This paper investigates the experiences of patients in communicating with healthcare practitioners within the context of supported self-management in the UK. Employing an innovative analytical concept of “narrative modulation”, this study examines narrative data from patients’ focus group discussions. Two contrasting processes, attunement and misattunement, emerge as narrative modulators that shape and form the meaning and trajectory of participants’ storytelling. The study identifies multiple instances of misattunement in patient-practitioner interactions, highlighting a prevailing emphasis on diagnosis and treatment-focused perspectives, often at the expense of individual patients’ experiences during clinical encounters. Despite these challenges, the participants expressed a desire for care that listens to and understands their unique experiences. They also wished to play an active role in their healthcare decisions, endorsing attunement, which promotes understanding and collaborative self-management supported by practitioners. This paper further discusses the implications of these findings for improving both patient-practitioner communication and supported self-management.
Declaration of competing interest
The author declares no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.
Data availability
The data that has been used is confidential.
| [1] |
Ahmed S. (2014). Not in the mood. New Formations, 82, 13-28.
|
| [2] |
Akhtar S. (Ed.). (2007). Listening to others: Developmental and clinical aspects of empathy and attunement. Rowman & Littlefield Publishing.
|
| [3] |
Ashworth P. D. (1992). Patient participation: its meaning and significance in the context of caring. Journal of Advanced Nursing, 17(12), 1430-1439.
|
| [4] |
Baynham, M. (2013). Narrative analysis. In K. Hyland, & B. Paltridge (Eds.), Bloomsbury Companion to Discourse Analysis (pp. 69-84). Bloomsbury.
|
| [5] |
Bhatia, V. K., Flowerdew J., & Jones R. H. (Eds.). (2008). Advances in discourse studies. Routledge.
|
| [6] |
Bolis D., & Dumas G., & L. S. (2022). Interpersonal attunement in social interactions: From collective psychophysiology to inter-personalized psychiatry and beyond. Philosophical Transactions of the Royal Society B, 378, 20210365.
|
| [7] |
Charon R. (2006). Narrative medicine: Honoring the stories of illness. Oxford University Press,.
|
| [8] |
Currie K., Strachan P. H., Spaling M., Harkness K., Barber D., & Clark A. M. (2015). The importance of interactions between patients and healthcare professionals for heart failure self-care: A systematic review of qualitative research into patient perspectives. European Journal of Cardiovascular Nursing, 14(6), 525-535.
|
| [9] |
Dancygier B., & Sweetser E. (2014). Figurative language. Cambridge University Press,.
|
| [10] |
Deledda G., Moretti F., Rimondini M., & Zimmermann C. (2013). How patients want their doctor to communicate: A literature review on primary care patients’ perspective. Patient Education and Counseling, 90(3), 297-306.
|
| [11] |
Edley N., & Litosseliti L. (2018). Critical perspectives on using interviews and focus groups. In L. Litosseliti (Ed.), Research Methods in Linguistics (pp. 155-179). Bloomsbury Academic.
|
| [12] |
Fu Y., McNichol E., Marczewski K., & José Closs S. (2018). The management of chronic back pain in primary care settings: Exploring perceived facilitators and barriers to the development of patient-professional partnerships. Qualitative Health Research, 28(9), 1462-1473.
|
| [13] |
Gifford, F. (2016). The biomedical model and the biopsychosocial model in medicine. In M. Solomon, J. Simon, R., & Eds.), The Routledge Companion to Philosophy of Medicine (pp. 445-454). Routledge.
|
| [14] |
Gordon K., Rice H., Allcock N., Bell P., Dunbar M., Gilbert S., & Wallace H. (2017). Barriers to self-management of chronic pain in primary care: a qualitative focus group study. The British Journal of General Practice: The Journal of the Royal College of General Practitioners, 67(656), 209-217.
|
| [15] |
Greenhalgh T., Collard A., Campbell-Richards D., Vijayaraghavan S., Malik F., Morris J., & Claydon A. (2011). Storylines of self-management: narratives of people with diabetes from a multiethnic inner city population. Journal of Health Services Research & Policy, 16(1), 37-43.
|
| [16] |
Griffiths C., & Smith M., M. (2016). Attuning: A communication process between people with severe and profound intellectual disability and their interaction partners. Journal of Applied Research in Intellectual Disabilities, 29, 124-138.
|
| [17] |
Gubrium J. F., & Holstein J. A. (1998). Narrative practice and the coherence of personal stories. The Sociological Quarterly, 39(1), 163-187.
|
| [18] |
Gucciardi E., Reynolds E., Karam G., Beanlands H., Sidani S., & Espin S. (2021). Group-based storytelling in disease self-management among people with diabetes. Chronic Illness, 17(3), 306-320.
|
| [19] |
Harré R. (2012). Positioning theory: Moral dimensions of social-cultural psychology. In J. Valsiner (Ed.), The Oxford Handbook of Culture and Psychology (pp. 191-206). Oxford University.
|
| [20] |
Heisler M., Cole I., Weir D., Kerr E. A., & Hayward R. A. (2007). Does physician communication influence older patients’ diabetes self-management and glycemic control? Results from the Health and Retirement Study (HRS). The Journals of Gerontology, Series A, 62(12), 1435-1442.
|
| [21] |
Herman D. (2007). Storytelling and the sciences of mind: cognitive narratology, discursive psychology, and narratives in face-to-face interaction. Narrative, 15(3), 306-334.
|
| [22] |
Hibbard J. H., Collins P. A., Mahoney E., & Baker L. H. (2009). The development and testing of a measure assessing clinician beliefs about patient self-management. Health Expectations, 13, 65-72.
|
| [23] |
Hojat M., DeSantis J., & Gonnella J. S. (2017). Patient perceptions of clinician’s empathy: Measurement and psychometrics. Journal of Patient Experience, 4(2), 78-83.
|
| [24] |
Hollander J. A. (2004). The social contexts of focus groups. Journal of Contemporary Ethnography, 33(5), 602-637.
|
| [25] |
Huang, M. (2020). Narrative modulation in the storytelling of breast cancer survivors’ transitional experiences. In M. Huang, & Eds.), The Language of Crisis: Metaphors, Frames and Discourses (pp. 255-280). John Benjamins.
|
| [26] |
Hydén L. C., & Bülow P. H. (2003). Who’s talking: Drawing conclusions from focus groups: some methodological considerations. International Journal of Social Research Methodology, 6(4), 305-321.
|
| [27] |
Imison C., Curry N., Holder H., Castle-Clarke S., Nimmons D., Appleby J., … Lombardo S. (2017). Shifting the balance of care: Great expectations. Research report. Nuffield Trust.
|
| [28] |
Jones R., Newbold M., Reilly J., Drinkwater R., & Stoate H. (2013). The future of primary and secondary care. British Journal of General Practice, 63(612), 379-382.
|
| [29] |
Kleres J. (2010). Emotions and narrative analysis: A methodological approach. Journal for the Theory of Social Behaviour, 41(2), 182-202.
|
| [30] |
Kligyte G. (2023). Collegiality as collective affect: Who carries the burden of the labour of attunement? Higher Education Research & Development.
|
| [31] |
Kralik D., Price K., & Telford K. (2010). The meaning of self-care for people with chronic illness. Journal of Nursing and Healthcare of Chronic Illness, 2, 197-204.
|
| [32] |
Lehoux P., Poland B., & Daudelin G. (2006). Focus group research and "the patient’s view". Social Science & Medicine, 63, 2091-2014.
|
| [33] |
Mar R. A. (2018). Stories and the promotion of social cognition. Current Directions in Psychological Science, 27(4), 257-262.
|
| [34] |
McCluskey U. (2005). To be met as a person: The dynamics of attachment in professional encounters. Karnac Books.
|
| [35] |
Moen J., Antonov K., Nilsson J., Lars G., & Ring L. (2010). Interaction between participants in focus groups with older patients and general practitioners. Qualitative Health Research, 20(5), 607-616.
|
| [36] |
Morgan, D., L. (2012). Focus groups and social interaction. In J. F. Gubrium, J. A. Holstein, A. B. Marvasti, & D. K. McKinney (Eds.), The Sage handbook of interview research: the complexity of the craft (pp. 161-176). SAGE.
|
| [37] |
NHS. (2014). Five year forward view. NHS England,.
|
| [38] |
NHS (2019). The NHS long term plan. Version 1.2. NHS England.
|
| [39] |
NHS (2020). Supported self-management: Summary guide. Version 1.0. NHS England and NHS Improvement.
|
| [40] |
Riessman, C. K. (2003). Narrative analysis. In M. S. Lewis-Beck, A. Bryman, & T. F. Liao (Eds.), The Sage Encyclopedia of Social Science Research Methods (pp. 705-709). Sage.
|
| [41] |
Rodham K. (2020). Self-management in practice: Mind the Gap. In K. Rodham (Ed.), Self-management for Persistent Pain: The Blame, Shame and Inflame Game?? (pp. 33-52). Palgrave Macmillan.
|
| [42] |
Sadler E., Wolfe C. D. A., & McKevitt C. (2014). Lay and health care professional understandings of self-management: a systematic review and narrative synthesis. SAGE Open Medicine, 2, 2050312114544493.
|
| [43] |
Semin G. R., & Smith E. R. (2013). Socially situated cognition in perspective. Social Cognition, 31(2), 125-146.
|
| [44] |
Silver I. (2018). Bridging the gap: person centred, place-based self-management support. Future Healthcare Journal, 5(3).
|
| [45] |
Street R. L. J., Makoul G., Arora N. K., & Epstein R. M. (2009). How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Education and Counselling, 74, 295-301.
|
| [46] |
Thomas C., Reeve J., Bingley A., Brown J., Payne S., & Lynch T. (2009). Narrative research methods in palliative care contexts: Two case studies. Journal of Pain and Symptom Management, 37(5), 788-796.
|
| [47] |
Wilson P. M., Kendall S., & Brooks F. (2006). Nurses’ responses to expert patients: The rhetoric and reality of self-management in long-term conditions: A grounded theory study. International Journal of Nursing Studies, 43, 803-818.
|
| [48] |
Zolnierek K. B. H., & DiMatteo M. R. (2009). Physician communication and patient adherence to treatment: A meta-analysis. Medical Care, 47(8), 826-834.
|
| [49] |
Zoumpouli A. (2021). Is a ‘good enough’ experience possible for patients and clinicians through remote consultations? A guide to surviving remote therapy, based on psychoanalytic and neuroscientific literature. Psychoanalytic Psychotherapy, 34(4), 278-292.
|
PDF
(549KB)
