Goals for living with a chronic condition: The relevance of temporalities, dispositions, and resources

Abstract

Introduction: Premised on the idea that setting goals motivates action and allocation of resources toward a desired future state, goal-setting has become a key component of self-management support. The notions that underpin goal-setting situate self-management firmly within the control and responsibility of individuals. Yet, we argue that goals are not solely individual pursuits to be achieved if individuals have the right knowledge and enough motivation; rather, they are social products, influenced by individual and collective subjectivities, which are structured over time. Objective: Drawing primarily on Bourdieu's concept of habitus, along with capital and field, we examine how goals are constructed in self-management support encounters. Method: Seventeen patient-professional dyads comprising 15 patients and 11 health professionals were inter- viewed on up to three occasions. In total 64 semi-structured interviews were conducted between 2015 and 2017 in Sydney, Australia. Results: Goals were manifested through patient participants' expressions of goal agency (as self-owned wants and opportunities; responsibilities to self and others; or necessities); goal-oriented dispositions (determined; re- sponsible; or powerless); temporal orientations (past, present or future); and access to resources to support self- management. These characteristics were grouped into three typologies: ‘Goals as opportunities'; ‘From goals to responsibilities’; and ‘Necessities when living precariously’. Conclusions: The way goals were constructed was structured over time by present experiences superimposed on past experiences and access to resources. These findings help broaden understandings of the tensions between patient and professionals’ goals for living well with chronic conditions and draw attention to the need for structural change to support people to live well with their chronic conditions.