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Illness identity as an important component of candidacy: Contrasting experiences of help-seeking and access to care in cancer and heart disease

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  • Macdonald, Sara
  • Blane, David
  • Browne, Susan
  • Conway, Ellie
  • Macleod, Una
  • May, Carl
  • Mair, Frances

Abstract

How and when we use health services or healthcare provision has dominated exploration of and debates around healthcare access. Levels of utilisation are assumed as a proxy for access. Yet, focusing on utilisation conceals an important aspect of the access conundrum: the relationships that patients and potential patients have with the healthcare system and the professionals within those systems. Candidacy has been proposed as an antidote to traditional utilisation models. The Candidacy construct offers the ability to include patient-professional aspects alongside utilisation and thus promotes a deeper understanding of access. Originally applied to healthcare access for vulnerable populations, additional socio-demographic factors, including age and ethnicity, have also been shown to influence the Candidacy process. Here we propose a further extension of the Candidacy construct and illustrate the importance of illness identities when accessing healthcare. Drawing on a secondary data analysis of three data sets of qualitative interviews from colorectal cancer and heart failure patients we found that though similar access issues are apparent pre-diagnosis, diagnosis marks a critical juncture in the experience of access. Cancer patients describe a person-centred responsive healthcare system where their patienthood requires only modest assertion. Cancer speaks for itself. In marked contrast heart failure patients, describe struggling within a seemingly impermeable system to understand their illness, its implications and their own legitimacy as patients. Our work highlights the pressing need for healthcare professionals, systems and policies to promote a person centred approach, which is responsive and timely, regardless of illness category. To achieve this, attitudes regarding the importance or priority afforded to different categories of illness need to be tackled as they directly influence ideas of Candidacy and consequently access and experiences of care.

Suggested Citation

  • Macdonald, Sara & Blane, David & Browne, Susan & Conway, Ellie & Macleod, Una & May, Carl & Mair, Frances, 2016. "Illness identity as an important component of candidacy: Contrasting experiences of help-seeking and access to care in cancer and heart disease," Social Science & Medicine, Elsevier, vol. 168(C), pages 101-110.
    • Handle: RePEc:eee:socmed:v:168:y:2016:i:c:p:101-110
    DOI: 10.1016/j.socscimed.2016.08.022
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    References listed on IDEAS

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    1. Martyn Hammersley, 2010. "Can We Re-Use Qualitative Data via Secondary Analysis? Notes on Some Terminological and Substantive Issues," Sociological Research Online, , vol. 15(1), pages 47-53, February.
    2. Gott, M. & Small, Neil & Barnes, Sarah & Payne, Sheila & Seamark, David, 2008. "Older people's views of a good death in heart failure: Implications for palliative care provision," Social Science & Medicine, Elsevier, vol. 67(7), pages 1113-1121, October.
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    1. Samantha Batchelor & Emma R. Miller & Belinda Lunnay & Sara Macdonald & Paul R. Ward, 2021. "Revisiting Candidacy: What Might It Offer Cancer Prevention?," IJERPH, MDPI, vol. 18(19), pages 1-14, September.
    2. Kathleen Markey & Anne MacFarlane & Maria Noonan & Mairead Moloney & Susann Huschke & Kate O’Donnell & Claire O'Donnell & Teresa Tuohy & Ahmed Hassan Mohamed & Owen Doody, 2022. "Service User and Service Provider Perceptions of Enablers and Barriers for Refugee and Asylum-Seeking Women Accessing and Engaging with Perinatal Mental Health Care Services in the WHO European Region," IJERPH, MDPI, vol. 19(2), pages 1-10, January.
    3. Mackintosh, Nicola & Gong, Qian (Sarah) & Hadjiconstantinou, Michelle & Verdezoto, Nervo, 2021. "Digital mediation of candidacy in maternity care: Managing boundaries between physiology and pathology," Social Science & Medicine, Elsevier, vol. 285(C).
    4. Oluwafemi Adeagbo & Kammila Naidoo, 2021. "Engaging the ‘Missing Men’ in the HIV Treatment Cascade: Creating a Tailored Intervention to Improve Men’s Uptake of HIV Care Services in Rural South Africa: A Study Protocol," IJERPH, MDPI, vol. 18(7), pages 1-8, April.
    5. Liberati, Elisa & Richards, Natalie & Parker, Jennie & Willars, Janet & Scott, David & Boydell, Nicola & Pinfold, Vanessa & Martin, Graham & Jones, Peter B. & Dixon-Woods, Mary, 2022. "Qualitative study of candidacy and access to secondary mental health services during the COVID-19 pandemic," Social Science & Medicine, Elsevier, vol. 296(C).

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