TY - JOUR
T1 - Contextualising renal patient routines: Everyday space-time contexts, health service access, and wellbeing
AU - McQuoid, Julia
AU - Jowsey, Tanisha
AU - Talaulikar, Girish
N1 - Funding Information:
The authors extend their gratitude to the participants of this study for generously sharing their time and experiences. This research was conducted with financial support from University of New South Wales, a National Cancer Institute Training Grant 2T32 CA113710-11, and recruitment assistance from Ms Patricia Johnson and The Canberra Hospital. The authors thank Dr Amy Griffin for feedback on earlier versions of this paper.
Publisher Copyright:
© 2017 Elsevier Ltd
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Stable routines are key to successful illness self-management for the growing number of people living with chronic illness around the world. Yet, the influence of chronically ill individuals’ everyday contexts in supporting routines is poorly understood. This paper takes a space-time geographical approach to explore the everyday space-time contexts and routines of individuals with chronic kidney disease (CKD). We ask: what is the relationship between renal patients’ space-time contexts and their ability to establish and maintain stable routines, and, what role does health service access play in this regard? We draw from a qualitative case study of 26 individuals with CKD in Australia. Data comprised self-reported two day participant diaries and semi-structured interviews. Thematic analysis of interview transcripts was guided by an inductive-deductive approach. We examined the embeddedness of routines within the space-time contexts of participants’ everyday lives. We found that participants’ everyday space-time contexts were highly complex, especially for those receiving dialysis and/or employed, making routines difficult to establish and vulnerable to disruption. Health service access helped shape participants’ everyday space-time contexts, meaning that incidences of unpredictability in accessing health services set-off ‘ripple effects’ within participants’ space-time contexts, disrupting routines and making everyday life negotiation more difficult. The ability to absorb ripple effects from unpredictable health services without disrupting routines varied by space-time context. Implications of these findings for the deployment of the concept of routine in health research, the framing of patient success in self-managing illness, and health services design are discussed. In conclusion, efforts to understand and support individuals in establishing and maintaining routines that support health and wellbeing can benefit from approaches that contextualise and de-centre everyday human behaviour. Opportunities to support renal patients in managing illness and experiencing wellbeing outside the clinical setting lie in a space-time re-design of chronic care services.
AB - Stable routines are key to successful illness self-management for the growing number of people living with chronic illness around the world. Yet, the influence of chronically ill individuals’ everyday contexts in supporting routines is poorly understood. This paper takes a space-time geographical approach to explore the everyday space-time contexts and routines of individuals with chronic kidney disease (CKD). We ask: what is the relationship between renal patients’ space-time contexts and their ability to establish and maintain stable routines, and, what role does health service access play in this regard? We draw from a qualitative case study of 26 individuals with CKD in Australia. Data comprised self-reported two day participant diaries and semi-structured interviews. Thematic analysis of interview transcripts was guided by an inductive-deductive approach. We examined the embeddedness of routines within the space-time contexts of participants’ everyday lives. We found that participants’ everyday space-time contexts were highly complex, especially for those receiving dialysis and/or employed, making routines difficult to establish and vulnerable to disruption. Health service access helped shape participants’ everyday space-time contexts, meaning that incidences of unpredictability in accessing health services set-off ‘ripple effects’ within participants’ space-time contexts, disrupting routines and making everyday life negotiation more difficult. The ability to absorb ripple effects from unpredictable health services without disrupting routines varied by space-time context. Implications of these findings for the deployment of the concept of routine in health research, the framing of patient success in self-managing illness, and health services design are discussed. In conclusion, efforts to understand and support individuals in establishing and maintaining routines that support health and wellbeing can benefit from approaches that contextualise and de-centre everyday human behaviour. Opportunities to support renal patients in managing illness and experiencing wellbeing outside the clinical setting lie in a space-time re-design of chronic care services.
UR - http://www.scopus.com/inward/record.url?scp=85018330846&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2017.04.043
DO - 10.1016/j.socscimed.2017.04.043
M3 - Article
C2 - 28482275
AN - SCOPUS:85018330846
SN - 0277-9536
VL - 183
SP - 142
EP - 150
JO - Social Science and Medicine
JF - Social Science and Medicine
ER -