Download (.pdf) Self-care in people with long term health problems: a community based survey
BMC Family Practice, 2011. 12(53)
Co-authored with C Paterson; W Henley; N Britten
Background:
Self-care is a key component of current policies to manage long term conditions. Although most people... more
Background:
Self-care is a key component of current policies to manage long term conditions. Although most people with long-term health problems care for themselves within lay networks, consultation rates for long-term undifferentiated illness remain high. Promotion of self-care in these individuals requires an understanding of their own self-care practices and needs to be understood in the context of health care pluralism. The aim was to investigate the extent and nature of self-care practices in patients experiencing long term health problems, sources of information used for self-care, and use of other forms of health care (conventional health care and complementary and alternative medicine).
Methods:
The study involved a cross-sectional community-based survey set in three general practices in South West England: two in urban areas, one in a rural area. Data were collected using a postal questionnaire sent to a random sample of 3,060 registered adult patients. Respondents were asked to indicate which of six long term health problems they were experiencing, and to complete the questionnaire in reference to a single (most bothersome) problem only.
Results:
Of the 1,347 (45% unadjusted response rate) who responded, 583 reported having one or more of the six long term health problems and 572 completed the survey questionnaire. Use of self-care was notably more prevalent than other forms of health care. Nearly all respondents reported using self-care (mean of four self-care practices each). Predictors of high self-care reported in regression analysis included the reported number of health problems, bothersomeness of the health problem and having received a diagnosis. Although GPs were the most frequently used and trusted source of information, their advice was not associated with greater use of self-care.
Conclusions:
This study reveals both the high level and wide range of self-care practices undertaken by this population. It also highlights the importance of GPs as a source of trusted information and advice. Our findings suggest that in order to increase self-care without increasing consultation rates, GPs and other health care providers may need more resources to help them to endorse appropriate self-care practices and signpost patients to trusted sources of self-care support.
Care and the Self: Biotechnology, Reproduction, and the Good Life
Philosophy, Ethics, and Humanities in Medicine, vol. 2, no. 6 (2007)
This paper explores a novel philosophy of ethical care in the face of burgeoning biomedical technologies. I respond to... more
This paper explores a novel philosophy of ethical care in the face of burgeoning biomedical technologies. I respond to a serious challenge facing traditional bioethics with its roots in analytic philosophy. The hallmarks of these traditional approaches are reason and autonomy, founded on a belief in the liberal humanist subject. In recent years, however, there have been mounting challenges to this view of human subjectivity, emerging from poststructuralist critiques, such as Michel Foucault's, but increasingly also as a result of advances in biotechnology itself. In the face of these developments, I argue that the theoretical relevance and practical application of mainstream bioethics is increasingly under strain. Traditionalists will undoubtedly resist. Together, professional philosopher-bioethicists, public health policymakers, and the global commercial healthcare industry tend to respond conservatively by shoring up the liberal humanist subject as the foundation for medical ethics and consumer decision-making, appealing to the familiar tropes of reason, autonomy, and freedom.
I argue for a different approach to bioethics, and work towards a new way to conceive of ethical relations in healthcare – one that does not presume a sovereign subject as the basis of dignity, personhood or democracy. Instead, I am critical of the narrow instantiations of reason, autonomy, and freedom, which, more recently, have been co-opted by a troubling neo-liberal politics of the self. Thus, I am critical of current trends in medical ethics, often running in tandem with corporate-governmental models of efficiency, accountability, and so-called evidence-based best practices. As an example of such market-driven conceptions of subjectivity, I discuss the paradigm of "self-care." Self-care shores up the traditional view of the self as a free agent. In this sense, self-care is looked upon favourably by mainstream bioethics in its focus on autonomy, while healthcare policy endorses this model for ideological and economic reasons. To contrast this, I propose a different model of care together with a different model of selfhood. Here I develop and apply Foucault's late work on the "care of the self." In this understanding of "care," I suggest that we might work towards an ethical self that is more commensurable both with recent theoretical views on subjectivity and – more pressingly – with the challenges of emergent biotechnologies. I end this paper with a discussion on ethical parenthood, which offers a practical reading of the "care of the self" in relation to new reproductive technologies (NRTs).
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The Heart of “Iyashi”: Health, Comfort and Nostalgia in Japanese Pilgrimage and Medicine
by Jason Danely
Delivered at the 2011 Meeting of the Association of American Anthropology
The study of religious pilgrimage in anthropology has been dominated by the Turnerian legacy of rites de passage and... more The study of religious pilgrimage in anthropology has been dominated by the Turnerian legacy of rites de passage and communitas and the chorus of critiques and rejoinders that have followed. Recent works on pilgrimage have attempted to shift this perspective towards a focus on the context of hegemonic discourses, negotiations of identity politics and invented traditions of nostalgic tourism. While these works underline the complexity of the pilgrim as cultural construct, they have also created an intractable distance between the fundamental importance of pilgrimage and the phenomenology of health that was so important to the Turners. Other recent work has started to reestablish the critical link between pilgrimage and healing though the theoretical lens of medical anthropology (Notermans 2006; Dubisch and Winkleman Eds. 2005). Expanding on this work, this paper examines the construction of healing in contemporary religious pilgrimage in Japan. There are hundreds of established pilgrimage routes throughout Japan, most composed of a circuit of several interlinked religious sites, and are completed in multiple trips over a period of years. Reflecting Japan's aging population and its long-standing association between health and spiritual journey, over half of the pilgrims to the most popular routes are over the age of 65, and newer pilgrimages dedicated to the prevention of senility and other contemporary health concerns of the elderly have increased. Following this trend is the promotion of pilgrimage as the path of “iyashi,” a concept sometimes glossed as physical and emotional “comfort” that has in the last few decades been taken into therapeutic and biomedical contexts such as palliative nursing care, as well as those of religious healing (Ueda 1997). “Iyashi”also links place, memory, and emotions as components of the healing experience, creating pilgrims both as nostalgic bodies in cultural landscapes and active agents in health prevention and end-of-life management. Following both the legacy of Turner and the semiotic legacy of “iyashi,” this paper examines encounters with healing on one Japanese pilgrimage route as well as post-pilgrimage accounts of older adult informants that indicate the possibilities of lasting traces of “iyashi” in the pilgrim's experience.