Beyond the realist turn: a socio‐material analysis of heart failure self‐care
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abstract
AbstractFor patients living with chronic illnesses, self‐care has been linked with positive outcomes such as decreased hospitalisation, longer lifespan, and improved quality of life. However, despite calls for more and better self‐care interventions, behaviour change trials have repeatedly fallen short on demonstrating effectiveness. The literature on heart failure (HF) stands as a case in point, and a growing body ofHFstudies advocate realist approaches to self‐care research and policymaking. We label this trend the ‘realist turn’ inHFself‐care. Realist evaluation and realist interventions emphasise that the relationship between self‐care interventions and positive health outcomes is not fixed, but contingent on social context. This paper argues socio‐materiality offers a productive framework to expand on the idea of social context in realist accounts ofHFself‐care. This study draws on 10 interviews as well as researcher reflections from a larger study exploring health care teams for patients with advancedHF. Leveraging insights from actor‐network theory (ANT), this study provides two rich narratives about the contextual factors that influenceHFself‐care. These descriptions portray not self‐care contexts but self‐care assemblages, which we discuss in light of socio‐materiality.
