Policy-makers in many western countries have promulgated the concept of self-management as a cornerstone in modern health care. This is presented as people's desire to being empowered to take care of their own health (Department of Health, 2010
) but, in contrast, its centrality in policy can be interpreted as a driver to reduce demand (Poortinga, 2006
). A considerable body of research has accumulated assessing the claims of self-management. First, the term tends to be used in many different ways and is often interchangeable with the term self-care. The most commonly used term defines self-management as
individuals making the most of their lives by coping with difficulties and making the most of what they have. It includes managing or minimising the way conditions limit individuals’ lives as well as what they can do to feel happy and fulfilled to make the most of their lives despite the condition. (Department of Health, 2008
Secondly, individuals with chronic conditions generally do not use this terminology and Kendall and Rogers argue that it is not a purposive action that stops when people consult formal health care. Rather, medical care operates alongside what people do for themselves (2007), and the “work” required to manage a long-term illness has been highlighted by Corbin and Strauss (1988
) and Bury, Newbould, and Taylor (2005
). They distinguish between “illness work” that includes managing one's symptoms and preventing crises, “everyday life work” encompassing daily tasks such as employment or childcare, and “biographical work” that involves making sense of the impact of illness on one's sense of self (Bury et al., 2005
). Building on these concepts, self-management can be better defined as the mobilisation of resources and the maintenance of normal activities and relationships in the face of an altered situation (Rogers, Lee, & Kennedy, 2007
). Third, health care practitioners have a more instrumental approach to self-management as a way to share responsibility with patients (Blakeman, Macdonald, Bower, & Gatley, 2006
). A recent study found that the topic of self-management in primary care consultations was constrained because health care professionals wanted to protect the relationship of self to the other; that is, they avoided topics that could create tension and endanger the longer-term doctor-patient relationship (Blakeman, Bower, Reeves, & Chew-Graham, 2010
Claims that self-management is a new concept can be countered when looking at the literature on chronic illness (Bury, 1991
; Charmaz, 1983
; Faircloth, Boylstein, Rittman, Young, & Gubrium, 2004
). From that it becomes clear that people develop strategies to cope with disease symptoms and their impact on everyday life, and that these include sophisticated decision-making about the use of health care alongside self-management. Furthermore, they carefully balance the interplay between the professional and lay systems.
In this paper, we focus on the meaning and enactment of self-management in everyday life. Knee osteoarthritis (OA) is used as an exemplar, because it allows for comparison with chronic conditions generally, showing both similarities but also important differences related to the nature and meaning of the condition. Like many chronic conditions knee OA has consequences for people's everyday life and to their biography in relation to symptoms. Simultaneously, people consider OA as part of normal ageing rather than a disruption to biography (Sanders, Donovan, & Dieppe, 2002
) and many older people with OA actually rate their health as “good for their age” and thus do not necessarily see the condition as an illness (Grime, Richardson, & Ong, 2010
). In the case of OA many people do not consult health care professionals because they feel that little is offered in terms of effective treatment, particularly if their joint pain is classed as “wear and tear” by health professionals (Gignac et al., 2006
) or because they make a clear distinction about “normal” pain and symptoms that can be managed routinely (Grime et al., 2010). The way in which OA is conceptualised by the people who suffer with joint pain sets it apart from other chronic conditions in that they are more inclined to see self-management as a normal strategy that is integrated within their daily life (Morden, Jinks, & Ong, 2011
). This may lead to obscuring the actual hard work that is involved in living with the disruptive aspects of the condition and our paper attempts to surface this work, and how it is similar or different from that required in chronic illness generally.
In order to provide a conceptual framework we first discuss the notion of the “work of self-management” as part of this introduction, followed by an explanation of the empirical study on which our argument is based. A detailed analysis of the way in which people develop and operationalise self-management using their accounts is then provided, drawing on a number of theoretical concepts from the social science literature. We will end with arguing that the emotional and embodied work involved in self-management needs to be recognised alongside the other types of work already identified by Corbin and Strauss (1988
) and Bury and colleagues (2005) and how this specifically relates to knee OA.