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

Green, J., Risk and Misfortune: the Social Construction of Accidents
Silverman, D., Discourses of Counselling: HIV Counselling as Social Interaction
Ham, C. (ed.), Health Care Reform: Learning from International Experience
Warde, A., Consumption, Food and Taste
Petersen, A. and Bunton, R. (eds.), Foucault, Health and Medicine     

Book Reviews

Clarke, A. and Parsons, E. (eds), Culture, Kinship and Genes: Towards Cross-cultural Genetics
Franklin, S., Embodied Progress: A Cultural Account of Assisted Conception
Shildrick, M., Leaky Bodies and Boundaries: Feminism, Postmodernism and (Bio)Ethics
Steinberg, D. L., Bodies in Glass: Genetics, Eugenics, Embryo Ethics
Barrett, R., The Psychiatric Team and the Social Definition of Schizophrenia: an Anthropological Study of Person and Illness
Clark, D., Hockley, J. and Ahmedzai, S. (eds), Facing Death: New Themes in Palliative Care
Miller, G. and Dingwall, R. (eds), Context and Method in Qualitative Research
Dopson, S., Managing Ambiguity and Change: the Case of the NHS     

Book Reviews

Book reviewed in this article: Title : Action Speaks Louder: A Handbook of Structured Group Techniques (2nd Edition). Author : Jane A. Remocker and Elizabeth T. Storch Title : Manual of Acute Orthopaedic Therapeutics (3rd ed.). Authors : Larry D. Iverson and D. Kay Clawson Title of book : Research guidelines: A handbook for therapists. Name of Authors : Cecily Partridge and Rosemary Barnitt Title of Book : There's lint in your bellybutton. A disabled fable. Author : Audrey J. King Title : The Functional Approach to Group Work in Occupational Therapy. Authors : Margot C. Howe and Sharon L Title : Grieving: A Handbook for those who care. Author : Ruth Bright     

Book Reviews

Books reviewed in this issue.
Bonnie Shepard Running the Obstacle Course to Sexual and Reproductive Health: Lessons from Latin America
Ylva Hernlund and Bettina Shell-Duncan, editors Transcultural Bodies: Female Genital Cutting in Global Context
M. Catherine Maternowska Reproducing Inequities: Poverty and the Politics of Population in Haiti     

Book Reviews

Book reviewed in this article:
Guide to managing OHS risks in the health care industry Edited y Claire ayhew and Chris eterson.
Global Pharmaceuticals: Ethics, Markets, Practices Edited by Adriana etryna, ndrew Lakoff and Arthur Kleinman.
Valuing health for regulatory cost-effectiveness analysis Edited y Wilhelmine iller, isa A. obinson and Robert S. awrence.
Occupational Health and Safety: International influences and the 'new epidemics' Edited by Chris L. Peterson and Claire Mayhew.
Health and Human Flourishing. Religion, Medicine, and Moral Anthropology Edited y Carol R. Taylor.
Health & Work Productivity: making the business case for quality health care Edited y Ronald.