Faculty of Nursing, University of Alberta, Clinical Sciences Building, Edmonton, Alberta, Canada.
Soc Sci Med. 2010 Apr;70(7):1077-83. doi: 10.1016/j.socscimed.2009.11.026. Epub 2010 Feb 1.
Improving chronic disease management and outcomes is vital. However, greater understanding is needed of how aspects of context influence experiences and reactions to chronic disease and self-care. This is exemplified in relation to heart failure (HF), a common and severe chronic form of heart disease. Semi-structured interviews were undertaken with 42 male and female patients (Mean age 76 years) and 30 nominated lay caregivers. Interviews were guided by critical realist theory and examined experiences of and reactions to HF and aspects of self-care. Patients were recruited from three rural sites in Alberta, a province in mid-Western Canada, which varied in size, health services, and proximity to large urban settings. The influence of the rural context on accounts of HF and its self-care was evident principally in patients and caregivers through work and place. Work and place were seen to be indivisible with work seen as integral to life in the rural setting both historically (connecting to past generations) and contemporaneously. Accounts of HF and its self-care were framed around broader narratives of work, its benefits, and the threats and disruptions made to work by HF. Gender differences mainly existed around normal working patterns related to land work, domestic work, and community work. Work was seen to be pleasurable and vital to life in the rural setting and was continued by those with HF where possible either functionally or symbolically. Accounts of HF and its self-care were grounded in work and place-related dimensions of the rural setting. Approaches and interventions related to chronic disease must engage with place and work-related dimensions of context.
改善慢性病管理和结局至关重要。然而，我们需要更好地了解背景的各个方面如何影响人们对慢性病和自我护理的体验和反应。心力衰竭（HF）就是一个很好的例子，它是一种常见且严重的慢性心脏病。研究人员对 42 名男性和女性患者（平均年龄 76 岁）和 30 名指定的非专业护理人员进行了半结构化访谈。访谈以批判现实主义理论为指导，探讨了 HF 的经历、反应以及自我护理的各个方面。患者是从加拿大中西部阿尔伯塔省的三个农村地区招募的，这些地区在规模、卫生服务和与大城市的距离方面存在差异。农村背景对 HF 及其自我护理的描述的影响主要体现在患者和护理人员身上，体现在工作和地点上。工作和地点是不可分割的，工作被视为农村生活的固有组成部分，无论是在历史上（与过去几代人联系）还是在当代。HF 及其自我护理的描述是围绕着更广泛的工作、工作的好处以及 HF 对工作造成的威胁和干扰的叙述展开的。性别差异主要存在于与土地工作、家务劳动和社区工作相关的正常工作模式上。工作被视为农村生活中愉快和至关重要的事情，那些有 HF 的人尽可能在功能上或象征性地继续工作。HF 及其自我护理的描述是基于农村环境中与工作和地点相关的维度。与慢性病相关的方法和干预措施必须与背景中的地点和工作相关维度相联系。
