Fletcher, Simon, Kulnik, Stefan Tino, Demain, Sara, Jones, Fiona (2019) The problem with self-management: Problematising self-management and power using a Foucauldian lens in the context of stroke care and rehabilitation. PLOS ONE, 14 (6). e0218517. ISSN 1932-6203. (doi:10.1371/journal.pone.0218517) (KAR id:97025)
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Official URL: https://doi.org/10.1371/journal.pone.0218517 |
Abstract
Self-management is a concept which is now firmly established in Western healthcare policy and practice. However, the term remains somewhat ambiguous, multi-faceted and contentious. This is evident in stroke care and rehabilitation, in which a self-management approach is increasingly adopted and advocated, yet interpreted in different ways, resulting in contradictions and tensions around control, responsibility, power and discipline. This paper aims to further our understanding of tensions and contradictions in stroke self-management, by critically examining contemporary self-management practices. We use a Foucauldian theoretical lens to explore the various power dynamics in the operationalisation of self-management, in addition to the complexity of the term self-management itself. Conducting a secondary analysis of interview and focus group data from the Self-Management VOICED study, supplemented with analysis of relevant documentary evidence from policy and practice, we describe the multiple aspects of power in operation. These include rhetorical, hierarchical, personal and mutual forms of power, representing interweaving dynamics evident in the data. These aspects of power demonstrate underlying agendas and tacit and explicit understandings of self-management which exist in clinical practice. These aspects of power also give insight into the multiple identities of ‘self-management’, acting as a simultaneous repressor and liberator, directly in keeping with Foucauldian thinking. The findings are also consistent with Foucault’s notions of bodily docility, discussions around governance and biopower, and contemporary discipline. Our analysis positions self-management as a highly nuanced and complex concept, which can fluctuate in its conceptualisation depending on the structures, routines, and the individual. We encourage healthcare professionals, policymakers and commissioners in the field of self-management to reflect on these complexities, to make transparent their assumptions and to explicitly position their own practice accordingly.
Item Type: | Article |
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DOI/Identification number: | 10.1371/journal.pone.0218517 |
Divisions: | Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Centre for Health Services Studies |
Funders: |
University of Kent (https://ror.org/00xkeyj56)
Health Foundation (https://ror.org/02bzj4420) |
Depositing User: | Simon Fletcher |
Date Deposited: | 21 Sep 2022 15:18 UTC |
Last Modified: | 05 Nov 2024 13:01 UTC |
Resource URI: | https://kar.kent.ac.uk/id/eprint/97025 (The current URI for this page, for reference purposes) |
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