Exploring the Meaning of 'Dissatisfaction' with Health Care: The Importance of 'Personal Identity Threat'

Researchers argue that a number of assumptions have been made about the concepts of patient satisfaction and dissatisfaction that have compromised their validity. The aim of this study was to explore the meaning of 'dissatisfaction' with health care. Forty-one people who had experienced problems in health care were identified from a household survey of health service users. They were interviewed in depth using an unstructured schedule. A grounded theory approach was used to construct a framework inductively from their accounts. The results suggest that 'dissatisfaction' could not accommodate the range of feelings, beliefs and values people express when they encounter problems in health care. However, another concept, that of 'personal identity threat', was identified which offered additional insights into the meaning of untoward experiences in health care. This concept delineates the grounds for disappointment or dissatisfaction, and helped to capture the complexity of the feelings and views expressed. Personal identity was perceived as being challenged through experiences which were felt to be disempowering, dehumanising and devaluing. Gender, class and race differences also emerged in respondents' perceptions of identity threat.     

Book Reviews

Barnes, C. & Mercer, G. (eds), Doing Disability Research
Barton, L. & Oliver, M., Disability Studies. Past, Present and Future
Charlton, J.I., Nothing About Us Without Us: Disability, Oppression and Empowerment
Couser, J.T., Recovering Bodies. Illness, Disability and Life Writing
Seymour, W., Remaking the Body: Rehabilitation and Change
Arksey, H., RSI and the Experts: the Construction of Medical Knowledge
Burtchart, A., The Anatomy of Power: European Constructions of the African Body
Zimmermann, S.M., Silicone Survivors. Women's Experiences with Breast Implants
Battle, D.E. (ed), Communication Disorders in Multicultural Populations     

Occupation as marker of self: Occupation in relation to self among people with advanced cancer

Background: Living with advanced cancer can have a profound impact on the person’s self. A person’s self is influenced by various aspects of daily life, including engagement in occupation. From an occupational perspective, little research has been done to explore how the self of people with advanced cancer is formed through their engagement in occupation.

Aim: The purpose of this study was to explore how people with advanced cancer experience that their sense of self is formed through engagement in occupation.

Methods: A total of 28 interviews were conducted with 22 people with advanced cancer. Grounded theory guided the collection and analysis of data.

Results: ‘Occupation as marker of self’ was identified as the core category. Occupations served as markers of the participants’ self (1) by mirroring their abilities and positioning of their self in the illness trajectory; and (2) as means of expressing their self. The core category provided explanations about how the participants’ experiences of occupation influenced their self-perceptions, as explained in the sub-categories ‘defining the self through occupation’ and ‘reassessing self and accepting limitations’.

Conclusions: For people with advanced cancer, engagement in occupation influences their self as current abilities become apparent and positions of their self can be created and expressed.     

Book Reviews

Books reviewed:
Greco, M., Illness as a Work of Thought. A Foucauldian Perspective on Psychosomatics
Nettleton, S. and Watson, J. (eds), The Body in Everyday Life
Bowers, L., The Social Nature of Mental Illness
Hudson, R.B. (ed.), The Future of Age-based Public Policy
Lee, C., Women's Health, Psychological and Social Perspectives     

Book Reviews

Books reviewed:
Seale, C., Constructing Death: the Sociology of Dying and Bereavement
Davies, D.J., Death, Ritual and Belief: the Rhetoric of Funerary Rites
Morris, D.B., Illness and Culture in the Postmodern Age
Cohen, L., No Aging in India: Alzheimer's, the Bad Family and OtherModern Things
Minichiello, V., Chappell, N., Kendig, H. and Walker A. (eds), Sociologyof Aging. International Perspectives
Berg, M. and Mol, A-M. (eds), Differences in Medicine: Unravelling Practices, Techniques and Bodies,     

Book Reviews

Abstract

This study evaluated the extent to which people living in Barbados, Guyana and Trinidad and Tobago believe that the anti-gay laws currently in place: (1) reflect moral standards; (2) stop the spread of homosexuality; (3) are important from a public health perspective; and (4) protect young people from abuse. Analysis reveals that demographics, religion, interpersonal contact and beliefs about the origin of homosexuality all influenced an individual’s views on the usefulness of the anti-gay laws in these states, but the significance of their impacts varied substantially across the arguments.     

Book Reviews

Bury, M., Health and Illness in a Changing Society
Pilgrim, D., Psychotherapy and Society
Davis, P., Managing Medicines. Public Policy and Therapeutic Drugs
Harrison, B., Not Only the 'Dangerous Trades'. Women's Work and Health in Britain – 1880–1914
Flynn, R. and Williams, G. (eds), Contracting for Health. Quasi-Markets and the National Health Service
Wilton, T., Engendering AIDS: Deconstructing Sex, Text and Epidemic
Turner, D.C., Risky Sex: Gay Men and HIV Prevention     

Book Reviews

The Wall Street Journal Portfolio of Business Cartoons , Charles Preston, editor, New York: Dow Jones & Company, 1999, 175 pages, $22.95

Health Care Consolidation and the Changing Health Care Marketplace: A Review of the Literature and Issues , Lawrence G. Goldberg, Washington, D.C.: Employee Benefit Research Institute, 1999, 16 pages, $25.00 printed copy, $7.50 e-mail electronic file.

The Virtual Volunteering Guidebook: How to Apply the Principles of Real-World Volunteer Management to Online Services , Susan J. Ellis and Jayne Cravens, Palo Alto, Calif.: Impact Online, 2000, 138 pages, free, Web site: http://www.serviceleader.org.vv/