title: Control in chronic condition self-care management: how it occurs in the health worker-client relationship and implications for client empowerment.
abstract: OBJECTIVE
  To examine health worker-client interactions during care planning to understand processes that foster client empowerment and disempowerment.
  
  
  BACKGROUND
  It is unclear how health worker-client exchanges and information sharing through chronic condition care planning currently operate in primary health care. Moreover, it is unclear how control in these exchanges either enhances collaborative decision-making, partnership and client empowerment, or works to create client disempowerment and dependency on workers and health services.
  
  
  METHODS
  Critical discourse analysis of qualitative data from ethnographic observations and audio-taped worker-client consultations.
  
  
  METHODS
  Multidisciplinary teams in two Australian community-based primary healthcare sites participated. This included nurses, general practitioners and allied health workers and their clients who had a chronic condition care plan. Nineteen worker-client consultations were observed/recorded in 2011.
  
  
  RESULTS
  Control was expressed through multiple processes inherent in the worker role and in their interactions with clients. When workers exercised disproportionate control and clients relinquished their own control, client disempowerment and dependency were evident. Clients' attempts to gain control and workers' attempts to relinquish control alleviated clients' disempowerment and dependency. However, structural features of information sharing systems and workers' care planning behaviours diminished such efforts.
  
  
  CONCLUSIONS
  Worker awareness of their communication style and the power of their role must improve for client chronic condition self-care management to be achieved. Training on the impacts of control in worker communication and systems where they work must be provided if unbeneficial forms of client dependency are to be overcome and true self-care management is to be realized.
authors.affiliation: Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Lawn
authors.forename: Toni
authors.initials: T
authors.lastname: Delany
authors.forename: Linda
authors.initials: L
authors.lastname: Sweet
authors.forename: Malcolm
authors.initials: M
authors.lastname: Battersby
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Skinner
mesh_terms: D000488:Allied Health Personnel; D001315:Australia; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy*; D003142:Communication; D003152:Community Health Nursing; D030881:Disclosure; D058006:General Practice; D006801:Humans; D064686:Nutritionists; D010342:Patient Acceptance of Health Care; D010347:Patient Care Planning; D010348:Patient Care Team; D011209:Power, Psychological; D011369:Professional-Patient Relations; D012648:Self Care / Q000523:psychology*
keywords: control; critical discourse analysis; dependency; empowerment; nursing interactions; nursing practice; power; primary health care; self-care management; self-management