Shifting images of chronic illness.
OBJECTIVE
To describe results of a meta-study of client roles in two decades of qualitative research on elements of chronic illness experiences. While a vast body of qualitative health research has uncovered insider perspectives on a range of chronic diseases and their related illness experiences, systematic analysis has not been attempted, and research has not yet contributed to coherent theoretical developments.


METHODS
Health care relationships as articulated in the context of insider research into chronic illness experience.


METHODS
Elements of meta-theory, meta-method, and meta-data-analysis in the available qualitative research reports addressing chronic illness experience published 1980 through June 1996. Of over 400 published reports, 158 met the inclusion criteria and were subjected to systematic analysis on a number of themes, one of which is reported in this article.


METHODS
Data selection, reduction, thematic analysis, and synthesis using constant comparative analysis.


RESULTS
Early conceptualizations of individuals with chronic illness shift from a focus on loss and burden toward images of health within illness, transformation, and normality. Parallel conceptualizations of health care relationships appropriate to chronic illness shift from client-as-patient to client-as-partner for the 15-year period.


CONCLUSIONS
Meta-study permits critical analysis of the location of current inquiry into the larger context of systematic patterns in knowledge development. Researchers are cautioned against uncritical acceptance of current trends in interpretation.
University of British Columbia School of Nursing, Vancouver, Canada. thorne@nursing.ubc.ca
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S
Thorne
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Paterson
D002170:Canada; D002908:Chronic Disease / Q000451:nursing; D003695:Delivery of Health Care; D006801:Humans; D009723:Nurse-Patient Relations; D012107:Research Design