Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom.
Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom.
Soc Sci Med. 2017 Mar;176:25-33. doi: 10.1016/j.socscimed.2017.01.018. Epub 2017 Jan 17.
Healthcare policy in developed countries has, in recent years, promoted self-management among people with long-term conditions. Such policies are underpinned by neoliberal philosophy, as seen in the promotion of greater individual responsibility for health through increased support for self-management. Yet still little is known about how self-management is understood by commissioners of healthcare services, healthcare professionals, people with long-term conditions and family care-givers. The evidence presented here is drawn from a two-year study, which investigated how self-management is conceptualised by these stakeholder groups. Conducted in the UK between 2013 and 2015, this study focused on three exemplar long-term conditions, stroke, diabetes and colorectal cancer, to explore the issue. Semi-structured interviews and focus groups were carried out with 174 participants (97 patients, 35 family care-givers, 20 healthcare professionals and 22 commissioners). The data is used to demonstrate how self-management is framed in terms of what it means to be a 'good' self-manager. The 'good' self-manager is an individual who is remoralised; thus taking responsibility for their health; is knowledgeable and uses this to manage risks; and, is 'active' in using information to make informed decisions regarding health and social wellbeing. This paper examines the conceptualisation of the 'good' self-manager. It demonstrates how the remoralised, knowledgeable and active elements are inextricably linked, that is, how action is knowledge applied and how morality underlies all action of the 'good' self-manager. Through unpicking the 'good' self-manager the problems of neoliberalism are also revealed and addressed here.
近年来，发达国家的医疗政策提倡慢性病患者进行自我管理。这种政策是新自由主义哲学的体现，例如通过增加对自我管理的支持，来促进个人对健康更大的责任。然而，对于医疗服务的委托方、医疗专业人员、慢性病患者和家庭照顾者如何理解自我管理，我们知之甚少。这里呈现的证据来自一项为期两年的研究，该研究调查了这些利益相关者群体如何概念化自我管理。该研究于 2013 年至 2015 年在英国进行，重点关注三种代表性的慢性病，即中风、糖尿病和结直肠癌，以探讨这个问题。与 174 名参与者（97 名患者、35 名家庭照顾者、20 名医疗专业人员和 22 名委托方）进行了半结构化访谈和焦点小组讨论。这些数据用于展示自我管理是如何根据成为一个“好”的自我管理者的含义来构建的。“好”的自我管理者是一个被重新道德化的个体；因此，对自己的健康负责；有知识，并利用这些知识来管理风险；并且，积极利用信息做出有关健康和社会福利的明智决策。本文探讨了“好”的自我管理者的概念化。它展示了被重新道德化、有知识和积极的因素是如何不可分割地联系在一起的，即行动是如何应用知识的，以及道德如何是“好”的自我管理者所有行动的基础。通过剖析“好”的自我管理者，本文还揭示并解决了新自由主义的问题。
