通过话语构建骨关节炎——对六份骨关节炎患者信息手册的定性分析
Constructing osteoarthritis through discourse--a qualitative analysis of six patient information leaflets on osteoarthritis.
作者信息
Grime Janet C, Ong Bie Nio
机构信息
Primary Care Musculoskeletal Research Centre, Keele University, Keele, UK.
出版信息
BMC Musculoskelet Disord. 2007 Apr 11;8:34. doi: 10.1186/1471-2474-8-34.
BACKGROUND
Health service policy in the United Kingdom emphasises the importance of self-care by patients with chronic conditions. Written information for patients about their condition is seen as an important aid to help patients look after themselves. From a discourse analysis perspective written texts such as patient information leaflets do not simply describe the reality of a medical condition and its management but by drawing on some sorts of knowledge and evidence rather than others help construct the reality of that condition. This study explored patient information leaflets on osteoarthritis (OA) to see how OA was constructed and to consider the implications for self-care.
METHODS
Systematic and repeated readings of six patient information leaflets on osteoarthritis to look for similarities and differences across leaflets, contradictions within leaflets and the resources called on to make claims about the nature of OA and its management.
RESULTS
Biomedical discourse of OA as a joint disease dominated. Only one leaflet included an illness discourse albeit limited, and was also the only one to feature patient experiences of living with OA. The leaflets had different views on the causes of OA including the role of lifestyle and ageing. Most emphasised patient responsibility for preventing the progression of OA. Advice about changing behaviour such as diet and exercise was not grounded in lived experience. There were inconsistent messages about using painkillers, exercise and the need to involve professionals when making changes to lifestyle.
CONCLUSION
The nature of the discourse impacted on how OA and the respective roles of patients and professionals were depicted. Limited discourse on illness meant that the complexity of living with OA and its consequences was underestimated. Written information needs to shift from joint biology to helping patients live with osteoarthritis. Written information should incorporate patient experience and value it alongside biomedical knowledge.
背景
英国的医疗服务政策强调慢性病患者自我护理的重要性。为患者提供的关于其病情的书面信息被视为帮助患者自我照顾的重要辅助手段。从话语分析的角度来看，诸如患者信息手册之类的书面文本不仅仅描述了医疗状况及其管理的现实，而是通过借鉴某些类型的知识和证据而非其他知识和证据，帮助构建了该疾病状况的现实。本研究探讨了关于骨关节炎（OA）的患者信息手册，以了解OA是如何被构建的，并思考其对自我护理的影响。
方法
对六份关于骨关节炎的患者信息手册进行系统且反复的阅读，以寻找各手册之间的异同、手册内部的矛盾之处，以及用于阐述OA的性质及其管理的资源。
结果
将OA视为一种关节疾病的生物医学话语占主导地位。只有一份手册包含了疾病话语，尽管内容有限，并且也是唯一一份提及OA患者生活经历的手册。这些手册对OA的病因有不同观点，包括生活方式和衰老的作用。大多数手册强调患者在预防OA进展方面的责任。关于改变饮食和运动等行为的建议并非基于实际生活经验。在使用止痛药、运动以及改变生活方式时是否需要专业人员参与方面，存在不一致的信息。
结论
话语的性质影响了OA以及患者和专业人员各自角色的呈现方式。关于疾病的话语有限意味着对OA患者生活的复杂性及其后果的低估。书面信息需要从关节生物学转向帮助患者应对骨关节炎。书面信息应纳入患者的经验，并将其与生物医学知识同等重视。
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