Constructing osteoarthritis through discourse – a qualitative analysis of six patient information leaflets on osteoarthritis

BACKGROUND: Health service policy in the United Kingdom emphasises the importance of self-care by patients with chronic conditions. Written information for patients about their condition is seen as an important aid to help patients look after themselves. From a discourse analysis perspective written texts such as patient information leaflets do not simply describe the reality of a medical condition and its management but by drawing on some sorts of knowledge and evidence rather than others help construct the reality of that condition. This study explored patient information leaflets on osteoarthritis (OA) to see how OA was constructed and to consider the implications for self-care. METHODS: Systematic and repeated readings of six patient information leaflets on osteoarthritis to look for similarities and differences across leaflets, contradictions within leaflets and the resources called on to make claims about the nature of OA and its management. RESULTS: Biomedical discourse of OA as a joint disease dominated. Only one leaflet included an illness discourse albeit limited, and was also the only one to feature patient experiences of living with OA. The leaflets had different views on the causes of OA including the role of lifestyle and ageing. Most emphasised patient responsibility for preventing the progression of OA. Advice about changing behaviour such as diet and exercise was not grounded in lived experience. There were inconsistent messages about using painkillers, exercise and the need to involve professionals when making changes to lifestyle. CONCLUSION: The nature of the discourse impacted on how OA and the respective roles of patients and professionals were depicted. Limited discourse on illness meant that the complexity of living with OA and its consequences was underestimated. Written information needs to shift from joint biology to helping patients live with osteoarthritis. Written information should incorporate patient experience and value it alongside biomedical knowledge

Optimising a sampling design for endangered wetland plant communities: another call for adaptive management in monitoring

Effective monitoring requires clear questions and a well-designed sampling regime. However, objectives often evolve over time which can render the initial sampling design ineffective. Using a vegetation monitoring program employed in Newnes Plateau Shrub Swamps, Australia, as a case study, we examine a sampling design based on small numbers of 400 m2 plots to assess if it can meet the stated monitoring objectives of detecting significant changes in number and abundance of species per wetland. To determine this, we intensively sampled four monitored wetlands using randomly distributed 4 m2 plots to obtain representative estimates of species composition and abundance. The 400 m2 plots captured 91 % of the common species and a similar proportional distribution of life-forms as found in the 4 m2 plots, but missed 62 % of the sparse species found in 4 m2 plots. Insufficient replication of 400 m2 plots made detection of statistically significant changes at the swamp scale difficult or impossible. Our review showed the weak sampling design was contributed to by 1) an initial lack of clearly stated management triggers and 2) changes in monitoring objectives and triggers over time, without revising the sampling design. We highlight the need for an adaptive approach to monitoring

We have to live in the future

ABINGDON, U