Context and complexity: the meaning of self-management for older adults with heart disease

Abstract

Self-management policy has presented opportunities for patients with long-term conditions to take control and actively improve their health. However, the ‘work’ of self-management appears to be packaged in the form of essential and desirable skills and attributes required for success. This article presents the findings of a qualitative study, employing longitudinal diary-interviews with 21 older patients diagnosed with coronary heart disease, from three contrasting general practice areas. Drawing on concepts of the care of the self and the reflexive self, this paper presents the diversity of self-management practices by older patients within the context of their lifeworld. Illustrated through individual case studies, it clearly identifies where patients are engaged self-managers with the agency, knowledge and self-discipline to modify their behaviour for an improved health outcome. This study highlights their life and illness perspectives as well as those patients who are burdened with emotional insecurity, co-morbidities and caring responsibilities. It shows the spectrum of relationships with health professionals that influence engaged self-management. We suggest that policy initiatives that favour behavioural change neglect social context and individualistic practices that are a necessary response to structural and psychosocial constraints.