title: Illness identity as an important component of candidacy: Contrasting experiences of help-seeking and access to care in cancer and heart disease.
abstract: How and when we use health services or healthcare provision has dominated exploration of and debates around healthcare access. Levels of utilisation are assumed as a proxy for access. Yet, focusing on utilisation conceals an important aspect of the access conundrum: the relationships that patients and potential patients have with the healthcare system and the professionals within those systems. Candidacy has been proposed as an antidote to traditional utilisation models. The Candidacy construct offers the ability to include patient-professional aspects alongside utilisation and thus promotes a deeper understanding of access. Originally applied to healthcare access for vulnerable populations, additional socio-demographic factors, including age and ethnicity, have also been shown to influence the Candidacy process. Here we propose a further extension of the Candidacy construct and illustrate the importance of illness identities when accessing healthcare. Drawing on a secondary data analysis of three data sets of qualitative interviews from colorectal cancer and heart failure patients we found that though similar access issues are apparent pre-diagnosis, diagnosis marks a critical juncture in the experience of access. Cancer patients describe a person-centred responsive healthcare system where their patienthood requires only modest assertion. Cancer speaks for itself. In marked contrast heart failure patients, describe struggling within a seemingly impermeable system to understand their illness, its implications and their own legitimacy as patients. Our work highlights the pressing need for healthcare professionals, systems and policies to promote a person centred approach, which is responsive and timely, regardless of illness category. To achieve this, attitudes regarding the importance or priority afforded to different categories of illness need to be tackled as they directly influence ideas of Candidacy and consequently access and experiences of care.
authors.affiliation: Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK. Electronic address: Sara.macdonald@glasgow.ac.uk.
authors.forename: Sara
authors.initials: S
authors.lastname: Macdonald
authors.affiliation: Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK.
authors.forename: David
authors.initials: D
authors.lastname: Blane
authors.affiliation: Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Browne
authors.affiliation: Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK.
authors.forename: Ellie
authors.initials: E
authors.lastname: Conway
authors.affiliation: Hull York Medical School, University of Hull, Hull, HU6 7RX, UK.
authors.forename: Una
authors.initials: U
authors.lastname: Macleod
authors.affiliation: Faculty of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
authors.forename: Carl
authors.initials: C
authors.lastname: May
authors.affiliation: Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK.
authors.forename: Frances
authors.initials: F
authors.lastname: Mair
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000523:psychology; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D000066505:Help-Seeking Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D036301:Qualitative Research; D012933:Social Identification; D035862:Vulnerable Populations / Q000523:psychology
keywords: Access; Cancer; Candidacy; Heart failure; Illness identities; Secondary analysis; United Kingdom