Managing expectations: cognitive authority and experienced control in complex healthcare processes

Area of Science:

• Social Sciences
• Health Services Research
• Sociology of Health & Illness

Background:

• Managing long-term conditions involves balancing normative expectations (accountabilities) with available resources (capacity).
• Widespread non-adherence to treatment regimens poses a significant challenge in long-term condition management.
• This study introduces a middle-range theory to explain this balancing work in social relations.

Purpose of the Study:

• To develop and present a middle-range theory for understanding the balancing work in social relations.
• To apply this theory to the context of long-term condition management and treatment adherence.
• To identify how cognitive authority influences patient and caregiver interactions within healthcare processes.

Main Methods:

• A four-stage process was used, starting with qualitative elicitation from heart failure patients.
• Systematic review of qualitative research literature and construct validation using reanalysis of meta-reviews informed theory development.
• The theory was refined into a logic model with two main theoretical propositions.

Main Results:

• Cognitive Authority Theory characterizes negotiation processes where individuals manage relations with normative systems.
• Cognitive authority is defined by assessments of competence, trustworthiness, and credibility within healthcare interactions.
• Experienced control relates to successfully managing external factors hindering role performance.

Conclusions:

• Cognitive Authority Theory explains how participants manage power and expertise inequalities in social processes, particularly in healthcare.
• The theory highlights how relational burdens can lead to non-adherence to treatment and self-care programs.
• It identifies potential intervention targets to mitigate adverse outcomes related to non-adherence.