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    Storylines of self-management: narratives of people with diabetes from a multiethnic inner city population 
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    Storylines of self-management: narratives of people with diabetes from a multiethnic inner city population

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    Published Version
    Embargoed until: 5555-01-01
    Volume
    16
    Pagination
    37 - 43
    DOI
    10.1258/jhsrp.2010.009160
    Journal
    J HEALTH SERV RES PO
    Issue
    1
    ISSN
    1355-8196
    Metadata
    Show full item record
    Abstract
    Objectives: To analyse the narratives of people with diabetes to inform the design of culturally congruent self-management education programmes. Methods: The study was based on quasi-naturalistic story-gathering; i.e. making real-time field notes of stories shared spontaneously in diabetes self-management education groups in a socioeconomically deprived London borough. Eighty-two adults aged 25-86, from six minority ethnic groups who were in the intervention arm of a randomized controlled trial of story-sharing, participated. Stories were translated in real time by the facilitator or group members. Ethnographic field notes were transcribed, and analysed thematically (to identify self-management domains raised by participants) and interpretively for over-arching storylines (i.e. considering how self-management domains were contextualized and made meaningful in personal narratives). Analysis was informed by both biomedical and sociological theories of self-management. Results: People with diabetes identified seven self-management domains: knowledge; diet; exercise; medication; foot care; self-monitoring; and attending check-ups. Interpretive analysis revealed eight illness storylines within which these practical issues acquired social meaning and moral worth: becoming sick; rebuilding spoiled identity; becoming a practitioner of self-management; living a disciplined and balanced life; mobilizing a care network; navigating and negotiating in the health care system; managing the micro-morality of self-management ‘choices’; and taking collective action. Conclusion: Living with diabetes involves both medically recommended behaviours and complex biographical work to make sense of and cope with illness. Self-management education programmes should take closer account of over-arching storylines that pattern experience of chronic illness and recognize that some elements of self-management knowledge cannot be pre-specified in a structured curriculum.
    Authors
    Greenhalgh, T; Collard, A; Campbell-Richards, D; Vijayaraghavan, S; Malik, F; Morris, J; Claydon, A
    URI
    http://qmro.qmul.ac.uk/xmlui/handle/123456789/2227
    Collections
    • Centre for Primary Care and Public Health [1603]
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    Copyright © 2018 by SAGE Publications
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