|dc.description.abstract||This thesis is about impairment, disability and health. Placed in the context of
Disability Studies, it engages with the theoretical debates about how disability and
impairment should be conceived. In doing so it pays particular attention to the
embodiment of impairment and its relation to health matters. It also identifies and
discusses the reasons for the apparent reluctance of Disability Studies to engage with
The main source of data is interviews with 28 disabled people from Edinburgh and
the Lothians. Using semi structured interviews, participants were encouraged to talk
about their experiences of using healthcare including the access barriers they faced,
the expertise they developed to manage their health care encounters and how these
encounters mediated and were mediated by their lived experience as disabled people.
A secondary source of data is autoethnographic writing. Through reflexivity, an
assessment is made of the value and validity of using this method to explicitly
incorporate the researcher’s own experiences in to the data and its analysis.
Similarly reflexivity is deployed to consider the methodological issues that arise
from the researcher being disabled and encountering access barriers during the
There were three sets of findings from the research. First, participants’ body talk
suggested that in everyday life impairment and maintaining good health can be
understood as something which is done by the embodied self to the body. This doing
is often a taken-for-granted activity. It is also mediated through a number of factors
including emotions, disabling barriers and broader social and economic structures.
Second, participants’ accounts of the access barriers they faced when using the NHS
suggested that there are two categories of access needs, the macro and micro. While
macro needs such as ramped or flat access to premises were anticipated and routinely
met without participants having to take any action, participants often felt they had to
take the initiative to ensure their micro needs, such as the need for a hoist, were met.
Some micro access needs were particular to a healthcare context and often emerged during diagnostic tests or treatment procedures. Healthcare professionals had to have
sufficient skills and confidence to respond effectively to these clinical micro needs.
The third set of findings was that some participants developed expertise to enable
them to access the appropriate services to meet their needs and form a high quality
relationship with healthcare professionals. However, other participants recalled
situations where their expertise was not respected and felt abandoned by the NHS.
The first set of findings has implications for theoretical development in Disability
Studies. More work is needed to connect the doing of impairment to theoretical
approaches found in sociology of the body and to empirically explore the nature and
scope of impairment doing, The second and third set of findings have implications
for current healthcare practice particularly in the context of the NHS’ responsibility
under the Disability Discrimination Act.||en