Reconsidering patient empowerment in chronic illness: A critique of models of self-efficacy and bodily control
Reconsidering patient empowerment in chronic illness: A critique of models of self-efficacy and bodily control
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DOI：
10.1016/j.socscimed.2007.11.034
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发表时间：
2008-03-01
影响因子：
5.4
通讯作者：
Deccache, Alain
中科院分区：
文献类型：
--
作者：
Aujoulat, Isabelle;Marcolongo, Renzo;Deccache, Alain
关注患者赋权的研究倾向于更具体地解决患者疾病经历的两个问题：管理方案和与卫生保健提供者的关系。疾病经历的其他方面，例如接受被破坏的身份，往往被忽视。因此，赋权的结果通常被称为实现自我效能、掌握和控制。我们进行了一项归纳探索性研究，基于对比利时和意大利的40名慢性病患者的个人深入访谈，以了解赋权过程，因为它可能发生在患者的疾病经历在某个时候引起了无力感，我们将其概念化为对他们的安全感和身份的威胁。我们的研究结果表明，授权和控制不是一回事。我们将患者赋权描述为一个个人转变的过程，该过程通过以下双重过程发生：（i）“坚持”先前的自我陈述和角色，并学习控制疾病和治疗，以便一方面将自己与疾病区分开来，另一方面（ii）“放手”，接受放弃控制，以便整合疾病和疾病驱动的边界，作为和解的自我的一部分。虽然分离身份的过程（“坚持”）确实被认为与旨在控制和保持或重新获得掌控感的努力有关，但调和身份的过程（“放手”）被认为与一致性的需要有关，其中包括寻求意义和接受并非一切都是可控的。我们认为，放弃控制权的过程与获得控制权的过程一样，都是赋权的核心。由于“成功的”赋权过程发生在患者接受其安全和身份受到威胁时，而不仅仅是接受其治疗，保健提供者可以通过使用叙述来促进这一过程。(C)2007爱思唯尔有限公司版权所有。
Studies that focus on patient empowerment tend to address more specifically two issues of patients' experience of illness: managing regimens and relating to health-care providers. Other aspects of illness experience, such as coming to terms with disrupted identities, tend to be overlooked. The outcome of empowerment is therefore usually referred to as achieving self-efficacy, mastery and control. We conducted an inductive exploratory study, based on individual in-depth interviews with 40 chronically ill patients in Belgium and Italy, in order to understand the process of empowerment as it may occur in patients whose experience of illness has at some point induced a feeling of powerlessness, which we conceptualised as a threat to their senses of security and identity. Our findings show that empowerment and control are not one and the same thing. We describe patient empowerment as a process of personal transformation which occurs through a double process of (i) "holding on" to previous self-representations and roles and learning to control the disease and treatment, so as to differentiate one's self from illness on the one hand, and on the other hand (ii) "letting go", by accepting to relinquish control, so as to integrate illness and illness-driven boundaries as being part of a reconciled self. Whereas the process of separating identities ("holding on") was indeed found to be linked to efforts aimed at taking control and maintaining or regaining a sense of mastery, the process of reconciling identities ("letting go") was found to be linked to a need for coherence, which included a search for meaning and the acceptance that not everything is controllable. We argue that the process of relinquishing control is as central to empowerment as is the process of gaining control. As a "successful" process of empowerment occurs when patients come to terms with their threatened security and identity, not only with their treatment, it may be facilitated by health-care providers through the use of narratives. (C) 2007 Elsevier Ltd. All rights reserved.