Prioritizing social identities: Patients' perspective on living with multimorbidity.
Ontology highlight
ABSTRACT: Objective
This article explores experiences of people with multimorbidity, and attempts to advance understandings of the complexity of living with multimorbidity outside the medical encounter in a social identity theoretical framework.Method
This is a qualitative study using individual semi-structured interviews among nine persons living with multimorbidity. The interviews are analysed inductively according to thematic content analysis.Results
The emerging themes are: 1) Impact on daily life, 2) Professional life and 3) Capacity for handling multimorbidity. People with multimorbidity experience physical limitations and psychological distress, which limits their ability to maintain social relations and affiliation to the labour market. Accordingly, they are challenged in their ability to retain a sense of normal everyday life, which is mediated by their capacity for handling multimorbidity.Discussion
Multimorbidity may compromise various social identities. The complexity of living with multimorbidity is increased by an aspiration to maintain valued social identities in order to preserve a coherent sense of self and a normal everyday life. This study suggests an increased focus on individual priorities and values outside the medical encounter, and argues in favour of recognizing the conflicts that people experience as they try to balance multimorbidity with other important aspects of their daily lives.
SUBMITTER: Sand CD
PROVIDER: S-EPMC8107931 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:We propose a view of identity beyond the individual in what we call interpersonal inter-identities (IIIs). Within this approach, IIIs comprise collections of entangled stabilities that emerge in recurrent social interaction and manifest for those who instantiate them as relatively invariant though ever-evolving patterns of being (or more accurately, becoming) together. Herein, we consider the processes responsible for the emergence of these IIIs from the perspective of an enactive cognitive science. Our proposal hinges primarily on the development of two related notions: enhabiting and coenhabiting. First, we introduce the notion of enhabiting, a set of processes at the individual level whereby structural interdependencies stabilize and thereafter undergird the habits, networks of habits, and personal identities through which we make sense of our experience. Articulating this position we lean on the notion of a tendency toward an optimal grip, though offering it a developmental framing, whereby iterative states of selective openness help realize relatively stable autonomous personal identities with their own norms of self-regulation. We then extend many of the notions found applicable here to an account of social coenhabiting, in particular, we introduce the notion of tending toward a co-optimal grip as central to the development of social habits, networks of habits, and ultimately IIIs. Such structures, we propose, also emerge as autonomous structures with their own norms of self-regulation. We wind down our account with some reflections on the implications of these structures outside of the interactions wherein they come into being and offer some thoughts about the complex animations of the individual embodied subjects that instantiate them.
| S-EPMC7136421 | biostudies-literature
Project description:BackgroundWith multimorbidity becoming the norm rather than the exception, the management of multiple chronic diseases is a major challenge facing healthcare systems worldwide.MethodsUsing a large, nationally representative database of electronic medical records from the United Kingdom spanning the years 2005-2016 and consisting over 4.5 million patients, we apply statistical methods and network analysis to identify comorbid pairs and triads of diseases and identify clusters of chronic conditions across different demographic groups. Unlike many previous studies, which generally adopt cross-sectional designs based on single snapshots of closed cohorts, we adopt a longitudinal approach to examine temporal changes in the patterns of multimorbidity. In addition, we perform survival analysis to examine the impact of multimorbidity on mortality.ResultsThe proportion of the population with multimorbidity has increased by approximately 2.5 percentage points over the last decade, with more than 17% having at least two chronic morbidities. We find that the prevalence and the severity of multimorbidity, as quantified by the number of co-occurring chronic conditions, increase progressively with age. Stratifying by socioeconomic status, we find that people living in more deprived areas are more likely to be multimorbid compared to those living in more affluent areas at all ages. The same trend holds consistently for all years in our data. In general, hypertension, diabetes, and respiratory-related diseases demonstrate high in-degree centrality and eigencentrality, while cardiac disorders show high out-degree centrality.ConclusionsWe use data-driven methods to characterize multimorbidity patterns in different demographic groups and their evolution over the past decade. In addition to a number of strongly associated comorbid pairs (e.g., cardiac-vascular and cardiac-metabolic disorders), we identify three principal clusters: a respiratory cluster, a cardiovascular cluster, and a mixed cardiovascular-renal-metabolic cluster. These are supported by established pathophysiological mechanisms and shared risk factors, and largely confirm and expand on the results of existing studies in the medical literature. Our findings contribute to a more quantitative understanding of the epidemiology of multimorbidity, an important pre-requisite for developing more effective medical care and policy for multimorbid patients.
| S-EPMC9163746 | biostudies-literature
Project description:IntroductionThe number of people living with and beyond cancer is increasing rapidly. Many of them will experience ongoing physical or psychological sequelae as a result of their original cancer diagnosis or comorbidities arising from risk factors common to cancers and other long-term conditions. This poses the complex problem of managing cancer as a 'chronic' illness along with other existing comorbidities. This scoping review aims to map the literature available on multimorbidity in patients living with and beyond cancer, to explore, quantify and understand the impact of comorbid illnesses to inform work around cancer care in UK primary care settings.Methods and analysisThis review will be guided by Joanna Briggs Institute Reviewer's manual for scoping reviews. A systematic literature search using Medical Subject Heading and text words related to cancer survivors and multimorbidity will be performed in MEDLINE, CINAHL, Embase and Web of Science, from 1990. Results will be described in a narrative style, reported in extraction tables and diagrams, and where appropriate in themes and text.Ethics and disseminationThe scoping review will undertake secondary analysis of published literature; therefore, ethics committee approval is not required. Results will be disseminated through a peer-reviewed scientific journal and presented in relevant conferences. The scoping review will inform understanding of the burden of multimorbidity for cancer survivors, thus allow families, practitioners, clinicians and researchers to take the steps necessary to improve patient-centred care.
| S-EPMC9109092 | biostudies-literature
Project description:Realtors match home-seekers with neighborhoods that have built and social characteristics they desire to pursue active lifestyles. Studies have yet to explore realtors' perspectives on neighborhood design that supports active living. Using qualitative description, our study was to explore the perceptions and understandings of neighborhood design (walkability, healthy, bike-ability, vibrancy, and livability) among urban residential realtors. Nineteen (6 men; 13 women; average age 48 years) self-identified residential realtors from Calgary, Edmonton, and Lethbridge (Canada) completed semi-structured telephone interviews. Content analysis identified themes from the interview data. Specifically, walkability was described as: perceived preferences, destinations and amenities, and connections; a healthy community was described as: encourages outdoor activities, and promotes social homogeneity; bike-ability was described as: bike-ability attributes, and was controversial; vibrancy was described as: community feel, and evidence of life; and livability was described as: subjective, and preferences and necessities. Our findings can inform the refinement of universal definitions and concepts used to in neighborhood urban design.
| S-EPMC7730987 | biostudies-literature
Project description:Background and objectivesPeople aged 65 and over, deemed most "vulnerable" by public health, were targeted by the COVID-19 protection measures which sought to minimize physical contact and social activities. Older adults living alone were particularly impacted by these measures. However, such measures meant to protect the older population may not have necessarily reflected older adults' individual prioritization choices. This study therefore aimed to understand how protecting oneself over the virus was considered in the prioritization of other health and social needs of older adults living alone during the pandemic.Research design and methodsThis study adopted a qualitative design. A total of 17 semi-structured interviews was conducted between May 2021 and June 2022 with older adults living alone. All interviews were audio-recorded and transcribed verbatim. A reflexive thematic analysis as defined by Braun and Clarke (2018, 2019) was performed.ResultsOur analysis showed two forms of prioritization across two themes. This first theme focused on participants who reported prioritizing protecting themselves over the virus by limiting in-person contact and activities. The second theme showed that although several participants reported that protecting themselves over the virus was important to them, the prioritization of this need was not shared by all and, in some cases, evolved over the course of the pandemic.Discussion and implicationsOur study demonstrated heterogeneity in the prioritization of older adults needs. Future public health recommendations should consider these variations in the needs and priorities of older adults when determining public health measures.
| S-EPMC11342055 | biostudies-literature
Project description:The last decades have seen the emergence of a divide pitting the new left against the far right in advanced democracies. We study how this universalism-particularism divide is crystallizing into a full-blown cleavage, complete with structural, political and identity elements. So far, little research exists on the identities that voters themselves perceive as relevant for drawing in- and out-group boundaries along this divide. Based on an original survey from Switzerland, a paradigmatic case of electoral realignment, we show that voters' "objective" socio-demographic characteristics relate to distinctive, primarily culturally connoted identities. We then inquire into the degree to which these group identities have been politicized, that is, whether they divide new left and far right voters. Our results strongly suggest that the universalism-particularism "cleavage" not only bundles issues, but shapes how people think about who they are and where they stand in a group conflict that meshes economics and culture.
| S-EPMC8575975 | biostudies-literature
Project description:Both in philosophy and in psychology, human rationality has traditionally been studied from an "individualistic" perspective. Recently, social epistemologists have drawn attention to the fact that epistemic interactions among agents also give rise to important questions concerning rationality. In previous work, we have used a formal model to assess the risk that a particular type of social-epistemic interactions lead agents with initially consistent belief states into inconsistent belief states. Here, we continue this work by investigating the dynamics to which these interactions may give rise in the population as a whole.
| S-EPMC4061898 | biostudies-other
Project description:Background:Age-associated conditions are increasingly common among persons living with human immunodeficiency virus (HIV) (PLWH). A longitudinal investigation of their accrual is needed given their implications on clinical care complexity. We examined trends in the co-occurrence of age-associated conditions among PLWH receiving clinical care, and differences in their prevalence by demographic subgroup. Methods:This cohort study was nested within the North American AIDS Cohort Collaboration on Research and Design. Participants from HIV outpatient clinics were antiretroviral therapy-exposed PLWH receiving clinical care (ie, ≥1 CD4 count) in the United States during 2000-2009. Multimorbidity was irreversible, defined as having ≥2: hypertension, diabetes mellitus, chronic kidney disease, hypercholesterolemia, end-stage liver disease, or non-AIDS-related cancer. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) comparing demographic subgroups were obtained by Poisson regression with robust error variance, using generalized estimating equations for repeated measures. Results:Among 22969 adults, 79% were male, 36% were black, and the median baseline age was 40 years (interquartile range, 34-46 years). Between 2000 and 2009, multimorbidity prevalence increased from 8.2% to 22.4% (Ptrend < .001). Adjusting for age, this trend was still significant (P < .001). There was no difference by sex, but blacks were less likely than whites to have multimorbidity (aPR, 0.87; 95% CI, .77-.99). Multimorbidity was the highest among heterosexuals, relative to men who have sex with men (aPR, 1.16; 95% CI, 1.01-1.34). Hypertension and hypercholesterolemia most commonly co-occurred. Conclusions:Multimorbidity prevalence has increased among PLWH. Comorbidity prevention and multisubspecialty management of increasingly complex healthcare needs will be vital to ensuring that they receive needed care.
| S-EPMC5889007 | biostudies-other
Project description:New and changing patterns of multimorbidity (MM), i.e., multiple concurrent acute or chronic diseases in a person, are emerging in low- and middle-income countries (LMICs). The interplay of underlying population-specific factors and lifestyle habits combined with the colliding epidemics of communicable and non-communicable diseases presents new disease combinations, complexities and risks that are not common in high-income countries (HICs). The complexities and risks include those arising from potentially harmful drug-drug and drug-disease interactions (DDIs), the management of which may be considered as MM in the true sense. A major concern in LMICs is the increasing burden of leading cardiovascular diseases, prevalence of associated risk factors and co-occurrence with other morbidities. New models of MM management and integrated care can respond to the needs of specific multimorbid populations, with some LMICs making substantial progress (e.g., integration of tuberculosis and HIV services in South Africa). But there is a dearth of relevant data on the changing patterns and underlying factors and determinants of MM, the associated complexities and risks of DDIs in MM management, and the barriers to integrated care in LMICs. This requires careful attention.
| S-EPMC7225439 | biostudies-literature
Project description:BackgroundCount scores, disease clustering, and pairwise associations between diseases remain ubiquitous in multimorbidity research despite two major shortcomings: they yield no insight into plausible mechanisms underlying multimorbidity, and they ignore higher-order interactions such as effect modification.ObjectivesWe argue that two components are currently missing but vital to develop novel multimorbidity metrics. Firstly, networks should be constructed which consists simultaneously of signs, symptoms, and diseases, since only then could they yield insight into plausible shared biological mechanisms underlying diseases.Secondly, learning pairwise associations is insufficient to fully characterize the correlations in a system. That is, synergistic (e.g., cooperative or antagonistic) effects are widespread in complex systems, where two or more elements combined give a larger or smaller effect than the sum of their individual effects. It can even occur that pairs of symptoms have no pairwise associations whatsoever, but in combination have a significant association. Therefore, higher-order interactions should be included in networks used to study multimorbidity, resulting in so-called hypergraphs.MethodsWe illustrate our argument using a synthetic Bayesian Network model of symptoms, signs and diseases, composed of pairwise and higher-order interactions. We simulate network interventions on both individual and population levels and compare the ground-truth outcomes with the predictions from pairwise associations.ConclusionWe find that, when judged purely from the pairwise associations, interventions can have unexpected 'side-effects' or the most opportune intervention could be missed. The hypergraph uncovers links missed in pairwise networks, giving a more complete overview of sign and disease associations.
| S-EPMC10557993 | biostudies-literature