Background
Theoretical background
Methods
Recruitment
Interview | Population group | Number of participants |
---|---|---|
Interview 1 | East European | 18 |
Older (75+ years) | 43 | |
Younger (18–26 years) | 39 | |
Total | 100 | |
Interview 2 | East European | 12 |
Older (75+ years) | 19 | |
Younger (18–26 years) | 10 | |
Total | 41 |
Data collection
Analysis and developing the model
Results
Concept of work | Individual level | Social network level | Nature of the work |
---|---|---|---|
Illness work | Assess and manage symptoms, regimens, and risk, and actions associated with these | Assess and manage symptoms, regimens, and risk, and actions associated with these across social network members | • Interpret, manage, evaluate symptoms and risk of symptoms • Identify what is being sought from a service • Decide if help is needed and/or level of care required |
Moral work | Assess and legitimate ‘appropriate’ service choices | Assess and legitimate service choices in comparison to others and influenced by others | • Decide what is appropriate use • Construct self as credible, responsible and appropriate service user • Balance moral positioning against health risk |
Navigation work | Assess services available (choose) and decide which to access (use) | Assess services available (choose) and decide which to access (use) informed by social network | • Know about, and choose, services, facilities and resources available at different times of day • Decide the most acceptable or convenient choice |
The work of making sense of urgent care
Illness work
P19: I didn’t know what else to do at the time because I was in a state. Well not panic, but I was highly stressed. I thought ‘I don’t know what to do’ so I just dialled 999 [ambulance service]. (Older).
P66: I called my dad ... ‘Dad … can you bring a first aid kit and just give me an opinion on whether you think this is a bad enough cut?’ Because I just... I didn’t know... (Younger).
P52: Well it’d be you, wouldn’t it [husband]? Then [our] daughter and then the GP [general practitioner]. (Older).P53: I think the most important one would be my mum, as well as my closest friends. The least, would be work. Yes, [and] the internet. (East European).
P93: The neighbours are brilliant. They are so important as they are invariably there. Or I could phone our really good friends who are a 10-min drive away…then the GP [general practitioner]. If I needed my son or daughter for anything … well, yes, if I needed them to come, I know they would come. (Older, married carer with children far away).
P54: I can definitely put my husband and mother [as sources of support] … She’s a Doctor … a paediatrician. (East European).P65: My mum was really supportive. Friends…a little less so, because … just, especially at that age [18], I don’t think anybody really, had much of a clue. Couldn’t empathise properly with what I was going through … ‘oh, he’s always ill’ … ‘attention and whatever’. (Younger).
P54: I may use my mum sometimes but I just don’t really want to bother her because she’s just going to be so worried. I would probably prefer to do … online symptom checks. (East European).
Moral work
P23: I think we were brought up in that generation, at the beginning of the war, and you had to get on with life [] You just try not to bother people. I never go to the doctors, if I can help it [] They’re [the ambulance service] up to their eyes. (Older).
P57: There would be an instinct in me [to use NHS 111] … I don’t want to make a fuss out of something that might not be a fuss, or I don’t want to annoy the doctor. (Younger).P5: It was pretty easy to make the decision to go to the pharmacy, so I wouldn’t have bothered the doctor or even the nurse. (Older).
P13: People panic so much. They can have a little thing like ‘alright you’ve broken your arm, it’s going to hurt like hell, but it’s not a big deal, you’re not dying’ … You need to go to A&E [Accident & Emergency Department] when you are bleeding like severely, or something … fatal … Unfortunately, we were there for something that really was not quite an emergency … but I panicked. (Younger).
P68: I tend to play down a lot of how I’m feeling, because I don’t like going to the doctor and I don’t want to go to hospital, but my boss said ‘no, I think you need to call [NHS] 111, you’re clearly not right’. (Younger).
Navigation work
P70: It’s a nuisance to get to the hospital because it is an hour away but once you are there…Interviewer: It’s all there?P70 : At the hospital [laughs]Interviewer: So here in town, there are different services [urgent care] at different places…P70: Yes. And that’s a bit of a pain. (Older)
P5: I prefer to go to one of the drop-in centres, rather than up to [ED] because ... it’s usually overflowing, isn’t it, with people waiting to be seen ... It’s a pleasanter experience, anyway, at [the Walk in Centre]. (Older).
P1: It’s more difficult to go to walking-in centre because most times you wait … You fill in loads of forms and definitely it will take you at least two, three hours [] I think the walking-in centre is good if you can’t get your appointment at GP [General Practitioner]. (East European).
P37: If you think something is not all that wrong but you still need to go to A&E, having the luxury of picking and choosing the time, like, go in the early hours of the morning because that might be a bit emptier, you’ll be seen quicker. (Younger).P46: The A&E was very calm, they served us pretty quickly in, like, half an hour or so. (Younger).
P67: With the knee, I think Friday or Saturday night, we actually didn’t want to go to A&E because you obviously spend, sometimes a few hours and it wasn’t that serious [] So we just rang them up and said ‘what is the approximate waiting time?’ … and they say ‘it is busy but you can try later on’ (East European).
P22: I knew it wasn’t really the correct place. I wanted a walk-in centre but there isn’t a convenient one … There’s the one in [area name] but trying to get [there] is murder, and the other one, it’s so far away you could die on the way. (Older).
P76: 111… you ring them up and they kind of assess you on the phone … you do not have to go all the way to hospital … talking on the phone beforehand [is] a better option because when you are in A&E you are around so many people who have different problems, a lot of it is people on drugs, or drunk … it’s a bit overwhelming (Younger).
P40: I tend to make my own decisions but sometimes I’ll ask my mum. But I know a lot of people … ask Facebook sort of thing. (Younger).
P28: If you’re on your own, it’s different. I mean, if I hadn’t had [friend] to talk to, I wouldn’t have gone to A&E at that stage. I might have left it a bit later. (Older).P7: I’m lucky because I have backup around me, or even the neighbours. I mean, for my eyes, I talked to several people within the [street] … then there’s the U3A [University of the Third Age, an international movement for mainly retired members], [the] Choir and the Masons. (Older).
P2: The Polish community families, the new families, are quite fragmented. So it’s people who have got to know each other over here … normally, back in Poland, the community is very close … you tended to be born somewhere, find work, study around that area, and have family not far … Whereas here, I think people tend to panic a little bit … a young family, isolated from everybody. They don’t know who to go to, so go to A&E. (East European).
The relevance and influence of socio-temporal context
P2: [There is] the likelihood of me … over-stating … you know, exaggerating. Because it’s me, and I’m on my own. It’s me, me, me. Yes, especially at night things may seem, a lot more drastic than they really are. (East European).P28: I knew [a friend] would take me. But she had to come over from [different area] ... If somebody’s taking me... she’s got to get here, she’s got to get back afterwards. (Older).P23: My neighbour … I’ve only got to ring her and she was round … She is always there for me … But … I thought, ‘this is like 7, 7:30 at night, I’m not going to be able to cope with him [husband] on my own, [later] in the night, if it goes on like this’. I know … if I’d have rung [her neighbour] she can come around. But there’s something different about bothering them in the middle of the night to the daytime. (Older).
P1: When you’ve got children [when husband was ill], should I take them with me [to healthcare service]? [] I don’t know if I could ask neighbours to come … because I never had to try that. But I can phone for example, my sister … (East European).
P32: Monday is quite a busy day [for health services] because everyone waits the weekend … I work nine to five so I would probably try to do it out-of-hours if possible or over my lunch break. (Younger).
P55: If it’s the weekend then I would contact them normally. But they’re not always around, you see? They’re all at work. You can’t rely on your family. (Older).P23: [The bus] stops at the bottom of the road … then it stops outside the hospital. It’s free for me because I’ve got a bus pass … If I can, I get there under my own steam. My neighbour really gets angry with me because I don’t ask for a lift … I said, ‘all the time I can do it, I will do it’. (Older).
P47a: Is there like option [with NHS 111] … to avoid all the questions? Because … obviously people with less understanding English they get confused as well. (East European).