Temporal capital and unaligned times as inequality mechanisms: A case study of chronic care in general practice

TY - JOUR

T1 - Temporal capital and unaligned times as inequality mechanisms

T2 - A case study of chronic care in general practice

AU - Paust, Amanda

AU - Lau, Sofie Rosenlund

AU - Bro, Flemming

AU - Prior, Anders

AU - Mygind, Anna

PY - 2023/12

Y1 - 2023/12

N2 - Addressing persistent health inequality is one of the most critical challenges in public health. Structural features of ‘time’ may provide new perspectives on the link between social inequality and time in a healthcare context. Drawing on the case of chronic care in Danish general practice, we aim to use temporal capital as a theoretical frame to unfold how patients' social positions are interlinked with their medical treatment. We followed patients with multimorbidity and polypharmacy in general practice. Data were collected from interviews, observations, informal conversations, and medical records. We used the concept temporal capital to illuminate the mechanism of inequality in healthcare. We suggest understanding temporal capital as patients' abilities and possibilities to understand, navigate, negotiate, and manage the temporal rhythms of healthcare.Unaligned times, i.e. the mismatch between patients’ temporal capital and healthcare organisations and/or professionals' rhythms, are unfolded in five themes: unaligned schedules (scheduling the consultation to fit everyday life and institutional rhythms and attending the consultation), sequences (preparing activities in a specific order to accommodate clinical linearity), agendas (timing the agenda to the clinical workflow), efficiency (ensuring efficiency in the consultation and balancing on-task and off-task content), and pace (conducting the consultation to accommodate fixed durations).Differences in temporal capital and hence abilities and possibilities for aligning with the temporal rhythms of healthcare may be facilitated or restrained by the individual patient's social position, thereby defining and establishing temporal mechanisms of social inequality in medical treatment. In conclusion, social inequality in medical treatment has several temporal references, resulting from pre-existing inequalities and causing new ones. Notions of temporal capital and temporal unalignment provide a useful lens for exploring social inequality in healthcare encounters.

AB - Addressing persistent health inequality is one of the most critical challenges in public health. Structural features of ‘time’ may provide new perspectives on the link between social inequality and time in a healthcare context. Drawing on the case of chronic care in Danish general practice, we aim to use temporal capital as a theoretical frame to unfold how patients' social positions are interlinked with their medical treatment. We followed patients with multimorbidity and polypharmacy in general practice. Data were collected from interviews, observations, informal conversations, and medical records. We used the concept temporal capital to illuminate the mechanism of inequality in healthcare. We suggest understanding temporal capital as patients' abilities and possibilities to understand, navigate, negotiate, and manage the temporal rhythms of healthcare.Unaligned times, i.e. the mismatch between patients’ temporal capital and healthcare organisations and/or professionals' rhythms, are unfolded in five themes: unaligned schedules (scheduling the consultation to fit everyday life and institutional rhythms and attending the consultation), sequences (preparing activities in a specific order to accommodate clinical linearity), agendas (timing the agenda to the clinical workflow), efficiency (ensuring efficiency in the consultation and balancing on-task and off-task content), and pace (conducting the consultation to accommodate fixed durations).Differences in temporal capital and hence abilities and possibilities for aligning with the temporal rhythms of healthcare may be facilitated or restrained by the individual patient's social position, thereby defining and establishing temporal mechanisms of social inequality in medical treatment. In conclusion, social inequality in medical treatment has several temporal references, resulting from pre-existing inequalities and causing new ones. Notions of temporal capital and temporal unalignment provide a useful lens for exploring social inequality in healthcare encounters.

KW - Chronic care

KW - Denmark

KW - General practice

KW - Medical treatment

KW - Qualitative research

KW - Social inequality

KW - Temporal capital

KW - Temporality

UR - http://www.scopus.com/inward/record.url?scp=85175264292&partnerID=8YFLogxK

U2 - 10.1016/j.socscimed.2023.116337

DO - 10.1016/j.socscimed.2023.116337

M3 - Journal article

C2 - 37918228

SN - 0277-9536

VL - 338

JO - Social Science & Medicine

JF - Social Science & Medicine

M1 - 116337

ER -