McDougall Allan, Kinsella Elizabeth Anne, Goldszmidt Mark, Harkness Karen, Strachan Patricia, Lingard Lorelei
Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Western University, Ontario, Canada.
Occupational Therapy, Western University, Ontario, Canada.
Sociol Health Illn. 2018 Jan;40(1):218-233. doi: 10.1111/1467-9566.12675.
For patients living with chronic illnesses, self-care has been linked with positive outcomes such as decreased hospitalisation, longer lifespan, and improved quality of life. However, despite calls for more and better self-care interventions, behaviour change trials have repeatedly fallen short on demonstrating effectiveness. The literature on heart failure (HF) stands as a case in point, and a growing body of HF studies advocate realist approaches to self-care research and policymaking. We label this trend the 'realist turn' in HF self-care. Realist evaluation and realist interventions emphasise that the relationship between self-care interventions and positive health outcomes is not fixed, but contingent on social context. This paper argues socio-materiality offers a productive framework to expand on the idea of social context in realist accounts of HF self-care. This study draws on 10 interviews as well as researcher reflections from a larger study exploring health care teams for patients with advanced HF. Leveraging insights from actor-network theory (ANT), this study provides two rich narratives about the contextual factors that influence HF self-care. These descriptions portray not self-care contexts but self-care assemblages, which we discuss in light of socio-materiality.
对于慢性病患者而言，自我护理与诸如住院次数减少、寿命延长和生活质量改善等积极结果相关联。然而，尽管人们呼吁开展更多更好的自我护理干预措施，但行为改变试验在证明有效性方面却屡屡失败。关于心力衰竭（HF）的文献就是一个典型例子，越来越多的HF研究主张采用现实主义方法进行自我护理研究和制定政策。我们将这一趋势称为HF自我护理中的“现实主义转向”。现实主义评估和现实主义干预强调，自我护理干预与积极健康结果之间的关系并非固定不变，而是取决于社会背景。本文认为，社会物质性为在HF自我护理的现实主义描述中扩展社会背景的概念提供了一个富有成效的框架。本研究借鉴了10次访谈以及来自一项针对晚期HF患者医疗团队的更大规模研究中的研究者反思。利用行动者网络理论（ANT）的见解，本研究提供了两个关于影响HF自我护理的背景因素的丰富叙述。这些描述描绘的不是自我护理背景，而是自我护理组合，我们将根据社会物质性对其进行讨论。
