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

Journal article

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

• Journal: Journal of health services research and policy
• Volume: 16
• Issue: 1
• Pages: 37-43
• Publication date: 2011-01-01
• DOI: 10.1258/jhsrp.2010.009160
• EISSN: 1758-1060
• ISSN: 1355-8196
• Language: English
• Keywords: Female; Adult; Ethnic Groups; Diabetes Mellitus; Urban Population; Minority Groups; Aged; Program Development; Poverty Areas; London; Self-Help Groups; Self Care; Aged, 80 and over; Middle Aged; Humans; Male; Narration; Cultural Diversity