in the Indian context. Diabetes management lies primarily in the hands of the patient, which signifies the need for understanding the various dimensions of individuals’ illness beliefs. While past research from abroad has stressed the need for understanding the patient’s perspective in effective illness management, the lack of studies in the Indian context calls for further research in this area.

Drawing on the Self-Regulation Model (Leventhal et al., 1980), semi-structured interviews were carried out to understand the beliefs about diabetes among individuals diagnosed to have T2DM. In total, 70 individuals with T2DM were included, taking into account the disease duration, urban-rural, age and gender distinctions. The data were analyzed using content analysis method.

The results of the analysis revealed numerous sub-themes related to the perceived consequences of diabetes, control or cure issues, timeline and emotional issues as experienced by the subjects.

Carrying out a triangulated research with the various stakeholders, namely, diabetologists, general practitioners and other support staff like dieticians could add more value to this exploratory study.

There is a dearth of research work that explores the illness beliefs that patients’ hold about diabetes, as discussed in the Indian context. It is expected that the insight provided by the study can help the government bodies, healthcare organizations and practitioners design and develop interventions from a patient-centric view. Additionally, such a patient-centric approach will enable individuals to achieve their treatment goals.

The purpose of this paper is to examine the perceptions of private and public sector managers in Barbados regarding the concepts of mental health and illness at work. It also explored their interactions and experiences with persons with mental illness at work and various forms of support and resources needed to improve the overall management of these persons within the organisational setting.

This qualitative study used an exploratory research design based on two focus groups of private and public sector managers.

The findings revealed that both private and public sector managers understood the distinction between the concepts of mental health and mental illness. However, managers believed that high levels of stigma and discrimination exist in both private and public sector workplaces due to a lack of understanding of mental illness, cultural norms, and socialisation in Barbados regarding mental illness and negative stereotypes. However, workplace education and promotion, associated workplace policies, and employee assistance programmes (EAPs) were identified as key strategies for effectively addressing issues of mental health stigma and the management of persons with mental illness at work.

Due to the qualitative approach used and small sample selected based on non-probability sampling, generalising the findings to larger populations is heavily cautioned.

Organisations in both private and public sectors should emphasise workplace mental health interventions such as mental health education and awareness, the development and implementation of supportive and flexible policies, and EAPs. These strategies are likely to help destigmatisation efforts and enhance managers’ understanding of mental health and the management of persons with mental illness.

This study provided a rich and in-depth understanding of mental health and illness from the perspective of private and public sector managers in a small developing country in the Caribbean. The Caribbean region possesses a dearth of empirical research concerning issues of mental health and illness at work.

One of the aspects that characterises neoliberal societies is the increasing attribution of individual responsibility. Citizens are required to commit themselves to adopting ‘appropriate’ lifestyles and to self-managing their health. Individual responsibility translates into a set of knowledge and techniques of self-governance, through which individuals learn and are expected to act in an increasingly autonomous way in order to prevent or mitigate health risks. This fostering of self-governance and individual responsibility affects both children and adults; in accordance with it, adults are required to transmit a sort of model of “pedagogy of responsibility” (Neyrand & Mekboul, 2014), through which children learn to acquire self-management of their health. This scenario becomes complicated if we take into consideration the two usual and contrasting representations of childhood in western societies: children as active subjects, or children as vulnerable subjects. Our work explores these contrasting representations through the narrations of adults and children of their experiences of Type 1 Diabetes.

The purpose of this paper is to discover the extent to which evidence‐based practices and computer systems for managing chronic illness are used within Swedish primary health care.

The methodology was a replication of a similar national USA survey study and an interview study.

The findings show large variations and an under‐use of a number of evidence‐based care management practices and of IT for managing depression, heart disease, asthma, and diabetes in Sweden. Follow‐up interview studies with heads of primary care centres gathered their views about the factors which helped and hindered improving care and prevention for these patient groups.

The study data identify actions which would significantly improve the quality of care for people suffering from chronic illnesses. Effective prevention and management of chronic illness in primary care can reduce unnecessary patient suffering and lower costs of care.

Evidence of effective methods for managing these illnesses has been reported, but it is not known how widely these methods or information technology are used in primary care outside the USA. The paper gives the first comprehensive nation‐wide data on the use of evidence‐based practices and computer systems for managing chronic illness in primary care in a European public health care system. It provides information allowing targeted actions which would improve quality of care which are low cost and high cost saving in the long term.

This paper reports outcomes from a holistic, recovery‐based, user‐led group training for people with DSM‐IV bipolar disorder. Drawn from professional therapies and personal experience of the illness by the user‐researcher, the training was delivered over 12 weekly sessions. Using a case‐study approach, an experimental design incorporated pilot (eight participants), main study (five) and control groups (six). Self‐report scales measured mood, coping, empowerment and quality of life pre‐, post‐ and six months post‐training. Semi‐structured interviews noted individual change within the same time frame. Interviews with mental health professionals, medical note analysis and user‐researcher observations also informed the study. Findings from self‐report questionnaires indicated that participants experienced improved mood stability, symptom severity, coping and quality of life and greater empowerment. Out of the six controls, two indicated slight but slow recovery, four continued to use poor coping skills, and two of these four experienced major relapses.

Anyone who has been in regular contact with the media during the last 10 years must have been impressed by the amount of information and interest in health and the stresses of modern life. Much of the attention has been centred on the role of work in creating stress and its possible contribution to major illnesses such as heart disease, stomach ulcers and hypertension. This interest has been stimulated by an ever growing amount of research into stress at work. Friedman and Rosenman in California have carried out many large scale studies of the role of behaviour/personality in causing heart disease. This lead to a semi‐popular book called A‐Type Behavior and your Heart. Three large surveys have been reported in the last few years: Caplan et al. carried out a survey of 2,300 persons from 23 different occupations for the US National Institute of Occupational Safety and Health. They collected data on perceived stressors at work, perceived strain and perceived supports from inside and outside the organisation. Physiological measures were taken from a sub‐sample of 390 The results are very complex but the most stressed persons were in occupations which involve tasks that are simple but inescapable such as in machine‐minding. Such jobs are low in status and the strain is possibly exacerbated by lack of support from both inside and outside the organisation. Zaleznik et al. studied over 2,000 managers and supervisors from a large Canadian Corporation. Pearlin and Schooler conducted a survey of 2,600 persons for the National Institute of Mental Health. As well as exploring the nature of the stresses and strains experienced by these people the authors asked about the different kinds of strategies they used to cope with their problems. Four different problem areas were explored: marital, child‐rearing, economic and work. It was found that the people with a greater range of coping strategies felt less strained except in the area of work. The authors suggested that this was because the in dividual person can do little to remove the stresses at work since they are inherent in the system. Coping with work problems, they argue, needs to be done more at the level of the system.

The chapter is an auto-ethnographic account of the self-management of a chronic illness within the context of a participatory research project on Mediterranean Diet (MD). A group of Italian women with type 2 diabetes is following a non-medical, personal interpretation of the Mediterranean-style diet. The research account is preceded by a critical appraisal of the scientific narratives of the MD.

Analysis of epidemiological research on MD examines some methodological aspects of gender blindness in its scientific approach. The ethnography concerns self-management of MD diet and redefinition of gender relations.

MD is analyzed as a case of transplantation of yesterday’s cultural and social capitals of the peasant classes, to today’s discourses on food considered as appropriate for affluent people suffering from satiety diseases. The ethnography highlights gender aspects of biographical work, examining in particular a “conversion” dietary model.

The ethnography must be amplified to include women and men from different social classes with various Mediterranean cooking habits, and family and gender patterns.

The chapter highlights cultural processes for women’s empowerment in self-managing type 2 diabetes.

This chapter may represent a seminal sociological work on chronic illness, gender and food studies in one of the “native” contexts of the Mediterranean-style diet.

The purpose of this paper is to explore the impact of chronic illness on a couple’s life experiences over a period of 40 years. It critically examines the assumptions of the public health discourse in the light of this couple’s attempts to balance love and health care within their relationship.

The couple, the first two authors, put themselves under the magnifying glass. They arranged for a dialogic encounter and built a co-constructed auto-ethnography. This study consists of a “raw” narrative and a reflection. This reflexive part was added by the third author, interpreting the couple’s experiences applying in a sociocultural way theories of ethical care. This sheds light on ethical care aspects encountered in the couple’s balancing of love and health care.

This study shows that the couple copes with adversity rather than being in control of it. Nonetheless their love relationship appears to be flourishing, thanks to their acknowledgement of the importance of mutual caring.

The current public health discourse puts the couple’s private love relationship under pressure. It turns a blind eye towards the difficulties they experience with the contemporary “self-management” paradigm. The couple feels that the government is an interloper intruding into their private relationship. This creates tension, friction, anxiety, as well as increasing the burden of the illness and makes them feel insecure and unsafe.

The novel method used in this study offers a rare and deep insight.