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People with multimorbidity: forgotten outsiders or dynamic self-managers?

Hujala, A., Rijken, M., Laulainen, S., Taskinen, H., Rissanen, S. People with multimorbidity: forgotten outsiders or dynamic self-managers? Journal of Health Organization and Management: 2014, 28(5), p 696-712
Purpose
The purpose of this paper is to draw attention to the discursive construction of multimorbidity. The study illustrates how the social reality of multimorbidity and the agency of patients are discursively constructed in scientific articles addressing care for people with multiple chronic conditions.

Design/methodology/approach
The study is based on the postmodern assumptions about the power of talk and language in the construction of reality. Totally 20, scientific articles were analysed by critically oriented discourse analysis. The interpretations of the findings draw on the agency theories and principals of critical management studies.

Findings
Four discourses were identified: medical, technical, collaborative and individual. The individual discourse challenges patients to become self-managers of their health. It may, however, go too far in the pursuit of patients’ active agency. The potential restrictions and consequences of a “business-like” orientation must be paid careful attention when dealing with patients with multimorbidity.

Research limitations/implications
The data consisted solely of scientific texts and findings therefore serve as limited illustrations of the discursive construction of multimorbidity. In future, research focusing for example on political documents and practice talk of professionals and patients is needed. Social implications: The findings highlight the power of talk and importance of ethical considerations in the development of care for challenging patient groups.

Originality/value
By identifying the prevailing discourses the study attempts to cast doubt on the taken-for-granted understandings about the agency of patients with multimorbidity.