Health care professional support for self-care management in chronic illness: insights from diabetes research
Section snippets
Issues of support in self-care management of chronic illness
Although support has been generally acknowledged as a critical factor in adapting to and coping with chronic illness, the mechanisms by which it influences the chronic illness experience are not at all well understood [1], [2], [3]. The majority of the research has been directed toward an understanding of supportive functions within the chronically ill person’s interpersonal networks, and has assumed that the health care professional may play a facilitative role in mobilizing or educating
Background to the diabetes study
Our grounded theory study of expert self-care decision making in Type I diabetes [33] followed each of 22 nominated individuals over a 12-month period. All participants had been diagnosed for at least 15 years. Half (those studied during the first year) were nominated by their specialist clinicians as being expert in self-care management; the remainder (followed during the second year of the study) volunteered to participate on the basis of self-identification of expertise. Each was extensively
Findings related to support
The social context in which Type I diabetes is experienced was a prominent theme throughout the interviews with these participants. Diabetes tends to be an invisible chronic illness, in that those who live with it conduct much of their self-care management outside of the gaze of their co-workers and casual acquaintances, who may remain unaware of the presence of the disease. However, in that it also interrupts and forces modifications in some of the most socially visible functions, such as
Interpretive context of support
The diabetes self-care decision making research illuminates that a number of the assumptions with regard to health care relationships that have generally been held within chronic illness theory deserve thorough critical reflection and rethinking. First and foremost, it seems quite clear that what is and is not supportive may be entirely unrelated to what the professional believes is consistent with friendly, kind, and helpful interactions. As the examples described above illustrate, the
Practice implications
From the results of this study, a number of clinical practice implications arise. Firstly, it seems evident that a complex skill such as self-care management of diabetes will evolve over time and take on differing forms throughout that trajectory. In order for health care professionals to be able to support, rather than interfere with, these processes, learning must be understood in context, and the trajectory of illness experience must be honored. Further, general knowledge with regard to the
Acknowledgements
The authors gratefully acknowledge the support of the British Columbia Health Research Foundation.
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