TY - JOUR
T1 - " If he gives in, he will be gone..."
T2 - The influence of work and place on experiences, reactions and self-care of heart failure in rural Canada
AU - Freydberg, Nicole
AU - Strain, Laurel
AU - Tsuyuki, Ross T.
AU - McAlister, Finlay A.
AU - Clark, Alexander M.
PY - 2010/4
Y1 - 2010/4
N2 - 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.
AB - 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.
KW - Canada
KW - Cardiac rehabilitation
KW - Chronic disease
KW - Coronary heart disease
KW - Disease management
KW - Environment
KW - Human ecology
KW - Place
KW - Work
UR - http://www.scopus.com/inward/record.url?scp=77951210937&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2009.11.026
DO - 10.1016/j.socscimed.2009.11.026
M3 - Journal Article
C2 - 20117867
AN - SCOPUS:77951210937
SN - 0277-9536
VL - 70
SP - 1077
EP - 1083
JO - Social Science and Medicine
JF - Social Science and Medicine
IS - 7
ER -