Contextualising renal patient routines: Everyday space-time contexts, health service access, and wellbeing.
Contextualising renal patient routines: Everyday space-time contexts, health service access, and wellbeing.
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肾病患者的日常生活背景：日常时空背景、医疗服务获取和福祉。
DOI：
10.1016/j.socscimed.2017.04.043
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Talaulikar,Girish
中科院分区：
文献类型：
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作者：
McQuoid,Julia;Jowsey,Tanisha;Talaulikar,Girish
对于世界各地越来越多的慢性病患者来说，稳定的日常生活是成功进行疾病自我管理的关键。然而，人们对慢性病患者的日常生活环境对日常生活的影响知之甚少。本文采用时空地理学的方法，探讨慢性肾脏病(CKD)患者的日常时空背景和日常生活方式。我们问：肾病患者的时空环境与他们建立和维持稳定日常生活的能力之间有什么关系？卫生服务的可获得性在这方面发挥了什么作用？我们从澳大利亚26名慢性肾脏病患者的定性案例研究中得出结论。数据包括自我报告的两天参与者日记和半结构化访谈。访谈记录的主题分析以归纳演绎的方法为指导。我们考察了例行公事在参与者日常生活的时空背景中的嵌入性。我们发现，参与者的日常时空环境非常复杂，特别是对那些接受透析和/或受雇的人来说，这使得日常生活很难建立，很容易受到干扰。获得医疗服务有助于塑造参与者的日常时空环境，这意味着在获得医疗服务方面的不可预测性事件会在参与者的时空环境中引发“连锁反应”，扰乱日常生活，使日常生活谈判变得更加困难。吸收不可预测的卫生服务的连锁反应而不打乱日常生活的能力因时空背景而异。讨论了这些发现对卫生研究中常规概念的部署、患者自我管理疾病的成功框架和卫生服务设计的影响。总而言之，理解和支持个人建立和维护支持健康和福祉的惯例的努力，可以受益于将日常人类行为与背景联系起来并使其去中心化的方法。支持肾脏患者在临床环境之外管理疾病和体验健康的机会在于对慢性护理服务的时空重新设计。
Stable routines are key to successful illness self-management for the growing number of people living with chronic illness around the world. Yet, the influence of chronically ill individuals' everyday contexts in supporting routines is poorly understood. This paper takes a space-time geographical approach to explore the everyday space-time contexts and routines of individuals with chronic kidney disease (CKD). We ask: what is the relationship between renal patients' space-time contexts and their ability to establish and maintain stable routines, and, what role does health service access play in this regard? We draw from a qualitative case study of 26 individuals with CKD in Australia. Data comprised self-reported two day participant diaries and semi-structured interviews. Thematic analysis of interview transcripts was guided by an inductive-deductive approach. We examined the embeddedness of routines within the space-time contexts of participants' everyday lives. We found that participants' everyday space-time contexts were highly complex, especially for those receiving dialysis and/or employed, making routines difficult to establish and vulnerable to disruption. Health service access helped shape participants' everyday space-time contexts, meaning that incidences of unpredictability in accessing health services set-off ‘ripple effects’ within participants' space-time contexts, disrupting routines and making everyday life negotiation more difficult. The ability to absorb ripple effects from unpredictable health services without disrupting routines varied by space-time context. Implications of these findings for the deployment of the concept of routine in health research, the framing of patient success in self-managing illness, and health services design are discussed. In conclusion, efforts to understand and support individuals in establishing and maintaining routines that support health and wellbeing can benefit from approaches that contextualise and de-centre everyday human behaviour. Opportunities to support renal patients in managing illness and experiencing wellbeing outside the clinical setting lie in a space-time re-design of chronic care services.