Being believed and believing in : the impact of delegitimation on person centred care for people with chronic back pain
Chronic back pain is an under researched area; the complexities of unseen pain inparticular, present challenges to the sociological assumptions made about the conceptof 'sickness'. The lack of Visible' signs and symptoms means that some people are leftwithout a diagnosis. If left undiagnosed, their experience of chronic back pain becomesdelegitimized and could result in the erosion of self-esteem, self-identity andpersonhood. Undiagnosed chronic back pain can undermine a person's moral selfthrough disrupting the person's biography and self -esteem. Ultimately, people withchronic back pain need person centred approaches to care that support the restorationof the self. The aims of this study were to generate a theory of person-centred carepredicated on the experiences of people who have chronic back pain. The researchdesign was influenced by a constructivist paradigm, which underpinned a GroundedTheory methodological approach. A purposive sampling strategy identified 17 peoplewith chronic back pain and 4 multi-professional teams who were involved in their care.Semi-structured interviews with people who have chronic back pain, and the multiprofessionalteams captured the experience of person-centred care and explicatedmeaning about its key concepts. Data were analysed using a constant comparativeapproach through which theoretical sensitivity developed and eleven categoriesemerged. The 'conditional partnership' became a core category, which formed asubstantive theory to explain the experience of person-centred care. The key findingshighlight the significance of legitimation on the chronic back pain experience andexposes the impact that 'delegitimation' has on the individual's ability to mobiliseresources and manage their pain effectively. This thesis presents the conditionalpartnership as a theory which explains the relationship needed to support personcentred care. The theory suggests that person centred care for people with chronic backpain is underpinned by a conditional partnership which is made up of three conditions;being believed, believing in and non-maleficence which represent the expectedconditions of health care and by health care.
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