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Programme: accepted abstracts

Abstract ID: 1084

Part of General Paper Session (Other abstracts in this session)

Assigning responsibility and motivating adolescents in pediatric diabetes care

Authors: Ottesjö, Cajsa (1); Ericsson, Stina (2)
Submitted by: Ottesjö, Cajsa (Gothenburg University, Sweden)

Diabetes is a chronic disease requiring the individual to have enough knowledge to control and handle measurement of blood glucose and insulin dosages, and to take responsibility for her/his health generally. This may be a particularly strong challenge for adolescents, in transit from carefree childhood to responsible adulthood. This study is part of a multidisciplinary project on communication, decision making, ethics and health in pediatric diabetic care, in a context of person-centred care (Munthe et al. 2011). We focus here on two aspects of responsibility that are particularly salient in our data: assigning responsibility to different agents (adolescent, parent, doctor) and motivating adolescents to take responsibility for their diabetes (cf. Silverman 1993).

The material is two (out of twelve in the corpus) conversations between a doctor and two different adolescents during one of their regular visits to the pediatric diabetes clinic. The visits were video recorded. The analytic method used is Conversation Analysis.

Regarding the assignment of responsibility, the importance of checking your blood glucose, to be able to adapt the dose of insulin, is made relevant throughout both conversations. The person portrayed as responsible for this is the adolescent. It is also important for a person with diabetes to eat at regular intervals and to give a correct dose of insulin adjusted to the meal. In one of the conversations the parent makes the whole family responsible for the regular food intake. They appear as a unit, parents and patient working together. In the other family the sharing of responsibility for the diabetes seems to be more problematic from what is said, and the patient’s control over the diabetes is not working well, which is even more problematic since this person will soon be transferred to the adult diabetic-care.

Regarding motivation, both conversations contain sequences where the doctor tries to motivate the patients to measure their blood glucose levels. Two main strategies for this can be identified in the conversations: one monological and the other dialogical. The monological strategy involves virtually no contributions from the adolescent. Hence, the adolescent’s own perspective is missing here, and the adolescent makes no decisions. The dialogical strategy centres on two questions, “What makes you do measurements?” and “What prevents you from doing measurements?”. We argue that the dialogical strategy is more in line with person-centred care.

References:

Munthe, Christian, Sandman, Lars & Ceutas, Daniela (2011). Person Centred Care and Shared Decision Making: Implications for Ethics, Public Health and Research. Health Care Anal DOI 10.1007/s10728-011-0183-y . Springer Science+Business Media, LLC 2011.

Silverman, David (1993). Policing the Lying Patient: Surveillande and Self-Regulation in Consultations with Adolescent Diabetics. In Fisher, Sue and Todd, Alexandra D. [eds] The Social Organization of Doctor-Patient Communication. Norwood, N.J. : Ablex, cop. pp. 213-241.