Dialogued into being: Constructing knowledge about hand osteoarthritis from a polyphony of voices in healthcare encounters

ABSTRACT

Purpose

Multiple knowledge sources inform healthcare. In healthcare encounters, patients and health professionals’ ideas intersect to understand illness and disease. Exploring what is thought of as legitimate knowledge, and where those reflections come from is central to the process of improving and developing healthcare. Within this context, we aim to explore how knowledge about hand osteoarthritis (OA) is constructed and negotiated in clinical consultations.

Methodology

The article is based on interviews with 21 patients and 14 health professionals in combination with observation in 16 clinical consultations. Reflexive thematic analysis was used to interpret the data.

Results

We generated four themes from codes to tell an interpretive story about how hand OA meaning-making is “talked into being” in patient-provider encounters: from the dominant voice of health professionals, from patients as knowers in the chronic healthcare dialogue, from health professionals and patients constructing knowledge together and from the construction of knowledge in hybrid positions when patients are health professionals and health professionals have hand OA.

Conclusion

New knowledge about hand OA is co-constructed in the situated context of the clinical encounter through a polyphony of voices—some of which are dominant, while others occupy the periphery—within and between the interactants in dialgue.

KEYWORDS:

• Reflexive thematic analysis
• dialogue
• clinical encounters
• health professional knowledge
• experiential knowledge
• knowledge construction

Acknowledgments

The authors would like to thank all the participants for their valuable time and insights.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data not available due to ethical restrictions.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17482631.2024.2330221

Additional information

Funding

The overall project is funded by the Research Council of Norway [Grant 300823/H40].

Notes on contributors

Hege Johanne Magnussen

Hege Johanne Magnussen is a PhD student and a physiotherapist with a master’s degree in international community health. Her research focuses on the organization of healthcare work.

Ingvild Kjeken

Ingvild Kjeken is professor in occupational therapy at Oslo Metropolitan University, senior researcher at the National Advisory Unit of Rehabilitation in Rheumatology at Diakonhjemmet Hospital and leads the work package “Empowering the individual” in the REMEDY centre, which is a clinical research centre for treatment of Rheumatic and Musculoskeletal Diseases. She has extensive clinical and research experience within rheumatology, occupational therapy, and rehabilitation.

Irma Pinxsterhuis

Irma Pinxsterhuis is an Associate Professor at Oslo Metropolitan University and Occupational Therapist. Research focus on complex interventions in health and rehabilitation services with an emphasis on services for individuals with chronic fatigue, including the Activity Calculator. She is particularly interested in municipal health and care services research and interventions that span across services and sectors.

Trine Amalie Sjøvold

Trine Amalie Sjøvold has a Cand Mag in Social Sciences. She is a member of the REMEDY patient council where she contributes experiential knowledge to research projects regarding rheumatic and musculoskeletal diseases. Her research interests include communication and exchange of experiences between patients and health personnel, and to make science more available for a broader audience.

Marte Feiring

Marte Feiring has a PhD in Sociology and a BA in Occupational Therapy. She is a Professor of Rehabilitation and Public Health at Oslo Metropolitan University, and a researcher at the National Advisory Unit of Rehabilitation in Rheumatology at Diakonhjemmet Hospital. Her research covers historical, cultural, and critical perspectives on health policies, welfare services, rehabilitation practices, civil movements, including studies of professional and lay knowledge.