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Title: Chronic illness and self-management in primary care : characterising the 'work' of older patients with coronary heart disease
Author: Moore, Lucy Elizabeth
Awarding Body: Exeter and Plymouth Peninsula Medical School
Current Institution: Exeter and Plymouth Peninsula Medical School
Date of Award: 2012
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Abstract:
Self-management policy has presented opportunities for patients with long-term conditions to improve their health and wellbeing by becoming active agents in their care. However, the 'work' of self-management for patients appears to need certain essential and desirable skills and attributes for improved health outcomes. A literature review and mind mapping analysis of policy literature produced a 'policy' model identifying 4 concepts described as active, competent, efficacious and responsible. The aim of this research was to characterise the self-management 'work' of older patients with coronary heart disease (CHD) in primary care and to identify the skills and attributes requi red for participation. This study was qualitative in design employing longitudinal diary-interviews with 21 patients, and interviews with 8 professionals, in th ree contrasting socio-economic general practice areas in the South West of England. The analysis for this study drew on concepts of governmentality and the reflexive self. It produced an alternative 'occupational' model of self- management with 5 dominant occupational roles and 3 levels of occupational status. This occupational model identified the breadth and depth of self- management practices by older patients with CHD. It incorporated the diversity of self-management strategies seen in relation to the everyday management of health problems, life and illness perspectives and challenges associated with bereavement, retirement and parallel responsibilities as carers and sufferers of co-morbidities. It clearly demonstrated where patients have the .interest, knowledge and confidence to modify their behaviour for an improved health outcome. It also highlighted the struggles associated with social, physical and emotional circumstances as well as the spectrum of relationships with health care professionals and significant others that improved or impacted upon optimum self-management. This occupational model provides a sociologically sensitive method of describing the older person's experience of living with CHD. This thesis outlines recommendations for primary care professionals based on this occupational model.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.559268  DOI: Not available
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