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

Figures & data

Table I. Summary participant demographics.

	Occupational therapist (8)	Rheumatologist (6)	Patients participating in interviews (21)	Patients participating in observations (16)
Gender
Male	1	1	6	5
Female	7	5	15	11
Age
Under 40	4	1	–	–
40–55	1	4	1	6
Over 55	3	1	20	10
Years of professional and/or lay experience with hand OA
Under 2	3	–	–	3
2–20	2	5	21	8
Over 20	3	1	–	1
Not known	–	–	–	4

Table II. Data generation summary.

Data source	Hospital A	Hospital B
Interviews with patients	9	12
Interviews with health professionals	Rheumatologists (3) Occupational therapists (3)	Rheumatologists (3) Occupational therapists (5)
Observation in clinical consultations	Clinical consultations rheumatologists and persons with hand OA (0)	Clinical consultations rheumatologists and persons with hand OA (5)
	Clinical consultations occupational therapists and persons with hand OA (4)	Clinical consultations occupational therapists and persons with hand OA (7)

Table III. Example of the analytical process from familiarization to codes to themes development.

Examples familiarization notes
Diverse explanatory models of health, illness and disease intersect in the construction of knowledge about hand OA. Knowledge about hand OA is generated through conversations with others in similar situations. Past experiences direct the understanding of hand OA in current consultations. Patients and health professionals complement each other in understanding hand OA. Uneven relationship when patients navigate unfamiliar terrain while health professionals operate on their own turf of the hospital. Health professionals and patients generate solutions to patient problems together. Chronic illness creates room for stronger relevance of patient experiences. The acquisition of new knowledge from science makes changes to clinical practice. Health professionals in specialist healthcare have the valid knowledge about hand OA. Osteoarthrosis a common condition where dual positions from being both health professionals and patients occur. Participants who are patients talk about how little they know about hand OA despite living with it over many years. Answers to patient problems found within the healthcare system, not with patients themselves. Patients often confirm health professional information: either health professionals are really good in exploring exactly what patients need or maybe patients see it as a way of contributing to a good relationship. To be polite? Create a good atmosphere? Test health professional knowledge? Do what is expected? Desire to learn more? The lack of a cure limits the value of biomedicine and contributes to balance knowledge differences.
Examples of codes
Patients depend on HP knowledge to solve problems Patients are passive recipients of hand OA knowledge Patients adapt to health professional views HPs control time, space, content, and transitions in clinical encounters Taken for granted hierarchy of ideas from history and culture HPs powerful position warrants voice HPs are experts by evidence HPs use scientific claims to legitimize own viewpoints Outdated patient ideas regarding hand OA Negotiation space limited when HPs know best Hand OA knowledge construction a linear process	Accrued lay understandings of hand OA brought into meaning making in consultations Patients claim no-knowledge about hand OA Experience from living with hand OA not epistemically relevant HPs view experience as valid knowledge Patient experiences actively used to understand hand OA Chronic condition with no cure call for recognition of experience	Complementary exchange of illness and disease ideas to jointly make sense of hand OA Discrepancy in illness and disease understandings create new knowledge Confirmation of subjective illness experiences facilitate more active patients in consultations Patient experiences trumps international recommendations in rheumatology Pain as both harmful and harmless Activities as both restricted and necessary Professional uncertainty an added value in the consultation dialogue HPs include patients in the clinical reasoning process Knowledge as relational Knowledge co-developed in local contexts Interactants participate from more equal positions	The patient HP navigates familiar territory Health professional background an added value for patients in understanding hand OA The patient HP act in line with expectations Patients do not disclose own HP background HPs openly communicate hand OA status to patients HPs with hand OA use own experiential knowledge in consultations Understanding hand OA from the other side Interactants with similar experiences enhance dialogue
Preliminary themes from codes
Knowledge construction a monolog from HPs to patients	Patients as experts by experience warrants central position in dialogue	Dialogue of equals in local contexts	Constructing knowledge from dual positions
Themes
Theme 1 HPs dominate dialogue when they know best	Theme 2 Patients are knowers in the chronic healthcare dialogue	Theme 3 HPs and patients construct knowledge together	Theme 4 Dialogue takes place from double positions when patients are health professionals and health professionals have hand OA
Overarching interpretive story from the themes
Hand OA sensemaking is dialogued into being in local patient-provider encounters

Figure 1. Research design map using Maxwell’s (2013) interactive model for qualitative research design.

Maxwell, J. A. (2013). Qualitative research design: An interactive approach 3rd ed. Sage.

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Data availability statement

Data not available due to ethical restrictions.