Illness identity as an important component of candidacy: Contrasting experiences of help-seeking and access to care in cancer and heart disease

Macdonald, S. , Blane, D. , Browne, S. , Conway, E., Macleod, U., May, C. and Mair, F. (2016) Illness identity as an important component of candidacy: Contrasting experiences of help-seeking and access to care in cancer and heart disease. Social Science and Medicine, 168, pp. 101-110. (doi:10.1016/j.socscimed.2016.08.022) (PMID:27643844)

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Abstract

How and when we use health services or healthcare provision has dominated exploration of and debates around healthcare access. Levels of utilisation are assumed as a proxy for access. Yet, focusing on utilisation conceals an important aspect of the access conundrum: the relationships that patients and potential patients have with the healthcare system and the professionals within those systems. Candidacy has been proposed as an antidote to traditional utilisation models. The Candidacy construct offers the ability to include patient-professional aspects alongside utilisation and thus promotes a deeper understanding of access. Originally applied to healthcare access for vulnerable populations, additional socio-demographic factors, including age and ethnicity, have also been shown to influence the Candidacy process. Here we propose a further extension of the Candidacy construct and illustrate the importance of illness identities when accessing healthcare. Drawing on a secondary data analysis of three data sets of qualitative interviews from colorectal cancer and heart failure patients we found that though similar access issues are apparent pre-diagnosis, diagnosis marks a critical juncture in the experience of access. Cancer patients describe a person-centred responsive healthcare system where their patienthood requires only modest assertion. Cancer speaks for itself. In marked contrast heart failure patients, describe struggling within a seemingly impermeable system to understand their illness, its implications and their own legitimacy as patients. Our work highlights the pressing need for healthcare professionals, systems and policies to promote a person centred approach, which is responsive and timely, regardless of illness category. To achieve this, attitudes regarding the importance or priority afforded to different categories of illness need to be tackled as they directly influence ideas of Candidacy and consequently access and experiences of care.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Conway, Dr Elaine and MacLeod, Dr Una and Mair, Professor Frances and Blane, Dr David and Browne, Dr Susan and Macdonald, Dr Sara
Authors: Macdonald, S., Blane, D., Browne, S., Conway, E., Macleod, U., May, C., and Mair, F.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO Unit
Journal Name:Social Science and Medicine
Publisher:Elsevier
ISSN:0277-9536
ISSN (Online):1873-5347
Published Online:18 August 2016
Copyright Holders:Copyright © 2016 Elsevier
First Published:First published in Social Science and Medicine 168:101-110
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
420855Establishing the potential for primary care to tackle social inequalities in established colorectal cancerUna MacLeodCancer Research UK (CAN-RES-UK)C542/A11341RI HEALTH & WELLBEING
526131Developing a conceptual model of the burden of treatment and the "work" involved in living with heart failure.Frances MairScottish Executive Health Department (SEHHD-CSO)CZG/3/22IHW - GENERAL PRACTICE & PRIMARY CARE