The problem with self-management: Problematising self-management and power using a Foucauldian lens in the context of stroke care and rehabilitation Article Swipe
Simon Fletcher
,
Stefan Tino Kulnik
,
Sara Demain
,
Fiona Jones
·
YOU?
·
· 2019
· Open Access
·
· DOI: https://doi.org/10.1371/journal.pone.0218517
YOU?
·
· 2019
· Open Access
·
· DOI: https://doi.org/10.1371/journal.pone.0218517
Self-management is a concept which is now firmly established in Western healthcare policy and practice. However, the term remains somewhat ambiguous, multi-faceted and contentious. This is evident in stroke care and rehabilitation, in which a self-management approach is increasingly adopted and advocated, yet interpreted in different ways, resulting in contradictions and tensions around control, responsibility, power and discipline. This paper aims to further our understanding of tensions and contradictions in stroke self-management, by critically examining contemporary self-management practices. We use a Foucauldian theoretical lens to explore the various power dynamics in the operationalisation of self-management, in addition to the complexity of the term self-management itself. Conducting a secondary analysis of interview and focus group data from the Self-Management VOICED study, supplemented with analysis of relevant documentary evidence from policy and practice, we describe the multiple aspects of power in operation. These include rhetorical, hierarchical, personal and mutual forms of power, representing interweaving dynamics evident in the data. These aspects of power demonstrate underlying agendas and tacit and explicit understandings of self-management which exist in clinical practice. These aspects of power also give insight into the multiple identities of 'self-management', acting as a simultaneous repressor and liberator, directly in keeping with Foucauldian thinking. The findings are also consistent with Foucault's notions of bodily docility, discussions around governance and biopower, and contemporary discipline. Our analysis positions self-management as a highly nuanced and complex concept, which can fluctuate in its conceptualisation depending on the structures, routines, and the individual. We encourage healthcare professionals, policymakers and commissioners in the field of self-management to reflect on these complexities, to make transparent their assumptions and to explicitly position their own practice accordingly.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1371/journal.pone.0218517
- https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0218517&type=printable
- OA Status
- gold
- Cited By
- 36
- References
- 44
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W2905071552
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W2905071552Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1371/journal.pone.0218517Digital Object Identifier
- Title
-
The problem with self-management: Problematising self-management and power using a Foucauldian lens in the context of stroke care and rehabilitationWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2019Year of publication
- Publication date
-
2019-06-19Full publication date if available
- Authors
-
Simon Fletcher, Stefan Tino Kulnik, Sara Demain, Fiona JonesList of authors in order
- Landing page
-
https://doi.org/10.1371/journal.pone.0218517Publisher landing page
- PDF URL
-
https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0218517&type=printableDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
-
https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0218517&type=printableDirect OA link when available
- Concepts
-
Context (archaeology), Stroke (engine), Rehabilitation, Medicine, Power (physics), Power management, Physical medicine and rehabilitation, Physical therapy, Physics, Biology, Thermodynamics, Paleontology, Quantum mechanicsTop concepts (fields/topics) attached by OpenAlex
- Cited by
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36Total citation count in OpenAlex
- Citations by year (recent)
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2025: 8, 2024: 8, 2023: 6, 2022: 7, 2021: 5Per-year citation counts (last 5 years)
- References (count)
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44Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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