Meaning-making in integrative health care : studies on patients’ and practitioners’ experiences
Andermo, Susanne
2017-02-23
13.00
H2 Grön, Alfred Nobels allé 23, Karolinska Institutet, Flemingsberg
Inst för neurobiologi, vårdvetenskap och samhälle / Dept of Neurobiology, Care Sciences and Society
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 ofinterdisciplinary forms of health care.