title: Health-care encounters create both discontinuity and continuity in daily life when living with chronic heart failure-A grounded theory study.
abstract: Living with chronic heart failure (CHF) often involves lifelong contact with health care, more or less frequently, depending on fluctuating health-generating disruptions in everyday life. To reduce the influence on continuity in life, health-care professionals should preferably focus on supporting patients in managing their daily lives, based on their perspective. The aim of this study was to describe how the interaction in health-care encounters contributes to either continuity or discontinuity in the daily life for persons with CHF. Interviews with 18 participants were carried out, using the grounded theory method, through data collection and analysis. Two core concepts were constructed from data which reveal a model that illuminates the characteristics of the encounters, the actions of health-care professionals and the normative discourse. Patient-centred agenda consists of the categories: "Experiencing a subordinate approach," "Objectifying during the encounter" and "Expected to be compliant." This describes how health-care professionals enhance discontinuity in daily life by using a paternalistic approach in the encounter. Person-centred agenda consists of the categories: "Experiencing an empowering approach," "Person-centredness during the encounter" and "Expected to be capable." It describes how participants perceive that health-care professionals enable them to deal with everyday life which enhances continuity. The findings highlight the importance of health-care professionals' attitudes and communication in encounters with patients. Health care must be designed to support and promote patients' own strategic thinking by strengthening their self-image to enhance continuity in everyday life. The experience of discontinuity is based on the prevailing health-care culture which focuses on disease and medical treatment and regards it as superior to the illness experience in an everyday life context. We therefore strongly suggest a paradigm shift in the health-care organisation and culture in order to support the patients in their efforts to live a meaningful, rich life, in spite of the chronic illness CHF.
authors.affiliation: a Institute of Health and Care Sciences Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.|b Närhälsan Källstorp Health Centre , Trollhättan , Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Östman
authors.affiliation: a Institute of Health and Care Sciences Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.|c University of Gothenburg Centre for Person-Centred Care (GPCC) , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.
authors.forename: Eva Jakobsson
authors.initials: EJ
authors.lastname: Ung
authors.affiliation: a Institute of Health and Care Sciences Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.|c University of Gothenburg Centre for Person-Centred Care (GPCC) , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.
authors.forename: Kristin
authors.initials: K
authors.lastname: Falk
keywords: Chronic disease; continuity; grounded theory method; heart failure; illness; patient perspective; person-centred care