Social comparisons influence self-evaluation and social and psychological adjustment to illness but are under-explored in relation to self-skills training group situations. Rogers and colleagues conducted a longitudinal qualitative study embedded within a randomized control trial of a national program of lay led self-care support in England. In-depth interviews were undertaken with a purposeful maximum variation sample of recruits. Data were analyzed thematically. Three key themes emerged highlighting (1) the experience of group participation and interaction, (2) the process, and (3) function of social comparison. The data highlighted the salience of social comparison as an underlying feature of the group dynamics of self-care skills training. The nature, dimensions, and scope of social comparisons extend beyond the cognitive states and dimensions traditionally forming the focus of social-psychological approaches to social comparison to include wider dimensions including entitlement to resources. The results confirm the tendency to make positive comparisons that result in beneficial self-evaluations. However, positive comparisons allow respondents to present themselves as socially and morally worthy, which may act to mask the identification of appropriate need and inequalities.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that social comparisons function both as an accurate representation of internal cognitive states but also constitutes identity work involving competing values and moral requirements. The investigators showed that even those who report significant needs will sometimes portray themselves in a way that suggests positive social comparisons, which fit with a rationed and morally prescriptive and acceptable view of entitlement to health services. Such insights suggest that social comparisons in initiatives may be beneficial for some but exacerbate rather than alleviate health inequalities in long-term condition management for others.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: Patients who perform self-management often portray themselves as doing better than they are actually are doing. This is often the case when they are in groups and hear what others say. For this reason, it is wise to conduct one-on-one interviews to determine how each individual patient undergoing self-management training is actually doing. The outcomes of such interviews allow investigators to tailor materials for individual patients.

A Rogers et al. Are some more equal than others? Social comparison in self-management skills training for long-term conditions. Chronic Illness, November 19, 2009.