Social status and living with a chronic illness: an exploration of assessment and meaning attributed to work and employment.
BACKGROUND
Traditional measures of social status are predicated on position in the labour market. There has been less attention directed to the meanings of social position for people with a long-term condition whose relationship to employment is precarious. Previous research has demonstrated that the MacArthur scale is capable of capturing contextualised aspects of social status, which makes it a useful tool for exploring changes in meaning.


OBJECTIVE
The paper explores the meanings and experiences of social status of people living with a long-term condition with particular reference to employment status.


METHODS
A sample of 300 participants was drawn from diabetes and chronic heart disease registers of General Practices in North West England. A cross-sectional survey with nested qualitative interviews was used in collecting and analysing the data.


RESULTS
Having financial independence and participating in valued activities are more important for people with chronic illness than power and status mediated through the labour market. Income and the lack and loss of employment were given a central role in respondents' narratives reflecting the absence of acceptable alternative routes through which social status for those with a long-term condition can realistically be rebuilt outside of participation in the labour market.


CONCLUSIONS
Social participation, where people with chronic illness feel valued and of tangible utility to other people, might offer some opportunities for rebuilding social status outside the labour market. Chronic illness management interventions need to focus on improving people's engagement with such activities.
Greater Manchester Collaboration for Leadership in Applied Health Research and Care, University of Manchester, Manchester, UK Faculty of Health Sciences, University of Southampton, Southampton, UK I.I.Vassilev@soton.ac.uk.
Ivaylo
I
Vassilev
Faculty of Health Sciences, University of Southampton, Southampton, UK.
Anne
A
Rogers
Greater Manchester Collaboration for Leadership in Applied Health Research and Care, University of Manchester, Manchester, UK Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
Caroline
C
Sanders
Greater Manchester Collaboration for Leadership in Applied Health Research and Care, University of Manchester, Manchester, UK Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
Sudeh
S
Cheraghi-Sohi
Greater Manchester Collaboration for Leadership in Applied Health Research and Care, University of Manchester, Manchester, UK Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
Christian
C
Blickem
Greater Manchester Collaboration for Leadership in Applied Health Research and Care, University of Manchester, Manchester, UK School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK.
Helen
H
Brooks
Greater Manchester Collaboration for Leadership in Applied Health Research and Care, University of Manchester, Manchester, UK.
Dharmi
D
Kapadia
Greater Manchester Collaboration for Leadership in Applied Health Research and Care, University of Manchester, Manchester, UK Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
David
D
Reeves
Department of Health Sciences, University of York, York, UK.
Tim
T
Doran
Greater Manchester Collaboration for Leadership in Applied Health Research and Care, University of Manchester, Manchester, UK Faculty of Health Sciences, University of Southampton, Southampton, UK.
Anne
A
Kennedy
D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000523:psychology*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000523:psychology; D004651:Employment / Q000523:psychology*; D004739:England; D005260:Female; D006331:Heart Diseases / Q000523:psychology; D006801:Humans; D007182:Income; D008297:Male; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology; D012923:Social Class; D011795:Surveys and Questionnaires
Health inequalities; capabilities; long-term conditions; social networks; social status