Searching for the good life: Rhetoric, medicine, and the shaping of lifestyle

The "Chronic Care Model" (CCM), developed by Edward H. Wagner, represents a watershed attempt to address the disconnect between acute models of care and those oriented toward chronic patients for whom lifestyle changes rooted in everyday life are a central concern. To achieve the system-wide changes needed to advance the cause of patient self-care, the CCM focuses on synergizing various layers of the healthcare system, including clinical research and quality improvements, new communication technologies, and provider-patient interactions. Crucially, the conduits that connect these layers have received scant attention, especially when it comes to the methods of interaction and persuasion that enhance the prospects for healthcare innovation. This project addresses this gap drawing inspiration from Richard McKeon's claim that the art of rhetoric provides tools for synergizing complex and highly interactive human systems. Thus, it rhetorically re-imagines the CCM, arguing that rhetoric plays a role in cultivating better clinical practices through collaboration across the spectrum of activities that make up chronic care. To achieve this end, this project focuses on a CCM inspired case study: the Online Lifestyle Support System (OLSS), developed through a robust relationship between academic researchers and corporate disseminators. The OLSS translates an evidence-based lifestyle curriculum into an online platform designed to assist obese and diabetic patients in managing their weight and co-morbid conditions. This online system includes online lessons and live lifestyle coaching. In order to capture unique insights about the practices of lifestyle management within the OLSS, this dissertation draws on three interview projects with individuals working at each layer of chronic care delivery: lifestyle coaches, participants in the study, and those tasked with advertizing and selling the OLSS to new clinical environments. Drawing on the words of these different groups provides grist for the granular development of new insights into the practices that make-up chronic care. Finally, in framing these interview projects, this dissertation draws on rhetorically-inflected terms from the ancient Greek tradition: paideia (education), phronesis (experiential learning), and eudaimonia (the fulfilling life), to articulate the developmental and persuasive processes involved in the preparation of practitioners, the cultivation of self-care, and the effort to disseminate new research findings.