Wetenschappelijke artikelen

‘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

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