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Since the introduction of antiretroviral medications, HIV has been regarded as a chronic illness. However, people living with HIV continue to experience social consequences of HIV infection such as stigma, discrimination, violence, and other human rights violations. In this paper, we focus on the experiences of Atoti, a person living with HIV in Kenya. We argue that HIV remains a biographically disruptive and exceptional illness that is complicated by its invisibility and unpredictable trajectory. Based on Atoti's experiences, we argue that Bury's (1982) concept of biographical disruption, used to explain the social processes of a person suffering a chronic illness, does not fully capture the complexity of experiencing living with HIV. Focusing on life as a whole, rather than on the disease response and process as a biographical disruption, allows for a deeper appreciation of HIV's complexity as a medical illness with major social ramifications. [ABSTRACT FROM AUTHOR]

Background: For people with long-term conditions, social networks provide a potentially central means of mobilising, mediating and accessing support for health and well-being. Few interventions address the implementation of improving engagement with and through social networks. This paper describes the development and implementation of a web-based tool which comprises: network mapping, user-centred preference elicitation and need assessment and facilitated engagement with resources. The study aimed to determine whether the intervention was acceptable, implementable and acted to enhance support and to add to theory concerning social networks and engagement with resources and activities.Methods: A longitudinal design with 15 case studies used ethnographic methods comprising video, non-participant observation of intervention delivery and qualitative interviews (baseline, 6 and 12 months). Participants were people with type 2 diabetes living in a marginalised island community. Facilitators were local health trainers and care navigators. Analysis applied concepts concerning implementation of technology for self-management support to explain how new practices of work were operationalised and how the technology impacted on relationships fit with everyday life and allowed for visual feedback.Results: Most participants reported identifying and taking up new activities as a result of using the tool. Thematic analysis suggested that workability of the tool was predicated on disruption and reconstruction of networks, challenging/supportive facilitation and change and reflection over time concerning network support. Visualisation of the network enabled people to mobilise support and engage in new activities. The tool aligned synergistically with the facilitators' role of linking people to local resources.Conclusions: The social network tool works through a process of initiating positive disruption of established self-management practice through mapping and reflection on personal network membership and support. This opens up possibilities for reconstructing self-management differently from current practice. Key facets of successful implementation were: the visual maps of networks and support options; facilitation characterised by a perceived lack of status difference which assisted engagement and constructive discussion of support and preferences for activities; and background work (a reliable database, tailored preferences, option reduction) for facilitator and user ease of use. [ABSTRACT FROM AUTHOR]

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Background: Wagner's Chronic Care Model (CCM), as well as the expanded version (ECCM) developed by Barr and colleagues, have been widely adopted as frameworks for prevention and management of chronic disease. Given the high prevalence of chronic illness in older persons, these frameworks can play a valuable role in reorienting the health care system to better serve the needs of seniors. We aimed to identify and assess the measured goals of E/CCM interventions in older populations. In particular, our objective was to determine the extent to which published E/CCM initiatives were evaluated based on population, community, system and individual-level outcomes (including clinical, functional and quality of life measures).Methods: We conducted a systematic search of the Science Citation Index Web of Knowledge search tool to gather articles published between January 2003 and July 2014. We included published CCM interventions that cited at least one of the fundamental papers that introduced and described the CCM and ECCM. Studies retained for review reported evaluations of senior-focused E/CCM initiatives in community-based settings, with the topic of "older adults" OR senior* OR elder* OR geriatric OR aged. The resulting 619 published articles were independently reviewed for inclusion by two researchers. We excluded the following: systematic reviews, meta-analyses, descriptions of proposed programs, and studies whose populations did not focus on seniors.Results: We identified 14 articles that met inclusion criteria. Studies used a wide range of measures, with little consensus between studies. All of the included studies used the original CCM. While a range of system-level and individual patient outcomes have been used to evaluate CCM interventions, no studies employed measures of population or community health outcomes.Conclusions: Future efforts to test E/CCM interventions with seniors would be aided by more consistent outcome measures, greater attention to outcomes for the caregivers of older persons with chronic illness, and a greater focus on population and community impacts. [ABSTRACT FROM AUTHOR]

Purpose of the Study: Though older adults smoke at a lower rate than younger adults, cessation can be difficult, especially after years of smoking. This paper examined the influence of a diagnosis of chronic illness, social isolation, and depression on smoking cessation among the most recent cohort of older smokers who were representative of U.S. Medicare beneficiaries. Design and Methods: We used data from the 2011 (T1) and 2012 (T2) interview waves of the U.S. National Health and Aging Trends Study. Multivariate regression models examined correlates of T1 smoking status (never smoker, former smoker, and current smoker; n = 6,680) and predictors of T2 smoking status among T1 smokers (quit smoking vs. continued smoking; n = 412). Results: At T1, 8.8%, 44.7%, and 46.5% of the sample, respectively, were current, former, and never smokers. Current smokers had lower socioeconomic status, were more socially isolated, and had higher depressive symptoms than never smokers. At T2, 88.9% of T1 smokers continued smoking and 11.1% no longer smoked. The odds of smoking cessation increased with a new diagnosis of chronic illness since T1 and decreased with a higher number of cigarettes smoked at T1. Social isolation at T1 increased the odds of smoking cessation, but depressive symptoms at T1 were not a significant factor. Implications: Heavy-smoking older adults may require extended pharmachotherapy and counseling. As newly diagnosed health problems can be a trigger for smoking cessation, health care providers can motivate and help older adults quit (or reduce) smoking as an integral part of their practices. [ABSTRACT FROM AUTHOR]

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. Aims: 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. Findings: 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. [ABSTRACT FROM AUTHOR]

Continuity outpatient palliative care practice is characterized by long relationships between patients, families, and palliative care clinicians and by periods of relative stability when the disease and resultant symptoms are less active. Compared to inpatient palliative care, outpatient practice requires a greater focus on encouraging healthy coping and on helping patients to live well with serious illness. This paper discusses the opportunities to promote adaptive coping in the delivery of outpatient palliative care. [ABSTRACT FROM AUTHOR]

Despite all technological advances in the last decades, kidney patients still need to adapt to emotional and behavioral changes due to chronic kidney disease and its treatment. This paper aims to identify the hemodialysis treatment role on chronic kidney patient's daily life. By means of interviews analyses, ambivalent feelings towards treatment were found as well as symptoms of depression and impotence with prevalence of dependence, which hinders patients' daily activities. Emotional alterations were found to be present, regardless of disease stage, age or gender. Other findings are: the influence of surroundings, with safety and stability stemming from the support network expressed by kidney patients regarding acceptance of the disease and treatment; individual characteristics as a part of the chronic disease treatment process; signs of rebellion and acceptance found in the diseased, which are shown to be a necessary part of the adaptation and adherence process of hemodialysis. [ABSTRACT FROM AUTHOR]

This paper investigates the occurrence of somatic involvement in spiritual development by exploring transpersonal dimensions of physical illness. Using semi-structured interviews and the qualitative method of heuristic inquiry, the transpersonal experiences of seven people with long-term health conditions are reported. Results expand on current literature by revealing that a spiritual perspective in illness can extend much beyond being a coping mechanism into profound experiences of self-transformation and healing, and by illustrating that the body can be intimately involved in the spiritual process. Participants considered the transpersonal dimension to be central to their experiences and as such understood their physical challenge as a state of potency wherein healing and embodiment of transpersonal influences were inextricably linked. Implications are that the body merits our acknowledgement as an integral part of a greater reality of being, and therefore needs to be fully included in the development of an embodied, holistic, and participatory spirituality. [ABSTRACT FROM AUTHOR]

This paper draws on qualitative research with Incapacity Benefit (IB) stakeholders in the North East of England, UK. Stakeholders’ experiences of working with long-term sickness benefits recipients reveal multiple barriers that both sick and disabled people, and themselves as practitioners, clearly face. Reflections on what ongoing welfare reform could mean for future practice for both stakeholders and recipients will be explored. The findings suggests that whilst stakeholders recognise the complex barriers faced by those receiving sickness benefits, a wider moral dialogue between ‘deserving’ and ‘undeserving’ is being created and sustained as a result of negative stereotyping of sickness benefits recipients. [ABSTRACT FROM PUBLISHER]

Chronic non-communicable diseases such as heart disease, cancer and diabetes are the biggest killers worldwide. Chronic conditions include heart disease, stroke, diabetes, cancer, chronic respiratory disease and are often comorbid with mental illness. Over 60 years ago, the British Medical Journal reported an association between mental illness and poor physical health (Philips, 1934). Comorbid mental illness and physical illness incrementally worsens health compared with mental illness alone or any of the chronic non-communicable diseases such as cardiovascular diseases, cancers, chronic respiratory diseases and diabetes alone. This paper aims to open the dialogue related to optimising, through nursing intervention, a patient's self-righting and self-management factors in the context of comorbid chronic conditions such as heart disease, stroke, diabetes, cancer, chronic respiratory disease, with mental illness. Self-management and self-righting capabilities are now being considered integral to reducing the negative impact of chronic conditions such as mental illness. Personal characteristics associated with resilience comprise optimism, an active or adaptable coping style and the ability to elicit social support. Existing resilience factors can be assessed for by nurses and optimised through interventions when patients with chronic conditions are in care. Representing over 70% of the global health workforce, nurses are well positioned to enact such practice enhancements to facilitate better outcomes for patients. [ABSTRACT FROM AUTHOR]

The term ‘chronicity’ is still widely used in psychiatric discourse and practice. A category employed in political, administrative and therapeutic contexts, it guides practitioners’ beliefs and actions. This paper attempts a review of the attitudes and procedures that result as a consequence of identifying ‘chronically’ disturbed identities in clinical practice. An essentially social, relational and materialist understanding of mental illness is used to highlight the kind of thinking underlying the notion of ‘chronic’ identities in day-to-day psychiatric routines. Problematising the notions of singularity and expressiveness, as well as mind/body- and self/other-distinctions, it claims the category itself is responsible for creating a ‘chronic’ kind of being. A spatial metaphor is presented in the conclusion, illustrating a mental strategy by which we can re-shape our thinking about ‘chronic’ identities. It attempts to describe how the shift from an epistemological to a praxeographic approach could build a more complete understanding of mental illness. [ABSTRACT FROM PUBLISHER]

Introduction. The Australian federal government is developing a policy response to chronic disease in Australia. The Serious and Continuing Illness Policy and Practice Study examined the experience of individuals with chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) or type 2 diabetes mellitus (diabetes) in the Australian Capital Territory (ACT) and Western Sydney. This paper describes the disease-specific experiences of people interviewed. Methods. We conducted semi-structured interviews with 40 individuals aged 45-85 years with CHF, COPD or diabetes in 2008. Interviews were recorded and transcribed. Qualitative content analysis was performed, assisted by QSR Nvivo 8 qualitative data software. Results. Participants with CHF (n = 9) came to terms with the prospect of unpredictable sudden death. Participants with COPD (n = 15) were angry about limitations it imposed on their lives. Participants with diabetes (n = 16) experienced a steep learning curve in self-management of their condition surrounded by high levels of uncertainty. Conclusion. Although people with chronic illness share many experiences, a person's overall experience of living with chronic illness is significantly shaped by the nature of their specific dominant disease. Policies for patient-centred care must take account of both generic and disease-specific elements. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2011; 25; 567-574 Embedded spirituality: gardening in daily life and stressful life experiences Background: There is a limited body of research examining the relationship between spirituality and leisure, or the impact of leisure in the context of daily life, and life with stressful events. Aim: To examine the meaning of gardens and gardening across different life experiences using hermeneutic phenomenology to focus on the lived experience of leisure gardening. Methods: Most participants were interviewed once in each season over a 1 year period usually in their home. There were 42 participants (27 women and 15 men) in this study. Fifteen individuals had been diagnosed with cancer and were in varying stages of diagnosis and treatment. Three people had a chronic and progressive disease. Four women were grieving the death of their spouse. Participants ranged in age from 32 to 80 years. Results: In this paper, we focus on the spirituality-related themes in this study: spirituality as connectedness; spirituality as an expression of inner being; the garden as a spiritual place and gardening as spiritual activity; gardening as a spiritual journey; and, stewardship. Participants with religious views saw their garden as an extension of their spirituality and a confirmation of their beliefs. Participants with secular or sacred views of spirituality that was not related to any religious beliefs were more likely to embed their spirituality in their relationship with nature as manifested in their garden. Conclusion: This study extends current theory regarding leisure and its contribution to meaning focused coping, and spirituality as a significant component of leisure in living with stressful health and life events. [ABSTRACT FROM AUTHOR]

The article presents guidelines for primary care nurses in Great Britain involved in the care of children with long-term conditions. The government paper "Every Child Matters" set several goals for children which include being healthy, staying safe and achieving economic well-being. Primary care nurses should consider the impact of the chronic disease on the child, as well as on his or her family including the siblings.

Background: There has been considerable research into the impact of chronic illness on health-related quality of life. However, few studies have assessed the impact of different chronic conditions on general quality of life (QOL). The objective of this paper was to compare general (rather than health-related) QOL and affective well-being in middle aged and older people across eight chronic illnesses. Methods and Findings: This population-based, cross-sectional study involved 11,523 individuals aged 50 years and older, taking part in wave 1 of the English Longitudinal Study of Ageing. General QOL was assessed using the CASP-19, happiness was evaluated using two items drawn from the GHQ-12, and depression was measured with the CES-D. Analysis of covariance and logistic regression, adjusting for age, gender and wealth, were performed. General QOL was most impaired in people with stroke (mean 37.56, CI 36.73-38.39), and least in those reporting cancer (mean 41.78, CI 41.12-42.44, respectively), compared with no illness (mean 44.15, CI 43.92-44.39). Stroke (mean 3.65, CI 3.58-3.73) was also associated with the greatest reduction in positive well-being whereas diabetes (mean 3.81, CI 3.76-3.86) and cancer were least affected (3.85, CI 3.79-3.91), compared with no illness (mean 3.97, CI 3.95-4.00). Depression was significantly elevated in all conditions, but was most common in chronic lung disease (OR 3.04, CI 2.56-3.61), with more modest elevations in those with osteoarthritis (OR 2.08, CI 1.84-2.34) or cancer (OR 2.07, CI 1.69-2.54). Multiple co-morbidities were associated with greater decrements in QOL and affective well-being. Conclusion: The presence of chronic illness is associated with impairments in broader aspects of QOL and affective wellbeing, but different conditions vary in their impact. Further longitudinal work is needed to establish the temporal links between chronic illness and impairments in QOL and affective well-being. [ABSTRACT FROM AUTHOR]

Objective: The objective of this paper is to describe how the ICF framework was applied as the foundation for a longitudinal study of changes in quality-of-life (QoL) for youth with chronic conditions. Method: This article will describe the study's aims, methods, measures and data analysis techniques. It will point out how the ICF framework was used--and expanded upon--to provide a model for studying the impact of factors on changes in QoL for youth with chronic conditions. Further, it will describe the instruments that were chosen to measure the components of the ICF framework and the data analysis techniques that will be used to examine the impact of factors on changes in youths'' QoL. Conclusions: Qualitative and longitudinal designs for studying QoL based on the ICF framework can be useful for unraveling the complex ongoing inter-relationships among functioning, contextual factors and individuals'' perceptions of their QoL. [ABSTRACT FROM AUTHOR]

Social drinking practices have been found to be a salient issue for young adults suffering from type 1 diabetes (T1DM), and inflammatory bowel disease (IBD), with many reporting participating in such practices in spite of the potential additional health risks (Eaton et al. 2001; Balfe 2009). Drawing on interviews with sufferers of T1DM and IBD, aged 18-29 (n = 30), this paper aims to investigate how their reasoning behind this behaviour is discursively constructed. Through using the 'Accounts' framework (Scott and Lyman 1968), sufferers were shown to construct an identity of 'good' diabetic, or IBD, sufferer. A key difference found across the two conditions was that T1DM sufferers more regularly constructed 'excuses' for engaging in potentially 'risky' behaviour, whereas IBD sufferers predominantly produced 'justifications', which framed their behaviour as not necessarily being irresponsible. This finding reflects the degree of risk at which sufferers of the respective conditions view their social drinking behaviour as placing them. The stronger biomedical evidence that alcohol has negative effects on T1DM leads sufferers to view their 'healthy body' (Balfe 2009) in terms of more serious health implications, whereas IBD sufferers view their 'healthy body' in terms of short-term exacerbation of symptoms, which they do not see as significantly affecting their general IBD-health. [ABSTRACT FROM AUTHOR]

Bury's (1982) argument that the onset of a chronic illness represents a biographical disruption has become paradigmatic in the sociology of illness studies. More recently Bury (1991, 1997) himself, Williams (2000) and other medical sociologists have argued that the notion of illness as biographical disruption needs re-examination. Following a phenomenological approach, in this paper the author draws on different narrative models (Labov and Waletzky 1967 and Ricoeur 1980) to analyze how patients orient to the onset of chronic illness as the complicating action. The data comprise eight narratives collected in South America: three correspond to patients with renal failure, and five to patients with HIV/AIDS disease. It is observed that in some cases, patients' complicating actions are rather oriented to experiences of poverty, drug addiction, and criminality that took place prior to their onset of their illnesses. These experiences, instead of the onset of their illnesses, occupy the place of the complicating action in these patients' narratives. The author discusses that in the studies of illness narratives, it is difficult to operate from a different paradigm, but argues that conflating the onset of chronic illness with a biographical disruption may confuse the episodic dimension of narrative with the configurational dimension. [ABSTRACT FROM AUTHOR]

AIM: The purpose of the study was to explore the issues surrounding chronic hepatitis C, combination therapy and its impact on personal relationships to enhance understanding of the experiences of patients living with hepatitis C. This paper focuses on the experiences of the patients and their partners' experiences will be published separately. BACKGROUND: Patients with chronic hepatitis C who have active inflammatory changes on liver biopsy may undergo combination therapy with interferon and ribavirin. For some patients, the adverse effects of combination therapy are so severe that it can potentially place an enormous stress on personal relationships. DESIGN: The study was informed by Heideggerian phenomenology. METHODS: Purposive sampling and semi-structured interviews of five patients and their partners were conducted between 2004-2006 in Sydney Australia, to obtain a rich description of their experiences. RESULTS: The findings from this study revealed that chronic hepatitis C and combination therapy had an enormous impact on the lives of the patients, their partners and families. The illness and treatment had significant physiological effects that had an impact on quality of life; however, the social and psychological consequences of living with a highly stigmatised disease with an unknown course and outcome cannot be underestimated. CONCLUSION: The results of this study lend support to the effectiveness of providing equitable services to persons diagnosed with chronic hepatitis C. However, additional research is needed to explore gender, socioeconomic, sexual-orientation, transmission, cultural, religious and genotype differences in this group to address their needs better. RELEVANCE TO CLINICAL PRACTICE: Nurses play a significant role in educating patients with chronic hepatitis C, advocating for them and helping them to achieve a reasonable state of well being. Through deeper understanding of their experiences of illness and treatment, nurses can move beyond the medical oriented approach to care. [ABSTRACT FROM AUTHOR]

This paper describes the use of internal psychology in the management of chronic disease, and the potential of methods such as reality therapy and motivational interviewing to facilitate behavioral change. A case example and tools such as SMART goal setting have been included, as well as counselling principles with reality therapy to illustrate the process that can be followed. [ABSTRACT FROM AUTHOR]

A Complex Chronic Disease (CCD) is a condition involving multiple morbidities that requires the attention of multiple health care providers or facilities and possibly community (home)-based care. A patient with CCD presents to the health care system with unique needs, disabilities, or functional limitations. The literature on how to best support self-management efforts in those with CCD is lacking. With this paper, the authors present the case of an individual with diabetes and end-stage renal disease who is having difficulty with self-management. The case is discussed in terms of intervention effectiveness in the areas of prevention, addiction, and self-management of single diseases. Implications for research are discussed. [ABSTRACT FROM AUTHOR]

Health-related quality of life (HRQOL) assessment in children and adolescents with chronic health conditions is increasingly considered as a relevant topic. The aim of the EU-funded DISABKIDS project is to develop, test, and implement European instruments for the assessment of HRQOL of children and adolescents with disabilities and their families. The current paper describes the development and pilot testing of a chronic generic HRQOL measure. Using literature searches, expert consulting and focus groups with children/adolescents and their families, items of the instruments were developed and translated into the respective languages. A pilot test with 360 children and adolescents was conducted. Children and adolescents (8-12, 13-16 years) with different chronic health conditions (asthma, epilepsy, diabetes, arthritis, atopic dermatitis, cerebral palsy, and cystic fibrosis) as well as their families were included. Data were analysed according to predefined psychometric and content criteria. Psychometric analyses resulted in a 56-item chronic generic HRQOL questionnaire with six domains ('Medication', 'Physical', 'Emotion', 'Independence', 'Social Inclusion', 'Social Exclusion') with acceptable internal consistency. [ABSTRACT FROM AUTHOR]

The topic of this paper is the change of perspective from the concept of "coping with illness" in a psychological sense to a concept of coping as "living with (chronic) illness" in a sociological sense. Whereas psychological and even some sociological research presupposes assumptions on causes and essentials of stress as well as on successful coping, we focused on the different ways, in which subjects define strain and their personal aim of coping. These subjective views might differ from the definitions of scientists as well. Furthermore we focus on the social constructions of illness and "normal living" and the social rules of coping with daily hardships, which underlay the subjective views. Assuming that the ways chronically ill or disabled persons look at stress and daily hardships as part of their coping, we conclude that stress and coping mutually constitute each other. This dialectic process is influenced by the person's current situation, by the individual's history and by cultural rules concerning appropriate coping or living with strain in general. Looking at these social rules and how they are modified under the conditions of illness and handicap was the topic of our research project "LIVE — Living and Defending Your Interests — Disabled Women", financed by the German Federal Ministry for Family, Seniors, Women and Youth and conducted from1996–1998. In this study a questionnaire was sent to disabled women aged 16 to 60 years old (return: N =987). Additionally, a qualitative interview was conducted with N = 60 of them. From a biographical approach the reconstruction of the main subjective patterns in their life histories led us to the social rules of appropriate "coping." We can take this as a starting point for a sociological discussion of everyday living with chronic illness that focuses on the social constitution of subjective meanings of stress and coping with illness, includes the social context and allows for integration of the gender perspective. [ABSTRACT FROM AUTHOR]

Based on a narrative account, this paper highlights and reviews the experiences of the author, a psychologist, experiencing a chronic illness. Areas covered include coping with doctors and medical personnel, adjusting to illness, complying, actively coping, and even, at times, resisting unwarranted medical procedures. Experiences such as loss of trust, a sense of isolation, re-working relationships, and generative reaching-out are also covered. Some positive consequences of chronic illness for personal growth are suggested. Suggestions for conducting psychotherapy with clients who are dealing with serious chronic illness are made. [ABSTRACT FROM AUTHOR]

Individuals who acquire a chronic illness or disability face a number of significant and profound challenges. Among these is coping with the permanence of the condition and its effects. Rehabilitation counselors working with people who are in the process of coping with such realities may feel that they have little to offer in the face of such monumental life changes. The recovery concept, which has, over the last decade, been receiving increased attention in the mental health literature, offers counselors and consumers a positive framework for healing and growth in the face of chronic disability. The recovery process and its potential application in working with persons with chronic illnesses and disabilities are presented in this paper. Recovery-based implications for rehabilitation service systems are also addressed. [ABSTRACT FROM AUTHOR]

Hans Selye's theoretical propositions and empirical findings provided many of the principles currently used in stress research, and are often cited as scientific bases for nursing theory, research and practice. His General Adaptation Syndrome (GAS) has been a useful model for realizing the physiologic processes involved in the relationship between stress and acute illness, and the evolution of diseases such as cancer. The GAS can also serve as a useful paradigm for understanding the symptomatic expression and progression of a chronic physical illness, however. This paper analyses the physiologic processes of stress from this perspective, proposing that individuals with a chronic illness are at risk for experiencing acute symptomatic distress and/or exacerbations of their illness in response to stress. Specific examples involving chronic disease are cited and several additional insights gained from this approach are proposed. [ABSTRACT FROM AUTHOR]

Self‐care, or self‐management, is presented in healthcare policy as a precursor to patient empowerment and improved patient outcomes. Alternatively, critiques of the self‐care agenda suggest that it represents an over‐reliance on individual autonomy and responsibility, without adequate support, whereby 'self‐care' is potentially unachievable and becomes 'care left undone'. In this sense, self‐care contributes to a blame culture where ill‐health is attributed to personal behaviours or lack thereof. Furthermore, self‐care may represent a covert form of rationing, as the fiscal means to enable effective self‐care and supplement, or replace, self‐care capacities, is not provided. This paper explores these arguments through a contemporary ethical analysis of the self‐care agenda. The terms self‐care and self‐management are used interchangeably throughout whereby self‐management is understood as a point in the wider self‐care continuum. [ABSTRACT FROM AUTHOR]