Publikationer

Various kinds of user and patient involvement are spreading in healthcare in most Western countries. The purpose of this study is to critically assess the actual conditions for patients’ involvement in healthcare practice in Greenland and to point to possibilities for development. Patients’ perspectives on their own conduct of everyday life with illness and their possibilities for participation when hospitalized are examined in relation to the conditions in a hospital setting dominated by biomedical practice. On a theoretical level, it is argued that the concept of ‘participation’ is preferable to the concept ‘involvement’ in healthcare. The study shows that there are several interconnected areas for development: the structural frames of hospital practice, including professionals’ possibilities for handling patient participation, and the agency of the patients conducting their everyday lives when hospitalized. Consequences of the biomedical hegemony are discussed in relation to WHO´s broader approach to disease, illness and health and the still existing postcolonial traces of power and hierarchy. Finally it is argued that patient participation during hospitalization will promote the patients´ conduct of everyday life, the cultural knowledge of the professionals, and the democratization of the healthcare sector. Such changes might be connected to a more encompassing democratic societal development – in Greenland as well as globally.

The growing incidence of chronic diseases and an ageing population, worldwide as well as in Greenland, call for an intensified focus on health promotion and rehabilitation. However, research shows that the existing disease-oriented healthcare system is not geared to manage the psychosocial problems of chronically ill or disabled citizens. The problem is related to the prevailing biomedical institutional structures where expert- and professional knowledge trumps the knowledge and perspectives of the users of the institutions. Speaking about health in the broad sense of WHO, there is a need for an intensified focus on wellbeing, not only physical health. The chapter presents the visions for an ongoing research project in Sermersooq Municipality.

The research aims at developing knowledge about the citizens’ everyday lives with illness or disabilities, their cultural values and perspectives. Involving this kind of knowledge in professional practice requires the professionals’ reflection on means and ends in a welfare institution like home care. Welfare-professional contributions are meant to support citizen participation in social living. Therefore, professionals must learn about citizens’ social and cultural conditions for managing their lives.

Furthermore, the project aims at revealing and describing the conditions for professional practice as a contribution to the professionals’ abilities to analyze their practice.

The material is developed through participant observations in the municipality and the citizens’ homes, and qualitative interviews with citizens, care personnel, therapists, and leaders on different levels.

The expected outcome is a set of tools for professional practice reflection following the principles described above.

The background of the study reported in this chapter was the growing number of chronically ill patients. The purpose was to explore patients’ perspectives on life with chronic illness and how it relates to healthcare practice. The research was conducted as an ethnographic field study. A conclusion of the study is that the disease-oriented healthcare system is not geared to deal with rehabilitation because of a narrow focus on disease and treatment, and the exclusion of patients’ knowledge. However, knowledge about patients’ everyday life and perspectives hold potentials for rehabilitative and health promotional professional interventions.