How to Implement Evidence-Based Healthcare by Trisha Greenhalgh

How to Implement Evidence-Based Healthcare by Trisha Greenhalgh

Author:Trisha Greenhalgh
Language: eng
Format: epub
ISBN: 9781119238539
Publisher: John Wiley & Sons, Inc.
Published: 2017-05-31T00:00:00+00:00


I hope you can see that when we study what people actually do (and why they do it) to manage their chronic condition in the real world, the biomedical framing of decision‐making, self‐efficacy and skills for ‘self‐management tasks’ captures only a fraction of the overall picture. Missing are the networks of peers, friends and family and the wider context in which the work of self‐management is contemplated, prioritised (or not) and accorded social meaning and moral worth.

An alternative view of self‐management is that it is best conceptualised not as a set of tasks to be learnt and exhibited but as a set of social practices (i.e. recurrent shared activities made up of bodily actions, mental schemas, meaning‐systems and tacit know‐how) that are deeply embedded in particular family routines and cultural traditions [33]. I will return to social practices in Section 10.4 when I talk about the importance of ‘communities of practice’ in supporting self‐management by patients.

This section illustrates a principle that runs through this book. I have deliberately not given you a formula for ensuring that self‐management support for patients is evidence‐based. Rather, I have tried to convey tensions and gaps in that evidence base, including key upstream questions about whether self‐management should be conceptualised in a narrowly biomedical or more holistic way – and the implications of this question for the design of research studies.

My own view, which others may not share, is that if we are to move forward in the evidence‐based support of self‐management, we will need to break free of the conceptual shackles that are currently constraining the development of new ideas in this field. In particular, I would like us to move on from the view that the gold standard in this field is a randomised trial of educational intervention versus no educational intervention, with self‐efficacy as the primary outcome.



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