From Guidelines to Lifelines-An Ethnographic Study of How Diabetes Management Is Emplotted During Clinical Encounters with Young Adults with Type 1 Diabetes.

Abstract

Background/Objectives: Working with young adults with T1D in outpatients clinic entails achieving a delicate balance between maintaining trust and improving diabetes management. By looking at the interactions between healthcare professionals and young adults with T1D as narrative emplotment, this article seeks to investigate how illness narratives are part of and actively worked on in consultations. Methods: Based on ethnographic observations of fourteen consultations with young adults 18-23 years of age, three narrative strategies to promote better diabetes management among the young adults were identified: (1) replacing sub-optimal practice with technology, (2) encouraging enhanced autonomy, and (3) setting realistic standards for diabetes care. Each strategy works to create a meaningful explanation for experienced challenges, formingas a basis for improved diabetes self-management. Results: Consultations were found to create a space where the meaning of living with an illness can be discussed between the healthcare professionals and the patients. Conclusions: Looking at how this meaning is negotiated in the consultations is an important aspect of understanding how daily diabetes management is made practicable, especially when working with young adults who are constituting their identities and often live with sub-optimal glycaemic control.