Supports to improve self-care or self-management are beneficial for many people living with health issues, especially chronic conditions. Yet, socioeconomically marginalized groups have often been neglected from self-management initiatives, despite experiencing an increased prevalence of chronicity and multimorbidity. To this end, there are several established critiques within the self-management literature that are addressed through this dissertation. First, limited attention has been given to equity considerations within self-management, thus there remain gaps in the evidence base around disadvantaged groups. Second, there is a lack of understanding about the mechanisms that make self-management supports work, as well as little evidence to explain the wide extent of non-participation, including understanding the impact of structural barriers. Third, the social embeddedness of self-care has received little attention, despite people highlighting social roles as important concerns within self-care. In addition, the grassroots history of self-care has been neglected, which has resulted in minimal recognition of the role of mutual aid/self-help groups. This dissertation includes two exploratory, qualitative studies that attend to these knowledge gaps: the first explored self-care experiences among people who use drugs with chronic health issues, and the second explored mutual support among people experiencing homelessness within the context of encampments during the COVID-19 pandemic. The study findings are also contextualized by worsening overdose and housing crises. I employed community-based participatory research methods and the transformative framework to contend with social injustice and power imbalance and amplify the worldviews of marginalized groups. We conducted in-depth interviews and reflexive thematic analysis to analyze data. Overarching findings demonstrate the importance of agency in shaping how marginalized groups manage their health and social needs, the critical structural limitations they face in doing so, and the substantial influence of their formal and informal social supports. Thus, findings show the importance of recognizing these groups’ alternative and holistic practices of care, the need to address structural and systemic barriers that inhibit their capacity for care, and the immense value of harnessing social support networks to meet care needs. Programs intended to support self-care among marginalized communities would benefit from incorporating a relational autonomy lens and community-centered approach.
| Identifer | oai:union.ndltd.org:uottawa.ca/oai:ruor.uottawa.ca:10393/44042 |
| Date | 12 September 2022 |
| Creators | Boucher, Lisa |
| Contributors | Kendall, Claire, Liddy, Clare, Leonard, Lynne |
| Publisher | Université d'Ottawa / University of Ottawa |
| Source Sets | Université d’Ottawa |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
| Rights | Attribution 4.0 International, http://creativecommons.org/licenses/by/4.0/ |
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