Care relationships in social interventions: a critical realist analysis

Mann, Gail Lucy (2021) Care relationships in social interventions: a critical realist analysis. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Concepts of personalisation and person-centred care have been a long-term focus in health and social care and are increasingly embedded in policy. It is a narrative that is popular with citizens, practitioners, and leaders as it encapsulates an aspiration for responsive care, sensitive to our own unique priorities and circumstances. Existing research reveals that effective person-centred care involves a meshing of principles and practice: ways of both ‘doing’ person-centred care and ‘being’ person-centred. If we limit ourselves to focus primarily on ways of ‘doing’ person-centred care, we risk overlooking the role of personhood and relationship and undervaluing important, albeit invisible, causal mechanisms. The value of people and relationships is noted in person-centred research and policy; however, this thesis argues that its inclusion is not adequately theoretically supported. This research employs Critical Realism, Archer's Realist Social Theory and Donati's Relational Sociology to reconceptualise the role of relationships between carers and care recipients in four social interventions; a support service for people with mild to moderate mental ill-health, a personal budget support service, a community sports intervention for young people, and family-based care and support for disabled people. It employs mixed methods, in a comparative case study methodology to explore whether, how, and under what conditions relationships that are established between carers and care recipients can foster personal reflexivity and generate relational goods. By operationalising Archer’s and Donati’s theory in practice contexts, this research delivers new theoretical support for the proposition that care relationships can have causal effects, given facilitative conditions. This work demonstrates the value of Archer’s theories of personhood and reflexivity to empirical research, applying these concepts to explore how the biographically formed identity and reflexive tendencies of each person are implicated in care relationships, and how organisation and system factors can be influential. The thesis contributes new conceptual tools that can support our understanding of the nature and role of care relationships and the conditions that support them, namely: the Relational/Reflexive Mechanism (RRM) model that visually captures how relationships are implicated in personal change, and the Orientation to Relational Reflexivity and Agency for Change (ORRAC) model, a contribution to Realist Sociology that can be used to qualitatively discern and track key aspects of a subject’s reflexivity over time. Building on the ORRAC model, this work also redescribes the requirements set out in Donati’s Relational Sociology for the generation of Relational Goods, in respect of care and support relationships, further enabling theorisation of relational configurations and their influence on the reflexive powers of individuals. The application of these research findings offers the potential for their practical application in social interventions and beyond.