Narratives of Aging and Patient Activation

207 Pages·2017·2.39 MB·English

Antioch University
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Dissertations & Theses
2016
Narratives of Aging and Patient Activation
T. A. Hulslander
Antioch University, New England
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Hulslander, T. A., "Narratives of Aging and Patient Activation" (2016).Dissertations & Theses. 283.
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Running head: NARRATIVES OF AGING AND PATIENT ACTIVATION

Narratives of Aging and Patient Activation

by
T. A. Hulslander

B.A., Keene State College, 2007
M.A., Antioch University New England, 2011
M.S., Antioch University New England, 2014

DISSERTATION

Submitted in partial fulfillment for the degree of
Doctor of Psychology in the Department of Clinical Psychology
at Antioch University New England, 2016

Keene, New Hampshire
ii

DIDSSeEpaRrTtmAeTnItO oNf CCliOnMicaMl PITsyTcEhEol PogAyG E

The undersigned have examined the dissertation entitled:
NARRATIVES OF AGING AND PATIENT ACTIVATION

presented on January 15, 2016

T. A. Hublys lander
Candidate for the degree of Doctor of Psychology
and hereby certify that it is accepted*.

Dissertation Committee Chairperson:
Roger L. Peterson, PhD, ABPP

Dissertation Committee members:
Cynthia Whitaker, PsyD
ThAocmceasp tSeteda brnys t,h Peh D

Department of Clinical Psychology Chairperson
1/1 5/16
George Trem blay, PhD
* on
Signatures are on file with the Registrar’s Office at Antioch University New England.
NARRATIVES OF AGING AND PATIENT ACTIVATION iii

Dedication
To my father, Phil, the cleverest man I ever met.
And to Maureen—my wife, my friend, my inspiration.
iv

Acknowledgements
Many thanks to my dissertation committee members: Drs. Thomas Stearns, Cynthia
Whitaker, and Roger Peterson for your encouragement and support. Dr. Stearns, thank you for
the many discussions we had, which led me to the topic at hand; Dr. Whitaker, your supervision,
your friendship, and your faith have meant so much to me; And Dr. Peterson, I could not have
had a better advisor in the doctoral program. The combination of your professionalism and
personal interest in my success has made this a wonderful journey.
My heartfelt thanks go out also to my Antioch cohort, some of the most talented and
caring people I have ever had the pleasure to know. You have inspired me to imagine a better
tomorrow.
And finally, I would like to acknowledge Dr. Homer (Tony) Stavely, who many years
ago sparked my imagination with a brief comment he scribbled on one of my undergraduate
papers. I cannot recall the note in its entirety, but it ended with, “in your future life as a scholar.”
I do believe it was there in that moment that the road began to turn.
NARRATIVES OF AGING AND PATIENT ACTIVATION
Table of Contents
Dedication ..........................................................................................................................................iii
Acknowledgements ............................................................................................................................iv
Abstract ..............................................................................................................................................1
Chapter 1: Introduction ......................................................................................................................2
Chapter 2: Literature Review .............................................................................................................5
Key Constructs .......................................................................................................................6
Patient activation ........................................................................................................6
Older adults ................................................................................................................6
Personal narrative.......................................................................................................7
Social discourse .........................................................................................................7
Social Construction as a Conceptual Framework ..................................................................8
Rationales for a constructionist framework ...............................................................8
Evidentiary .....................................................................................................9
Social justice ..................................................................................................10
Pragmatic .......................................................................................................10
Application to Clinical Psychology .......................................................................................11
An aging US population.............................................................................................11
Clinical intervention implications ..............................................................................13
Critical Intersections with Other Domains within Clinical Psychology ................................14
Relationship ...............................................................................................................15
Diversity .....................................................................................................................16
Ethics..........................................................................................................................16
NARRATIVES OF AGING AND PATIENT ACTIVATION
Competence....................................................................................................16
Human relations .............................................................................................17
Developmental psychology ........................................................................................18
Research Questions ................................................................................................................20
Methodology ..........................................................................................................................21
Rationale for IPA .......................................................................................................21
Phenomenology..............................................................................................22
Hermeneutics .................................................................................................24
Idiography ......................................................................................................25
Participants and Sampling Methods and Rationales ..................................................26
Purposive sampling ....................................................................................................27
Gathering data through the semi-structured interview ...............................................27
Data analysis ..............................................................................................................33
Data immersion ..............................................................................................33
Initial noting ...................................................................................................33
Emergent themes ............................................................................................34
Connections across themes ............................................................................34
Repeat process for all cases ...........................................................................34
Connections across cases ...............................................................................35
Ethical Considerations and Informed Consent ..........................................................35
Chapter 3: Methods ............................................................................................................................36
Participants .............................................................................................................................36
Interviews ...............................................................................................................................38
NARRATIVES OF AGING AND PATIENT ACTIVATION
Self of the researcher .............................................................................................................39
Losing my father ........................................................................................................39
Education, clinical training, and philosophy..............................................................40
Age .............................................................................................................................40
Analysis..................................................................................................................................41
Chapter 4: Results ..............................................................................................................................46
General observations ..............................................................................................................46
An Introduction to the Participants ........................................................................................47
Predominant codes .................................................................................................................50
Human relationship ....................................................................................................50
Distancing self from aging peers ...............................................................................51
Ongoing personal development .................................................................................54
Staying physically active ...........................................................................................54
Acceptance .................................................................................................................54
Faith ...........................................................................................................................55
Informed consumer of healthcare ..............................................................................56
Emergent themes ....................................................................................................................57
Distances self from aging peers .................................................................................57
Human relationship ....................................................................................................57
Values: Staying active................................................................................................57
Faith/Spirituality ........................................................................................................58
Ongoing personal development .................................................................................58
Values: Staying sharp (mentally) ...............................................................................59
NARRATIVES OF AGING AND PATIENT ACTIVATION
Acceptance .................................................................................................................59
Concern about future health .......................................................................................59
More free time............................................................................................................60
Proactive in healthcare ...............................................................................................61
Separation between generations .................................................................................61
Adventure ...................................................................................................................61
Money ........................................................................................................................62
Tolerance....................................................................................................................62
Social discourse and personal narratives on aging ................................................................63
Chapter 5: Discussion ........................................................................................................................64
Distancing and acceptance .....................................................................................................64
Acceptance or apathy .................................................................................................66
Power in numbers: A secure base ..........................................................................................67
Ongoing personal development .............................................................................................69
Spirituality and generativity ...................................................................................................70
Limitations and Future Directions .........................................................................................71
References ..........................................................................................................................................73
Appendix A ........................................................................................................................................81
Appendix B ........................................................................................................................................82
Appendix C ........................................................................................................................................85
Appendix D ........................................................................................................................................94
Appendix E ........................................................................................................................................107
Appendix F.........................................................................................................................................198
NARRATIVES OF AGING AND PATIENT ACTIVATION 1

Abstract
I highlight the generally negative social discourse on aging in the United States, which is often
characterized by themes of marginalization and stagnation, and I advocate for a more
developmental view. I propose a conceptual framework of social constructionism to consider
how the intersection between social discourse and personal narrative regarding aging might
influence older adults’ patient activation; Interpretative Phenomenological Analysis (IPA) is an
appropriate qualitative methodology through which to understand these relational dynamics. Key
constructs are defined and evidentiary, social justice, and pragmatic rationales are provided. In a
discussion of the application to clinical psychology I suggests that how the “baby boomer”
generation—the largest birth cohort of the 20th century—navigate older adulthood will have
social implications in how subsequent generations experience aging. Clinical intervention
implications are explored, as are several intersections, including relationship, diversity, ethics,
and developmental psychology. Themes of distancing one’s self from an aging peer group;
ongoing personal development; staying active, both mentally and physically; and acceptance
emerged from conversations with ten older adults ages 60 to 68.
Keywords: patient activation, older adults, depression, social constructionism,
social discourse, personal narrative, Interpretative Phenomenological Analysis