Evolving ‘self’‐management: exploring the role of social network typologies on individual long‐term condition management

Abstract

BackgroundWhilst there has been a focus on the importance of social support for managing long‐term conditions, there has been little specific focus on the characteristics of social networks that shape self‐management. Policy emphasis is placed on individual responsibility for self‐care, and this influences commissioning of health‐care services. Assumptions are often made by policymakers about accessibility and preference for support and the influence of the social context on chronic illness management.ObjectiveTo examine the social networks of individuals with long‐term conditions and identify how the characteristics of their composition influences support needs.Design, setting and participantsThirty participants completed initial face‐to‐face in‐depth interviews, telephone follow‐ups and final face‐to‐face interviews in the north‐west of England. A longitudinal qualitative design was used to elicit the subtle changes in relationships over a year.FindingsThe findings suggest that the relationships which constitute a social network influence perceived support needs and attitudes to self‐management. The amalgamation of relationships was characterized into three network typologies (family focused, friend focused or health‐care professional focused) according to which types of relationships were dominant. In the absence of support, accounts highlighted a small number of substitutes who could provide support at times of critical need.DiscussionThis study challenges the notion of ‘self’‐management as an individual construct as many of the practices of illness management involved the support and/or negotiation of roles with others. By examining the nuances of relationships, this study has highlighted the tacit boundaries of practical and emotional support provision.

The social networks of New Zealand patients with multimorbidity and the work of those nominated as their ‘significant supporters’: An exploratory study

“…Nomination by patients likely indicates their appreciation of the professionals’ attitude and continuity of care. However, in contrast to Morris et al’s (), in this study not all patients followed the advice of the nominated health professional but this did not diminish the quality of the patient–professional relationships, with respect shown by professionals to patient choice and opinion. The importance of quality relationships aligns with Dwarswaard, Bakker, van Staa, and Boeije () finding that relational support (helpful interactions with others) is the most important of the three types of support (instrumental, psychosocial, relational) needed by patients to successfully self‐manage long‐term conditions.…”

“…Previous research on the work undertaken by social network members has focused on lay supporters, whereas patients in the current study nominated both lay and professional supporters from their social networks (Rogers et al, ). Morris et al, have defined three different foci of social networks (family‐focused, friend‐focused, health professional‐focused) and in this study both family‐focused and health professional‐focused networks were represented by inclusion of lay (family) and professional (health) supporters (Morris, Kennedy, & Sanders, ). In networks that are health professional‐focused, Morris et al believe patients consider health professionals to be “the only legitimate people with whom to discuss health… (and) advice from healthcare professionals was prioritised” (Morris et al, , p, 1055).…”

“…Morris et al, have defined three different foci of social networks (family‐focused, friend‐focused, health professional‐focused) and in this study both family‐focused and health professional‐focused networks were represented by inclusion of lay (family) and professional (health) supporters (Morris, Kennedy, & Sanders, ). In networks that are health professional‐focused, Morris et al believe patients consider health professionals to be “the only legitimate people with whom to discuss health… (and) advice from healthcare professionals was prioritised” (Morris et al, , p, 1055). In our study, nominated professional supporters described illness, everyday and emotional work which had been undertaken over long periods of time.…”

One size does not fit all – Stroke survivor’s views on group self-management interventions

“…An individual's support network can impact their ability to SM [41]. It is therefore unsurprising that we found participants wanted family and friends to be able to attend a group SMP with them.…”

Reconsidering the ‘self’ in self‐management of chronic illness: Lessons from relational autonomy

“…Research suggests that in supporting patient self‐management priorities, it is key to be cognizant of a patient’s immediate environment and identify the patient's emotional and practical support. Discussing the types of support patients find useful, and can access, is a starting point to be included in care (Morris, Kennedy, & Sanders, ). Other helpful strategies include increasing self‐management services through outpatient, internet‐based interventions, and telephone access to support.…”