Disrupted Candidacy: A Longitudinal Examination of the Constrained Healthcare-Access Journeys of National Health Service Workers in Scotland Seeking Supports for Long COVID Illness

IF 3 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations Pub Date : 2024-10-02 DOI:10.1111/hex.70050

Nicholas Norman Adams, Emma MacIver, Flora Douglas, Catriona Kennedy, Diane Skåtun, Virginia Hernandez Santiago, Nicola Torrance, Aileen Grant

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引用次数: 0

Abstract

Introduction

Evidence examines how persons experiencing Long COVID (LC) struggle to secure healthcare for symptoms. However, few studies examine healthcare workers experiencing LC, nor the complex and multiple difficulties faced when seeking and receiving healthcare.

Methods

This study is based on two phases of longitudinally conducted qualitative interviews, 6 months apart, with National Health Service (NHS) workers experiencing LC, from different occupational roles at NHS locales in Scotland (first interviews, n = 50; second interviews, n = 44).

Results

Multiple factors restricted healthcare access, including worries about pressuring the NHS and concerns over LC being legitimised. When healthcare was sought, workers struggled to secure support, referrals and treatment. The following reasons were included: (1) context: the restrictive pandemic healthcare context; (2) illness climate: low GP knowledge surrounding LC and how this could be treated, trends for ascribing symptoms to other causes and reluctance to diagnose LC; (3) sense-making of LC: healthcare availability linked to occupational role identity. To visualise and examine healthcare barriers, candidacy theory is applied, drawing inferences between healthcare context, illness climate, sense-making and identities.

Conclusion

NHS workers' complex journeys represent Disrupted Candidacy, intersecting challenges across candidacy domains, restricting the seeking and receiving of LC healthcare. Findings provide insights into why NHS workers resisted and withdrew from healthcare-seeking, and the barriers they faced when attempting to secure LC support. This study presents a pathway for future LC illness research to use a modified candidacy theory framework.

Patient and Public Contribution

This research focuses on amplifying and learning from lived experiences, and the voices of NHS workers in Scotland experiencing LC. Interviews represent primary data for this study; thus, participants and their healthcare journeys are centred in this research and all aspects of production, reporting and output. Explicit discussions of stakeholder group involvement are highlighted in the methods section.

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中断的候选资格：纵向研究苏格兰国民健康服务工作者因长期慢性病而寻求支持的受限医疗服务之旅。

导言：有证据显示，长期慢性阻塞性肺病（Long COVID，LC）患者在出现症状时如何努力获得医疗服务。然而，很少有研究对经历长期慢性阻塞性肺病的医护人员进行调查，也很少有研究调查他们在寻求和接受医疗保健时所面临的复杂和多重困难：本研究基于两个阶段的纵向定性访谈，访谈时间相隔 6 个月，访谈对象是苏格兰国家医疗服务系统（NHS）中经历过长期慢性阻塞性肺病的不同职业的工作人员（第一次访谈，n = 50；第二次访谈，n = 44）：多种因素限制了医疗服务的获取，包括对国家医疗服务系统施压的担忧以及对 LC 合法化的担忧。在寻求医疗保健服务时，工作者很难获得支持、转诊和治疗。原因如下(1) 背景：大流行病医疗保健的限制性背景；(2) 疾病氛围：全科医生对 LC 及其治疗方法知之甚少，将症状归咎于其他原因的趋势，以及不愿意诊断 LC；(3) 对 LC 的认识：医疗保健的可获得性与职业角色认同相关。为了直观地显示和研究医疗保健障碍，应用了候选理论，在医疗保健环境、疾病氛围、意识形成和身份之间进行推论：结论：英国国家医疗服务系统工作人员的复杂历程代表了 "中断候选资格"（Disrupted Candidacy），各候选资格领域的挑战相互交织，限制了他们寻求和接受LC医疗服务。研究结果让我们深入了解了国家医疗服务系统工作人员抵制和放弃寻求医疗保健的原因，以及他们在试图获得 LC 支持时所面临的障碍。本研究为未来的慢性淋巴细胞白血病研究提供了一个使用修改后的候选理论框架的途径：本研究的重点是放大和学习生活经验，以及苏格兰国家医疗服务体系中患有慢性淋巴细胞白血病的工作人员的声音。访谈代表了本研究的主要数据；因此，参与者及其医疗历程在本研究及其制作、报告和产出的各个方面都处于中心地位。方法部分强调了对利益相关者群体参与的明确讨论。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Expectations 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.20

自引率

9.40%

发文量

251

审稿时长

>12 weeks

期刊介绍： Health Expectations promotes critical thinking and informed debate about all aspects of patient and public involvement and engagement (PPIE) in health and social care, health policy and health services research including: • Person-centred care and quality improvement • Patients'' participation in decisions about disease prevention and management • Public perceptions of health services • Citizen involvement in health care policy making and priority-setting • Methods for monitoring and evaluating participation • Empowerment and consumerism • Patients'' role in safety and quality • Patient and public role in health services research • Co-production (researchers working with patients and the public) of research, health care and policy Health Expectations is a quarterly, peer-reviewed journal publishing original research, review articles and critical commentaries. It includes papers which clarify concepts, develop theories, and critically analyse and evaluate specific policies and practices. The Journal provides an inter-disciplinary and international forum in which researchers (including PPIE researchers) from a range of backgrounds and expertise can present their work to other researchers, policy-makers, health care professionals, managers, patients and consumer advocates.