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Paternalism and some empowerment
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| Narratives related to empowerment were few. Nevertheless, some of them indicated that paternalism was still pervasive (Narrative 1),
15
and in this case, there was virtually no “decisional control.”
57
Carnes et al. also revealed a similar situation (Narrative 2).
9
In other interviews with patients carried out by Pescheny et al., empowerment was also observable—to a certain extent—in the sense that the decision in favor of SP (e.g., in contrast to medication) is left to the patient's judgment (Narratives 3, 4).
15
In most cases, the patients referred to SP appeared to have made judgments, “hoping for the future.”
57
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If, I mean, even if possibly another doctor would have recommended it, the thing is I know [name of GP]. We know each other for so long, I trust him. And I trust him that he knows me well enough, so I said ‘yeah okay’. (Service user 3)
15
My GP knows me so well he probably just referred me because he thought it would be good for me. (Practitioner partially engaged)
9
One question was: ‘Do I need help?’ And my answer was: ‘Definitely yes!’ And it all sort of started from there really. (Service user 2)
15
Well, I do not want to pop any more pills than I have to. I regard pills as a short‐term solution and I thought this [social prescribing] is something more than a short‐term solution. I mean happy pills might get me through the winter, but what then? (Service user 3)
15
|
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Empowered by someone more empowered
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| Face‐to‐face consultation between a patient, on the one hand, and a link worker (SP coordinator) who is more empowered, on the other,
50
,
51
provides the patient with necessary information, builds trust between them, generates an opportunity for the patient to be empowered to explore his or her needs and aspirations, and coproduces solutions for his or her benefit. Thus, support by a link worker appeared indispensable to allow patients to be empowered to make decisions, as no one would be able to be empowered by another person himself or herself not empowered (Narratives 1, 2).
10
,
13
|
-
5
I just expected the Link Worker to introduce me to the gym, and that would have been it. And I think, if it had just been [that] I would have turned round, and I would have gone the opposite direction. But because of the way it was so gradually and really professionally linked in to different things, I just felt as though I'd floated into it, rather than getting shoved from behind. I just felt as though I was gradually moved into it. (P2, female, 70–74 years)
10
-
6
It would have been much nicer if they [social prescribing coordinators] had had a conversation face‐to‐face cause it felt like I was sitting there and they were at the desk trying to write everything down quickly…I think a better way would be someone is giving you eye‐contact rather than just writing things down and you’re thinking what are they writing? (service user)
13
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