Social Networks and Long-Term Condition Management: A Critical Realist Review

Long-term conditions have emerged as a central policy issue. There is also a large body of literature that addresses different aspects of prevention, treatment, and the management of long-term conditions. The challenges of chronic illness are often associated with questions of the capacity of the health services and the welfare state, the adequacy of the existing structure of healthcare provision and the current division of labour between professionals.

These different challenges are addressed within a dominant discourse organised around the notions of self-care and self-management. These tend to be centred on individual responsibility and interactions with healthcare professionals, and prioritise the provision of information, education, health literacy, and individual behaviour-focussed psychological models to improve established measures of health outcomes.

The extensive literature on the role of social networks in the context of self-management offers conceptualisations and methodologies that offer critical perspective on the dominant set of arguments and can help improve our understanding of the processes involved in everyday illness management. This is by offering a relational perspective on self-management and recognising the centrality of informal relations and support. This paper takes a critical realist perspective in reviewing this literature and distinguishes between uses of social networks as a metaphor, concept, method and structure. We discuss the underlying assumptions, boundaries of different uses, their limitations, the sets of questions that could be explored and the added value, the contexts in which they can be helpful, and the possible slippages between them.