Self-Care Narratives: Life Stories of Rural Adults Managing Chronic Illness without Insurance

Abstract

Uninsured rural adults with chronic illness are more likely to experience worse outcomes than insured individuals. Without access to healthcare or insurance, self-care is an important variable in the management of chronic illness in this rural population. Although rural safety-net programs have been implemented for decades, research on the effectiveness of these programs and self-care is rare and limited. Rural health disparity persists while voices from this marginalized population have gone unheard. The purpose of this study was to give them a voice by capturing first person storied accounts of self-care from chronically ill, uninsured, rural non-elderly adults and to describe the importance of self-care in their illness narratives. Storytelling is a common method of sensemaking among rural populations. Using narrative inquiry methodology, stories were collected from 10 rural participants in semi-structured interviews and then transcribed to text for the analysis. Each story was analyzed for structural and thematic elements, then synthesized into a cohesive self-care narrative. The stories divided into four narrative segments: backstories, crisis, tragedy or overcoming, and resolution. These narratives illustrated the challenges faced by rural adults with chronic illness, including inadequate care, financial difficulties, and the need for better support systems. A self-care / self-reliance framework was derived to better explain their real-world experience. Suggested clinical practice changes include integrated and reconfigured services, person-centered care, and support for health policy change and advocacy. Future research should include a clear definition of the term rural, a concept analysis of self-reliance, access to rural research subjects, and an organized research program.