Institute of Psychological Sciences, University of Leeds, UK.
Psychol Health. 2012;27(3):378-93. doi: 10.1080/08870446.2011.583649. Epub 2011 Jul 8.
Type 2 diabetes is a metabolic disorder characterised by chronically elevated blood glucose and a high risk of cardiovascular and other complications. Self-management is central to diabetes care and includes taking regular exercise, low-fat/sugar diet and blood glucose monitoring. However, little is understood about how people with diabetes make sense of self-management. Our aim, therefore, is to explore the process of 'getting one's thoughts straight' in relation to illness self-management for women with poorly controlled type 2 diabetes. Eight women were recruited from two hospitals in the North of England. Each was interviewed using a biographic-narrative method. Narratives were analysed using a dialogical approach. We use Bakhtin's concepts of voice, official and unofficial truth, and internally persuasive discourse to explore how participants considered, struggled with, and, sometimes, acted upon self-management. We demonstrate how the truth by which participants lived shifted as they encountered new perspectives and experiences. The accounts revealed tension between official, authoritative voices, typically concerned with optimal illness control and unofficial voices that speak at a lived, embodied level. In conclusion, we suggest moving beyond the notion of self-management towards a conceptualisation of life with chronic illness that includes personal goals, values and embodied experience in context.
2 型糖尿病是一种代谢紊乱，其特征是长期血糖升高，心血管和其他并发症的风险很高。自我管理是糖尿病护理的核心，包括定期运动、低脂/低糖饮食和血糖监测。然而，人们对糖尿病患者如何理解自我管理知之甚少。因此，我们的目的是探讨与女性 2 型糖尿病控制不佳相关的疾病自我管理有关的“理清思路”的过程。从英格兰北部的两家医院招募了 8 名女性。每位参与者都使用传记叙事方法进行了访谈。使用对话方法对叙事进行了分析。我们使用巴赫金的声音、官方和非官方真理以及内部有说服力的话语的概念来探索参与者如何考虑、努力应对、有时还采取自我管理措施。我们展示了参与者所依据的真理是如何随着他们遇到新的观点和经验而发生变化的。这些描述揭示了官方、权威声音（通常关注最佳疾病控制）与生活在身体层面上的非官方声音之间的紧张关系。总之，我们建议超越自我管理的概念，朝着包括个人目标、价值观和具体背景下的身体体验的慢性疾病概念发展。
