Health Education Research Advance Access originally published online on July 4, 2005
Health Education Research 2006 21(1):97-107; doi:10.1093/her/cyh044
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Issues of cause and control in patient accounts of Type 2 diabetes
1 Social Inclusion Research Unit, North East Wales Institute of Higher Education, Wrexham LL11 2AW, 2 School of Life and Health Sciences, Aston University, Birmingham B4 7ET, 3 Lothian NHS Board, Edinburgh EH8 9RS and 4 Research Unit in Health, Behaviour and Change, University of Edinburgh, Edinburgh EH8 9AG, UK
5 Correspondence to: O. Parry; E-mail: o.parry{at}newi.ac.uk
Patients experience considerable difficulties in making and sustaining health-related lifestyle changes. Many Type 2 diabetes patients struggle to follow disease risk-management advice even when they receive extensive information and support. Drawing on a qualitative study of patients with Type 2 diabetes, the paper uses discourse analysis to examine their accounts about disease causation and disease management, and the implications for how they respond to their condition and health services advice. As it is a multifactorial disease, biomedical discourse around Type 2 diabetes is complex. Patients are encouraged to grasp the complicated message that both cause and medical outcomes related to their condition are partly, but not wholly, within their control. Discursive constructions identified from respondent accounts indicate how these two messages are deployed variously by respondents when accounting for disease causation and management. While these constructions (identified in respondent accounts as ‘Up to me’ and ‘Down to them’) are a valuable resource for patients, equally they may be deployed in a selective and detrimental way. We conclude that clear messages from health professionals about effective disease management may help patients to position themselves more effectively in relation to their condition. More importantly, they might serve to hinder the availability of inappropriate and potentially harmful patient positions where patients either relinquish responsibility for disease management or reject all input from health professionals.
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