Are some more equal than others? Social comparison in self-management skills training for long-term conditions
- 19 November 2009
- journal article
- research article
- Published by SAGE Publications in Chronic Illness
- Vol. 5 (4), 305-317
- https://doi.org/10.1177/1742395309350384
Abstract
Background: Social comparisons influence self-evaluation and social and psychological adjustment to illness but are under-explored in relation to self-skills training group situations. Methods: A longitudinal qualitative study embedded within an RCT of a national programme of lay led self-care support in England (Department of Health, 2001). In-depth interviews were undertaken with a purposeful maximum variation sample of recruits. Data were analysed thematically. Three key themes emerged highlighting (1) the experience of group participation and interaction, (2) the process and (3) function of social comparison. Results: Data highlight the salience of social comparison as an underlying feature of the group dynamics of self-care skills training. The nature, dimensions and scope of social comparisons extend beyond the cognitive states and dimensions traditionally forming the focus of social—psychological approaches to social comparison to include wider dimensions including entitlement to resources. The results confirm the tendency to make positive comparisons that result in beneficial self-evaluations. However, positive comparisons allow respondents to present themselves as socially and morally worthy, which may act to mask the identification of appropriate need and inequalities. Conclusion: Social comparisons function both as an accurate representation of internal cognitive states but also constitutes identity work involving competing values and moral requirements. We show that even those who report significant needs will sometimes portray themselves in a way that suggests positive social comparisons, which fit with a rationed and morally prescriptive and acceptable view of entitlement to NHS services. Such insights suggest that social comparisons in initiatives such as the EPP may be beneficial for some but exacerbate rather than alleviate health inequalities in long-term condition management for others.Keywords
This publication has 44 references indexed in Scilit:
- Factors important for the measurement of social comparison in chronic illness: a mixed-methods studyChronic Illness, 2006
- Does NHS Direct empower patients?Social Science & Medicine, 2005
- Social Comparison: Why, With Whom, and With What Effect?Current Directions in Psychological Science, 2002
- Social comparison and patient information: what do cancer patients want?Patient Education and Counseling, 2002
- Comparison Direction and Comparison Dimension among Disabled Individuals: Toward a Refined Conceptualization of Social Comparison Under StressPersonality and Social Psychology Bulletin, 1995
- Arthritis Patients' Reactions to Unavoidable Social ComparisonsPersonality and Social Psychology Bulletin, 1991
- Social comparison activity under threat: Downward evaluation and upward contacts.Psychological Review, 1989
- Downward comparison and coping with serious medical problems.American Journal of Orthopsychiatry, 1987
- Downward comparison principles in social psychology.Psychological Bulletin, 1981
- A Theory of Social Comparison ProcessesHuman Relations, 1954