Self-managing versus self-management: reinvigorating the socio-political dimensions of self-management

Abstract

In Australia, self-management predominantly refers to education programmes that, theoretically, equip people with chronic disease with the necessary information and skills to manage their own healthcare, maintain optimal health, and minimize the consequences of their condition. These programmes are designed, and often delivered, by practitioners. Our research has demonstrated that for consumers, self-management involves navigating and responding to a myriad of information sources and experiences, many of which originate in their own lived bodily experiences and personal knowledge. In contrast to this organic and dynamic version of self-managing that is naturally practised by consumers, common practitioner and policy representations of self-management tend to discount consumer agency and overlook the daily ways in which people manage their own body, experiences and health choices. We argue that if the self-management movement is to tackle health inequalities (rather than creating new ones), health professionals and policy-makers must examine the potentially damaging assumptions that are inherent in contemporary self-management discourse.

Exploring the Experiences of Living With Stroke Through Narrative

“…Exemplified by the Chronic Disease Self-Management Programs (Lorig & Holman, 2003), these models are also used worldwide as a framework to design self-management programs to respond to the challenges such as an aging population and increasing chronic diseases. Current approaches to self-management are often based on normative descriptions of the standards, values, and understandings of the illness experience among chronically ill patients, while training and education remain at the heart of such programs and the expert patient is defined implicitly as a “responsible individual” (Kendall, Ehrlich, Sunderland, Muenchberger, & Rushton, 2011) who is able to make appropriate use of resources. These approaches fail to address the more complex aspects of living with a chronic illness as depicted mostly by qualitative research, for example, patients’ experiences of bodies and how the changed bodies affect the construction of new identities, roles, and their relationships with self and others following a chronic illness (Kvigne & Kirkevold, 2003).…”

"This does my head in". Ethnographic study of self-management by people with diabetes

“…Neither self-management nor self-care has a universally agreed definition. The former is sometimes viewed as a complex construct which, in addition to the biomedical tasks of self care (defined as the various behaviours linked to managing illness and promoting and restoring health [4]), includes personal, cultural, social and political dimensions such as making sense of illness, rebuilding what sociologists have called "spoiled identity" after the diagnosis of a potentially stigmatising condition and lobbying for disability rights [5-10]. Lorig and Holman define self management as the full range of tasks undertaken by a person with chronic illness, including medical management, role management and emotional management [11].…”

The experiences of patients and carers in the daily management of care at the end of life

“…Self-managing can also be understood as a naturally occuring process whereby people are engaging in action and decision within their own context at all times. This is a dynamic process in which consumers of care (patients and spouse-carers) are knowledgeable about their own body, experiences, values and beliefs, and will access information from a wide range of sources to meet their selfperceived needs (Kendall et al (2011). These will include health and care…”