Publications (English)

Negotiating exercise as medicine: Narratives from people with type 2 diabetes
Peer reviewed article in Health: an interdisciplinairy journal for the social study of health, illness and medicine, May 2019

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Abstract
The dominant notion that exercise is medicine puts a strong normative emphasis on individual responsibility for participation in sport and physical activity. The aim of this article was to explore how people with type 2 diabetes, a condition strongly linked to lifestyle behaviour both in origin and in management, translate this notion into their daily life. Based on a critical narrative analysis of stories of 18 Dutch people diagnosed with type 2 diabetes collected between 2012 and 2016, we found a range of meanings given to sport and physical activity. In addition, almost all respondents seemed to subscribe to the notion of exercise as medicine on a general level, either quite explicitly or in more subtle ways, for example, elicited by the interview setting. However, they employed different strategies to negotiate with the translation of this notion into their daily life, ranging from (almost) total acceptance to resistance. In addition, nearly all stories revealed mostly negative experiences with care and professional support regarding the uptake or continuation of sport or physical activity participation after diagnosis.

Stepping outside the consultation room. On nurse–patient relationships and nursing responsibilities during a type 2 diabetes walking project
Peer reviewed article in Journal of Advanced Nursing, April 2019

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Abstract
Aims To examine the care practices of nurses during the organization of 20 weeks of walking sessions for people with type 2 diabetes and to reflect on implications for nurse–patient relationships and nursing responsibilities in the provision of physical activity (PA) care.
Design Qualitative, ethnographic study.
Methods Almost 70 hr of field work was completed by participant observations and informal conversations with nurses and participating patients of two different walking groups (April–October 2016). Analysis of field notes followed an inductive holistic‐content approach, using both within‐case and across‐case analysis.
Results The analysis revealed four main themes related to the nurses’ care practices: (a) organizational efforts; (b) combining group and individual care; (c) stepping in‐ and outside the patient mode; and (d) implications back inside the consultation room. Underlying these themes was a process of relational development, both with and among patients.
Conclusion Stepping outside the consultation room seems to offer more space for patients’ lifeworld narratives and contribute to more continuous and person‐centred care. However, it also raises new questions about the provision of PA care and nursing responsibilities in this.
Impact Current nursing repertoires for PA counselling in type 2 diabetes care are insufficient and might be extended by organizing walking sessions for patients. Related nursing care practices impacted relationships both with and among participating patients. These have consequences for boundaries of both nursing responsibilities and care provision.

Developing a Relational Narrative about Diabetes: Towards a Polyphonic Story

in Voices of Illness: Negotiating Meaning and Identity

Authors: Mirjam Stuij, Agnes Elling, Anja Tramper and Tineke Abma
DOI: https://doi.org/10.1163/9789004396067_013

Abstract
The restitution story, the type of illness story about living a healthy life again, is the most prominent type in Western society. Patients who are unable to realise a restitution story might need an alternative ‘corpus of stories’ to draw on, for example narratives that more explicitly incorporate quest and/or loss. In this chapter, we present the narrative of Anja, a woman with diabetes who wanted, but was unable to live the restitution story. Although she seemed to have all characteristics in favour of ‘restitution’, such as willingness, capacities, and a higher socioeconomic background, she encountered losses and was not able to go back to her ‘normal life’. Through a sociological lens, her narrative habitus was influenced by her privileged position and expressed in her emphasis on ‘starting all over again’, departing from dominant health discourses that emphasise restitution and individual responsibility. The encounters with the voice of the researcher(s) made her aware of the dominant storyline and, as an incidental outcome of the research process, enabled her to reconstruct her story. Along the way, Anja’s story became more polyphonic, as she began to incorporate the voices of the researcher(s) and others. A detailed elaboration of this specific case shows the relational dynamics of narrative development and interpretation, and offers important implications for health care. It points towards the importance of attentiveness, responsibility, and responsiveness as well as solidarity with a broader group of patients suffering from diabetes, including those in less privileged positions.

‘Physical activity, that’s a tricky subject.’ Experiences of health care professionals with physical activity in type 2 diabetes care

 
Background: Based on a growing body of epidemiological and biomedical studies, physical activity (PA) is considered a cornerstone in type 2 diabetes treatment. However, it is also a practice embedded in daily life and, as such, may produce certain frictions as a topic in health care. The aim of this article is to give in-depth insight into experiences of health care professionals with the delivery of PA counselling to people with type 2 diabetes.
Methods: This study is based on in-depth interviews with 24 Dutch professionals providing care to people with type 2 diabetes. They were asked to tell about their experiences with PA in different roles, both in their professional and personal lives. The interviews were audio-recorded and transcribed verbatim. Data analysis followed a narrative approach with not only a focus on what was told, but also on how this was constructed in interaction with the interviewer, the cultural resources that were drawn on and inconsistencies or alternatives that were presented. This narrative focus was used to explore how professionals made sense of their experiences with PA counselling within the wider sociocultural context.
Results: While the professionals view PA as a foundation of type 2 diabetes treatment, they experience it to be a tricky subject. Two main areas of tension were identified: (1) the understanding of patient behaviour; and (2) professionals’ views on responsibilities, both on their responsibilities as professionals and their notions on who is responsible for
behaviour change.
Conclusions: Health care professionals providing PA counselling to people with type 2 diabetes have to navigate between possibilities within the diabetes care framework, options for an embedding of PA in the patient’s lifeworld, and the professionals’ opinions on and experiences with PA and healthy living from their own lifeworld. This makes PA
a complex topic of care.

Keywords: Experiences of healthcare professionals, Type 2 diabetes, Physical activity, Qualitative design, In-depth interviews, Narrative analysis

 

Mirjam Stuij (2018). ‘Physical activity, that’s a tricky subject.’ Experiences of health care professionals with physical activity in type 2 diabetes care. BMC Health Services Research, 18:297, open access: https://doi.org/10.1186/s12913-018-3102-1

Conflict between diabetes guidelines and experienced counselling in sports and physical activity. An exploratory study
According to medical guidelines counselling on sports and physical activity should be part of diabetes treatment. Using an online questionnaire (n = 181), we explored how people with both type 1 and type 2 diabetes experienced this counselling in the Netherlands. Most respondents were critical, indicating that they did not receive proper guidance or helpful advices. A third of the respondents mentioned that there was hardly any attention for the subject during their treatment. This conflict between guidelines and experiences point towards the need for more insight in critical issues in counselling regarding taking up sports and physical activity (again) after diagnosis. 

Mirjam Stuij, Agnes Elling & Tineke A. Abma (2016). Conflict between diabetes guidelines and experienced counselling in sports and physical activity. An exploratory study. European Journal of Public Health,
DOI: http://dx.doi.org/10.1093/eurpub/ckw156. First published online: 27 September 2016

‘Starting all over again.’ Living with diabetes and the quest for restitution
The restitution story, the type of illness story about living a normal and healthy live (again), is the most prominent illness story in Western society. Patients who are unable to realize a restitution story might need an alternative ‘corpus of stories’ to draw on, e.g. narratives that more explicitly incorporate quest and/or loss. In this paper, we present the narrative of ‘Hippolyta’, a woman with diabetes who wanted to but was unable to live the restitution story. Although she seemed to have all characteristics in favour of ‘restitution’ – i.e. willingness, capacities, a higher socioeconomic background – she encountered losses and was not able to go back to her ‘normal’ life. In her story, she repeatedly emphasized to ‘start all over again’, departing from dominant health discourses emphasizing restitution and individual responsibility. The encounters with the researcher made her aware of the dominant storyline and enabled her to reconstruct her story. A detailed elaboration of this specific case shows the interactive dynamic of narrative development and interpretation, and offers important complementary communicative elements for health care.

Mirjam Stuij, Agnes Elling & Tineke Abma (2016). ‘Starting all over again.’ Living with diabetes and the quest for restitution. Paper presented at the Storytelling, Illness and Medicine conference of the Interdisciplinary net. Budapest, March 14-16, 2016. Download conference paper