Tuesday, 15 November 2011

Anne Rogers on ‘Social Networks and the Patient Work of Chronic Illness Management’

I went to a talk today by Professor Anne Rogers, Head of the Health Sciences Research Group, University of Manchester called ‘Social Networks and the Patient Work of Chronic Illness Management’. The abstract ran as follows:

The effective targeting and promotion of self-care support for long-term conditions needs to acknowledge the importance of everyday living and people’s social contexts and networks. Social networks are viewed as being centrally involved in the mobilisation and deployment of resources in the management of a chronic condition. This forms the basis of a novel approach to understanding, designing, and implementing new forms of self-management support.

It was an interesting talk, more an overview of some ideas than an argument but one line of thought seemed of note.

This thread began – actually five minutes into the talk – with mention of some research by Corbin and Strauss (1985) who identified 3 types of work relevant to the long term management of illness:
  • illness work: symptom management
  • everyday life work: practical tasks eg housework
  • biographical work: reconstruction of ill person’s biography
Anne suggested that there were other forms of work, too, including articulation and emotional work. As a technological term ‘work’ was helpful, she suggested, because it suggests division of labour. These forms of work can be shared between different participants in a social network. But if so, what’s the nature and type of knowledge needed to do work?

There is, we heard, evidence that professionals and patients do indeed view self-management as a form of work but they diverge in their degree of optimism about it. In general, she suggested, although there are aspects of management which are individualistic, it also involves collective work. There was, however reason to believe from previous surveys that this collective element was downplayed by individuals who stressed, instead, their own responsibility for their pain management. In other words, the thought, by patients, that the work was or was not carried out by others was not enough to make that claim true. I'll return to this.

The second main element of this thread of the talk was the nature of social networks or rather networks of networks, Anne suggested, which might include group plus family plus personal communities. In other areas of sociology, empirical work suggested that often quite weak or distant relationships were key to connect individuals to resources (the person who can get one’s son an internship, for example). Might this also be true for self-management of illness? Sadly, she reported, we don’t yet know: it is an epidemiological gap.

But in the US Nicolas Christakis has looked at a major US database and found that weight gain in one person is associated with others in their social network. Likewise, smoking spreads through close and distant ties. Health or illness behaviours should thus be seen as collective phenomena.

Anne thus reported her own recent survey of 300 people in Greater Manchester asking them to identify their personal supportive communities or networks. The empirical work included quantitative data based on interviews and the use of a kind of network diagram: a set of concentric circles centred on the subject in which they were asked to locate their relevant social support networks. Professionals tended to be out a bit from the centre except amongst those who were otherwise socially isolated. Outside that might be the lunch club, diabetes club, the church, particular individuals.

Another finding was that, of those surveyed, 18% owned 1 or more pets. Some familiar findings about health and pets were replicated but, more interestingly, people suggested that pets were part of their social networks. Pets as person substitutes, as it were. But, further, the survey implied not only that but also that pets were taken to have unique qualities. For example, they did not nag. And, Anne argued, they were found to mediate relationships with others, in weak relations. Dog walking, for example, prompted chance conversations. Thus, she argued, pets take on aspects of illness work in social networks. Whilst partners provide most emotional support. pets come second, higher than health professionals. She was tempted but did not say that pets are better than doctors at emotional support.

All this seemed to me to be interesting but I worried, and asked, about one aspect. The connection between work, social networks and pets seemed to support two conflicting views of the nature of her research. In one view, work is actually shared and the thought by individuals about who undertakes it may be wrong. Who is actually in the network doing the work is, to that extent, objective. Thinking it so does not make it so.

But on the other, dogs do not actually do emotional work. They may serve as emotional support; they may catalyse conversations in the park. But they do not undertake to take on this duty. So if they are indeed to count as part of an individual's network of those who are undertaking work then it is merely the case that thinking it makes it so. The network is subjective: it is what an individual sincerely takes it to be.

But social networks surely cannot be both?

In response, Anne replied that she did indeed intend both senses. Perhaps in her written work the distinction is clear. Perhaps she adds subscripts to the phrase ‘social network’: an ‘o’ or an ‘s’ to disambiguate them. (If so that went missing in the presentation). But I can’t help feeling that running two distinct kinds of ontological category at the very least quite closely together is likely to confuse.