A female lay perspective on health, disease, and sickness absence

• Background: Knowledge about a female perspective on health and disease is important to understand what happens in e.g. the medical meeting. A deeper understanding for the phenomenon of health also has social and economic importance. In Sweden women account for about 60% of the long-term cases of sickness absence.Aim: To explore and describe women's perceptions of health and disease and their accounts of sickness absence.Methods: The chronic diseases mentioned by elderly women in an interview study are compared with those documented in their respective medical records (n=199). The prevalence of positive diagnoses, overall agreement, and the kappa-coefficient were calculated for each group of diagnoses. Semi-stmctnred interviews were conducted with 82 women who had been on sick leave (60 days or more) or who had disability pension. Sixty of these middle-aged women also carried out a Q-sort.Results: The lowest overall agreement between the elderly women report during interviews and their medical records was observed for psychiatric diseases, followed by diseases of the gastrointestinal system. Poor chance-adjusted agreement was found concerning diseases of the gastrointestinal system and diseases of the skin (Paper I). Long-term sickness absence can be said to arise in three distinguishable "spaces": the workspace, the medical-legal space, and the mental space. In the beginning, the women were positive about sick leave as such, which they saw as an opportunity for physical rest. But as time went on, they came to regard sick leave as creating a vicious circle of new problems related to inactivity and isolation. Apart from this vicious circle and chronic physical impairments, certain conditions at the workplace, at the hospital, and the social insurance office transformed seemingly trivial sick leaves into long-term and irreversible sickness absences (Paper II). The women's accounts of being sickness absent contained interpretations of what had happened to them, how things were for the moment, and what they thought the future would bring. Three different accounts could be distinguished: the crisis, the breakpoint, and the migration. The perceptions of their own situation and especially what they thought about their future were associated with their feelings of power to initiative and well-being. The descriptions of life on sick leave are connected to a theory of "loss of work" (Paper III). For these women, to be able to get back to work was found to be equivalent to breaking away from the prospect of isolation and loneliness. Five actors were identified along with suggestions for their actions: the woman who is on sick leave herself, the employer, the health care provider, the social insurance official, and the shop-steward. It was found important to take oneself seriously and also to be taken seriously by others. The results are related to a theory of enduring and suffering (Paper IV). Six accounts representing different conceptions of health, illness, and medicine were identified and described (Paper V).Conclusions: The results point to the importance of doing research from different perspectives, using different methods and different sources of information to obtain a deeper understanding of a complex phenomenon like health. Above all, the results presented in this thesis point to a large variation at the individual level in perceptions, which implies the need for care in, for example, the planning of rehabilitation programs. The results also highlight the point that sick leave without follow-up from work, health care, and the social insurance office might have negative consequences on health. Implications for practice are suggested along with proposals for future research.

Nyckelord

sickness absence

sick leave

women

lay explanation models

phenomenology

interview

Q-methodology

account

health

vital goal

life plan

sense of coherence

prevention

rehabilitation

diagnosis

medical records

patients

medical decision making

MEDICINE

MEDICIN

Publikations- och innehållstyp

vet (ämneskategori)

dok (ämneskategori)