Public Defence: Dagmara Bossy
Master Dagmara Bossy at Institute of Health and Society will be defending the thesis “Individualized fellowship? Competing logics of group-based self-management support for long-term conditions” for the degree of PhD (Philosophiae Doctor).
Photo: The Cecilie Engelsen
Trial Lecture – time and place
See Trial Lecture.
- First opponent: Lektor Sine Lehn-Christiansen, Roskilde University
- Second opponent: Professor Frode Fadnes Jacobsen, Western Norway University of Applied Sciences
- Third member and chair of the evaluation committee: Post.doc. Ida Lillehagen, University of Oslo
Chair of the Defence
Professor Jan Helge Solbakk, University of Oslo
Professor Christina Foss, University of Oslo
The current thesis examines different actors’ understandings of group-based self-management support for people with long-term conditions. The actors comprise representatives from health-related organizations, people diagnosed with type 2 diabetes, and health professionals. Inspired by the theoretical framework of institutional logics, I have tried to grasp what kind of logics influence the understanding of actors in the sphere of group-based self-management support for people diagnosed with type 2 diabetes. The data consist of qualitative semi-structured telephone interviews with representatives from a range of health-related organizations, in addition to focus group interviews with people diagnosed with type 2 diabetes and health professionals working with group-based measures targeted at people with long-term conditions. The research theme is part of a larger international project investigating the importance of social networks for self-management support of long-term conditions. The international project aimed to investigate systems of support at the macro, meso and micro levels. Type 2 diabetes is here viewed as representative for long-term conditions. The thesis focuses on the Norwegian context. Instructions for generating data and interview guidelines were developed within the international collaboration. The overall aim of thesis is however to provide an independent contribution to the field of group-based self-management support of long-term conditions in Norway. Epistemologically, the thesis is grounded in social constructivism. The context of health policy reforms addressing the prevalence of long-term conditions, as well as the idea that chronic disease represent an anticipated burden for the public health services, is relevant in the interpretation of findings.
Sub-study I presents findings based on 50 semi-structured telephone interviews with representatives from health-related organizations. What I call logics had elements of ideologies related to "fellowship" (collective (self)-management of disease), "healthy mind-set" (thinking in terms of possibilities rather than limitations), "self-representation" (looking healthy), "moral responsibility" (adhering to diet and exercise recommendations) and "health pedagogy" (encompassing the ideology of viewing patients as part of a wider context). There seemed to be an overall logic of individual versus collective responsibility for disease management that governed all of the informants’ understandings, with certain articulations dependent on organizational context. I argue that there is a movement towards seeing individuals as responsible for their disease in the logic of moral responsibility, influenced by neo-liberal politics.
Sub-study II shows people diagnosed with type 2 diabetes constructing a sense of dignity in illness when faced with a culture that sees the disease as the moral responsibility of the individual. Patients describe lack of support from health professionals (especially general practitioners) and skewed access to information. In terms of institutional logics, the logic of moral responsibility seemed to govern the discussions in all of the focus groups with people diagnosed with type 2 diabetes. The concept of “self-management” appears as reduced to “following life-style recommendations”. Participating in group-based self-management support and withdrawing from group-based programmes are both strategies for handling the stigma of disease that, in my assessment, are influenced by the logic of (individual) moral responsibility for health/disease.
Sub-study III shows health professionals critically reflecting on their medical practices (termed the medical perspective), which they bring with them into the group-based self-management support programmes. Sub-study III distinguishes between a medical perspective and a health-promoting ideology. The medical perspective is apparent in the health professionals’ focus on expert-based knowledge, adherence to medical guidelines and the importance of lifestyle-change. However, the discussions between health professionals also show movement between ideologies, as the critical assessment of the categorization of diagnoses suggests a move towards a health promoting ideology.
In the discussion, I view logic of moral responsibility as inhabiting the logic of fellowship, contributing to the notion of individualized fellowship in contemporary society.
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