Fletcher, S; Kulnik, ST; Demain, S; Jones, F
(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
https://doi.org/10.1371/journal.pone.0218517
SGUL Authors: Jones, Fiona
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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Additional Information: |
Copyright: © 2019 Fletcher et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
Keywords: |
Focus Groups, Humans, Power, Psychological, Self-Management, Stroke, Stroke Rehabilitation, Surveys and Questionnaires, Humans, Focus Groups, Stroke, Surveys and Questionnaires, Stroke Rehabilitation, Self-Management, Power, Psychological, General Science & Technology |
SGUL Research Institute / Research Centre: |
Academic Structure > Population Health Research Institute (INPH) |
Journal or Publication Title: |
PLoS One |
ISSN: |
1932-6203 |
Language: |
eng |
Dates: |
Date | Event |
---|
19 June 2019 | Published | 4 June 2019 | Accepted |
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Publisher License: |
Creative Commons: Attribution 4.0 |
Projects: |
Project ID | Funder | Funder ID |
---|
UNSPECIFIED | Health Foundation | UNSPECIFIED |
|
PubMed ID: |
31216337 |
Web of Science ID: |
WOS:000482885300051 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/115290 |
Publisher's version: |
https://doi.org/10.1371/journal.pone.0218517 |
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