Meaning-making in integrative health care : studies on patients' and practitioners' experiences

• Background and aim: Patients living with chronic pain often turn both to conventional and complementary health care. Integrative health care combines conventional and complementary therapies in the clinical care of patients. Despite frequent integrative health care services internationally, there are knowledge gaps relating to patients' and practitioners' experiences of integrative health care in different clinical contexts. The overall aim of this thesis was to elucidate patients' and practitioners' meaning-making in integrative health care for persons living with chronic pain, and to develop a first version of a patient instrument measuring existential signs of health and suffering. Methods: The thesis has a qualitative enquiry design with four studies conducted in two different integrative health care settings; in primary health care (studies I and II), and in anthroposophic integrative health care (studies III and IV). Primary care patients' experiences and perceptions were explored in focus group discussions (n=11) and analysed with latent content analysis (I). The collaborative process of integrative primary care practitioners in patient conferences (n=15) was analysed with discourse analysis (II). Individual interviews (n=15) concerning the meaning of caring were conducted with practitioners of anthroposophic integrative health care and analysed using phenomenological hermeneutics (III). The patient instrument was developed in three phases; first, interview data from patients (n=64) who had received anthroposophic integrative health care were used to develop an item pool, secondly, cognitive patient interviews (n=8) and third, expert consultations (n=5) were used to refine the instrument. Results: Patients experienced being encountered as whole persons in integrative primary care, a model of care that despite some collaboration and financial challenges was characterised by a valuable combination of bio-medical diagnostics and empowering self-help strategies (I). The shared meaning-making among integrative health care practitioners in primary care was interpreted as a basis for collaboration and caring that enabled a synergetic process contributing to the formation of an enhanced team identity over time (II). Anthroposophic integrative health care practitioners' use of a shared language, including certain concepts, seemed to extend the practitioners' understanding of patients' health, suffering and caring, and their existential dimensions (III). The patient instrument was based on two interrelated dimensions, the existential signs of “Health" and "Suffering", which were characterised by five domains: “Life passion and energy”, “Personal freedom”, “Presence in life”, “Relationships” and “Meaning” (IV). Conclusion: The findings suggest that patients’ and practitioners’ meaning-making in integrative health care relates not only to biopsychosocial aspects but also to existential dimensions of health and suffering, which can have implications for caring of persons with pain. Integrative health care practitioners' integrated collaboration and use of shared concepts may contribute to their ability to understand and alleviate pain patients’ suffering and to facilitate broader whole person perspectives of care. This understanding, taken together with the developed patient instrument that measure existential signs of health and suffering, can be used to further inform the evaluation and development of interdisciplinary forms of health care.

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