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Qualitative Health Research
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Uncovering the Limits of Patient-Centeredness: Implementing a Self-Management Trial for Chronic Illness

Anne Rogers

Sociology of health care at the National Primary Care Research and Development Centre, The University of Manchester, United Kingdom.

Anne Kennedy

National Primary Care Research and Development Centre, The University of Manchester, United Kingdom.

Elizabeth Nelson

National Primary Care Research and Development Centre, The University of Manchester, United Kingdom.

Andrew Robinson

Hope Hospital, Salford, United Kingdom.

Research evaluating self-management of chronic conditions points to the effectiveness of interventions’ changing the health behavior of individuals. However, we know little about how self-management is negotiated within health services. The authors designed a qualitative investigation to illuminate the quantitative findings of a randomized controlled trial (RCT) of a self-management program for people with inflammatory bowel disease. They conducted in-depth interviews with physicians and patients, and qualitative analysis illuminated the nature of doctor-patient encounters and possible reasons for lack of change in patient satisfaction with the consultation. The findings suggest that factors inhibiting effective patient-centered consultations include failure of physicians to incorporate expressed need relevant to people’s self-management activities fully, interpretation of selfmanagement as compliance with medical instructions, and the organization of outpatients’ clinics. Giving attention to these barriers might maximize the opportunities for patient selfmanagement of chronic illness based on a therapeutic alliance with health care professionals.

Key Words: self-management • chronic disease • patient-centeredness

Qualitative Health Research, Vol. 15, No. 2, 224-239 (2005)
DOI: 10.1177/1049732304272048
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