Le présent travail a pour objet une description croisée de la maladie chronique en prenant l'exemple du diabète de type 2. Ce dernier est d'abord saisi par des approches médicales en lien avec l'épidémiologie, la santé publique, le politique et l'économique nommés ici « univers médicaux ». Ces univers médicaux sont l'apanage d'une idéologie néolibérale qui pense l'individu comme rationnel. Il est ensuite appréhendé par les « univers du malade » à partir de témoignages de personnes diabétiques, reflets de la « vraie vie » avec la maladie dans sa dimension sociale. Le diabète de type 2, emblème de la maladie chronique, est une maladie de civilisation, du mode vie, qui atteint les individus dans des dimensions multiples, notamment l'univers du quotidien, comme la sphère domestique ou l'alimentation. Vivre avec la maladie chronique est une épreuve ordinaire qui conjugue autocontrôle et réflexivité, et qui lie malades et soignants de façon répétée et prolongée, mettant en question les rôles de chacun tels que les a définis Parsons dans sa théorie fonctionnaliste. Pour les malades, ces interactions sont autant d'inscriptions dans le social ; elles montrent en quoi le travail de santé est une inscription sociale importante, particulièrement pendant la période de la retraite. Cette confrontation de deux univers permet de mieux comprendre la maladie chronique, décrite comme le visage contemporain de la maladie. Le malade chronique peut être vu comme une figure avancée de l'individu contemporain. Ce travail ouvre des perspectives pour penser une logique du soin, faisant écho aux théories du care. / The aim of this study is to describe chronic illness using the example of type 2 diabetes. Firstly, diabetes is comprehended by a medical approach in connection with epidemiology, public health, politics and economy, here referred to as « medical worlds ». These medical worlds belong to the neoliberal ideology which defines the individual as rational. Then, diabetes is perceived by testimonies given by diabetic people, reflecting « real life » with the illness in its social dimension, here referred to as « patient worlds ». Type 2 diabetes, emblem of a chronic condition, is a disease of civilization, of a way of life, which affects individuals in multiple dimensions of their every day life, such as the domestic sphere and food habits. Living with a chronic condition is a common hardship which associates auto control and reflexivity, and which puts in contact patients and medical actors in a repetitive and prolonged manner. This questions the roles of each as defined in Parsons's functionalist theory. For the patients, these interactions are part of the social world; they show how care working is an important concern, particularly during the retirement period. The confrontation of these two worlds help to understand chronic illness, described as the contemporary face of illness. The chronically ill individual allows to make the hypothesis that he is an advanced figure of the contemporary individual. This work outlines a care logic, which is close to care theories.

The present study was conducted to help understand the impact of living with multiple sclerosis (MS), an unpredictable, chronic illness that is widely known to have a large influence on psychosocial functioning, mental health, and life satisfaction (Motl & Gosney, 2007; Weiner, 2004). Recent research has begun to position certain chronic illnesses, such as MS, as traumatic events that influence mental health in both beneficial and detrimental ways. Thus, the present study investigated the positive and negative consequences of centralizing one’s identity within their MS experiences as related to trauma, growth, and psychosocial influences via a path model with 616 individuals with MS. The results indicate strong support for the hypothesized paths between the variables of interest—centrality of MS, posttraumatic stress, posttraumatic growth, social support, personal mastery, depression, and life satisfaction. Specifically, results indicate that posttraumatic stress and posttraumatic growth partially mediated the relations between centrality of MS with depression and life satisfaction. Moderation analyses indicated that social support and personal mastery did not moderate any relations between centrality of MS with depression and life satisfaction. Rather, additional analyses suggest social support and personal mastery may be viewed as additional mediators between centrality and posttraumatic stress and posttraumatic growth. The results of the present study is the first known study to extend trauma literature to the population of MS in order to provide an approach to help understand the high rates of depression and inconsistent findings on quality of life for this population. Implications for practice, theory and research are discussed.

Magister Artium (Social Work) - MA(SW) / Ever since United Nations’ declaration of 1994 as the Year of the Family, the study and understanding of families has taken center stage, albeit with constant references to ‘normal’ versus ‘deviant’ families based on structural functionalism theory’s rigid definitions of what a ‘normal’ family should be. On the other hand HIV/AIDS has attracted much attention too because of its life threatening traits, especially in Sub-Saharan Africa where Zimbabwe lies. Efforts to fight the epidemic have seen the mushrooming of innovative programs, which include home–based care (HBC) services for those infected with HIV. However, although HIV and AIDS has clearly had adverse impacts on families, it is rarely discussed within perspectives that integrate family dynamics. To fill this gap this study has explored how HBC, as a response to HIV and AIDS, may change our understanding of families. Research data was gathered within the participatory action research design through methods such as focus group discussions by 35 HBC volunteers and patients, interviews of 26 of these, review of relevant family policies and other interactive participatory exercises by which research participants expressed their opinions through drawings. The evaluation showed that households were not always synonymous with families, although a thin line divided the two. Further, survival considerations are the leading priority why people find themselves in families within HBC settings. However, survival options available to women are exploitative and this has kept those in HBC settings reeling under the burden of demanding but unrewarded care work and domestic household jobs. The study teaches that families cannot be understood in aggregated terms and that individuals dictate what families become, not the other way round. The research essentially recommends policy revisions to reflect unique realities found in HBC settings, and among female HBC volunteers. This should be coupled with awareness campaigns in communities and further research on families.

This naturalistic exploratory study focused on Australians living with chronic illnesses who chose to use complementary and alternative medicine (CAM). The purpose of this sociological study was to discover and illuminate the lived experience of using CAM by individuals living with chronic illnesses in an attempt to understand their reasons for choosing CAM for their health care needs within the social contexts of their lives. The research question guiding this qualitative study was: Based upon a reflection of lived experiences, why do individuals living with chronic illnesses choose to use CAM? The major finding of this study was that research participants turned to CAM to find practical solutions for coping with pain and the ongoing demands of living daily lives while suffering and living with chronic illnesses. Unlike existing research findings, participants in this study did not turn to CAM for ideological reasons, nor were they seeking a holistic approach to health and health care. As such, the findings of this study strongly suggest that individuals living with chronic illnesses initially choose to use CAM for pragmatic reasons rather than ideological dispositions. However, the findings also suggest that after their initial use of CAM, individuals appear to adopt, via enculturation processes, more holistic ideologies resulting in modifications to perceptions of self, illness and health. / Doctor of Philosophy (PhD)

This thesis explores, through critical dialogue and personal experience, various aspects of rehabilitation in the context of Myalgic Encephalomyelitis or Chronic Fatigue Syndrome. The journey visits broad, in principle, government policy reports. It touches on insurance and political aspects of health care; the separation between medical, convalescent and tertiary divisions of the rehabilitation professions; and, most importantly, it is concerned with the personal struggle to find some ‘meaning’ in the experience of a chronic illness for which there is, at this stage, no cure. From this arises the complexity of the inter-relationships between professionals and clients and the vexed question of ethics. The writing or methodology is first-person narrative, with deep roots in natural philosophy, and the dissertation can be read on several levels. It can also be read as a meta-thesis, that is, as an illustration of the process of researching/writing in an experiential methodology / Master of Science (Hons) Social Ecology

Inadequate, expensive health care services for the chronically ill, confront the lay person as one of the major forces in the social movement toward self-care. The purpose of this predictive correlational study was to investigate within a theoretical framework derived from Orem's conceptual model of nursing relationships among family as a social support system, exercise of self-care agency, and health status for the person with a chronic illness. The sample group was 51 chronically ill adults diagnosed with diabetes mellitus who attended diabetic instructions from one of the Central Indiana Hospitals. Findings indicated a weak positive correlation between self-care and cohesion and weak negative correlation between health status and cohesion. Findings also revealed significant differences between male and female for the variables self-care and conflict.Conclusions were that this study supported certain relationships proposed by Orem's conceptual model in nursing. Results can guide diabetics in providing optimal daily self-care. Professionals in the health care arena can utilize the results for educational development and encouragement of self-care agency in the adult diabetic. The family members can also clarify roles in supporting the diabetic adult. / School of Nursing

Thesis (M.A.) - Simon Fraser University, 2005. / Theses (Dept. of Psychology) / Simon Fraser University. Also issued in digital format and available on the World Wide Web.

Thesis (M.N.)--Memorial University of Newfoundland, School of Nursing, 2000. / Typescript. Bibliography: leaves 140-150.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Social Work and Social Administration / Master / Master of Philosophy