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Control in chronic condition self-care management: how it occurs in the health worker–client relationship and implications for client empowerment

Authors

  • Sharon Lawn BA MSW PhD,

    Associate Professor, Corresponding author
    1. Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
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  • Toni Delany BHSc/BSSc PhD,

    Research Fellow
    1. Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
    2. South Australian Community Health Research Unit, Flinders University, Adelaide, South Australia, Australia
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  • Linda Sweet PhD RN MNgS,

    Senior Lecturer of Clinical Education
    1. Rural Clinical School, Flinders University, Adelaide, South Australia, Australia
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  • Malcolm Battersby MBBS PhD FRANZCP,

    Director
    1. Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
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  • Timothy C. Skinner BSc PhD

    Head of Psychological and Clinical Sciences
    1. Faculty of Engineering, Health, Science and the Environment, Charles Darwin University, Casuarina, Australia
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Abstract

Aim

To examine health worker–client interactions during care planning to understand processes that foster client empowerment and disempowerment.

Background

It is unclear how health worker–client exchanges and information sharing through chronic condition care planning currently operate in primary health care. Moreover, it is unclear how control in these exchanges either enhances collaborative decision-making, partnership and client empowerment, or works to create client disempowerment and dependency on workers and health services.

Design

Critical discourse analysis of qualitative data from ethnographic observations and audio-taped worker–client consultations.

Method

Multidisciplinary teams in two Australian community-based primary healthcare sites participated. This included nurses, general practitioners and allied health workers and their clients who had a chronic condition care plan. Nineteen worker–client consultations were observed/recorded in 2011.

Results

Control was expressed through multiple processes inherent in the worker role and in their interactions with clients. When workers exercised disproportionate control and clients relinquished their own control, client disempowerment and dependency were evident. Clients' attempts to gain control and workers' attempts to relinquish control alleviated clients' disempowerment and dependency. However, structural features of information sharing systems and workers' care planning behaviours diminished such efforts.

Conclusion

Worker awareness of their communication style and the power of their role must improve for client chronic condition self-care management to be achieved. Training on the impacts of control in worker communication and systems where they work must be provided if unbeneficial forms of client dependency are to be overcome and true self-care management is to be realized.

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