An ethnographic study of support groups : The pain accounts of older members.

The government of the United Kingdom (UK) has signalled that people with long term conditions such as chronic pain should be supported to self manage their conditions. A review of the literature reports that self management of chronic pain can impact on the psychological and physical well being of those who are experiencing long term painful conditions. The UK government (DoH, 2001) suggests that support groups can help recruit participants to self management courses such as the Expert Patient Programme and Challenging Arthritis. The government (DoH, 2001) also recognises the importance of local access to self care information and support networks that support groups can offer. However review of the literature reveals that support groups can offer more and have an impact on the psychological as well as physical wellbeing of those experiencing chronic pain. The literature also revealed that there has been little research into the impact of support group memberships on the lives of older adults. Increasing the knowledge of the functions of support groups can be used to offer older adults choice and help motivate them to become members of support groups. The socially constructed definition of older adults defined in the National Service Framework (DoH, 2001) includes those who are aged 55 years or older and will be used in this current study. The aims of this study are: To identify the purpose of support groups from the perspective of older adults members. To determine the motivation and routes that are taken by older adults to join support groups. To explore the provision within support groups of the four elements of social support identified by Langford et al (1997) which include; informational, emotional, appraisal and instrumental. To examine the impact that support group membership has on the chronic pain self management activities of older adults. To identify the location within an individual's chronic pain trajectory of when they are likely to benefit from group membership group members.This ethnographic study used participant observation and semi-structured interviews to generate accounts of older adults' perspectives of support groups. To prevent authoritarianism a partial feminist approach was used. Purposive sampling was used to select older adult participants (=9) from three chronic illness support groups. Schema analysis (Ryan and Bernard, 2003) was used to collapse the data into thematic groups, schema analysis has similarities to grounded theory (Strauss and Corbin, 1998) in that it discovers links themes into theoretical models.The sampled support groups in this study had representation of older adults but this was limited to white Irish or white British despite being located in areas with diverse ethnic populations. There was also an identification of a core group of members in each of the sampled groups. The core group consisted of members who attended the meeting regularly and contributed to the voluntary activities of the group as well as the committees.The data analysis from the interviews revealed that participants were also experiencing co-morbid illnesses and these were not reported as being bothersome and were affectively self managed by the individual. The perceived dominant illness was one of the motivating factors for joining the support group. There was also evidence of perseverance, living life despite the chronic pain and locus of control. The motivation to join the support group had already been reported in the literature such as a response to an information deficit, social networking and starting the group and recommendations by healthcare professionals. However there was also evidence of philanthropy which has not previously been reported, this impacted positively on the participants quality of life because of their ability to contribute within society. The interviews also identified three selves within the chronic pain trajectory including; the past self, the chronic pain self and the present self The present self is identified as the location within the chronic pain trajectory which benefits from support group membership.The provision of social support offered by the groups consisted of four components (Langford et al, 1997) which are informational, emotional, instrumental and appraisal support. Previous support group studies have only focused on informational and social support which has been reported separately.This thesis adds to the body of knowledge about the activities of support groups for long term conditions and their contribution to the support of older adults experiencing painful conditions. New findings suggest that support groups can be affective at certain points within the chronic pain trajectory and that co-morbid illnesses are demonstrated to be effectively managed by the individual. The findings also identify the social support activities that have not been previously reported in the reviewed literature but are present within support groups.