The Practice of Regulating Insulin Dependent Diabetes: An Empirical Study With a Cultural Historical Activity Theory (CHAT) Perspective
Translated title
Praksissen at regulere insulinkrævende diabetes: Et empirisk studie med et Kulturhistorisk Aktivitets Teoretisk (CHAT) Perspektiv
Authors
Jørgensen, Line Østereng ; Bach, Anne Katrine
Term
4. term
Education
Publication year
2015
Submitted on
2015-06-10
Pages
100
Abstract
Denne afhandling undersøger, hvorfor det trods moderne diabetesteknologi og viden stadig er svært for mange insulinafhængige personer at holde et stabilt blodsukker i hverdagen. Vi talte med mennesker, der lever med diabetes, og med fagpersoner, og vi kiggede på rollerne hos kommuner, ambulatorier, leverandører og en medicovirksomhed. Vi indsamlede observationer, dagbogsinterviews og semistrukturerede interviews. Vi analyserede materialet med kulturhistorisk aktivitetsteori (CHAT), en praksisorienteret ramme, der ser på samspillet mellem mennesker, redskaber, regler og kontekster. Vi kortlagde otte aktivitetssystemer, herunder den centrale praksis for regulering af diabetes, og brugte CHAT‑værktøjer til at identificere spændinger og relationer i og mellem systemerne. Vi fandt, at bærbar teknologi til blodsukkermåling har forandret selvreguleringen: Den gør det muligt at følge blodsukkeret i løbet af dagen, men skaber også en mere kompleks praksis med mange indbyrdes afhængige faktorer. Konsultationer er gået fra faste instruktioner til behov for mere individuel vejledning. Forskellige fortolkninger af retningslinjer blandt diabetikere og i deres omgivelser kan skabe forvirring og dømmende holdninger, og begrænset adgang til teknologi kan hæmme reguleringen. Samlet set er regulering grundlæggende kompleks. Perfekt kontrol ville kræve konstant opmærksomhed på mange forhold, hvilket ikke er muligt, når livet også skal leves. Selvreguleringen må flettes ind i hverdagens aktiviteter; når rutiner ændrer sig, skal reguleringen følge med, ellers kan noget, der virkede før, give uventede udsving i blodsukkeret. Derfor er det, trods fremskridt i teknologi og viden, stadig en vanskelig balance at holde blodsukkeret stabilt—men vi peger på muligheder for bedre støtte til praksis.
This thesis asks why, despite modern diabetes technology and knowledge, many insulin-dependent people still find it hard to keep blood glucose stable in everyday life. We spoke with people living with diabetes and with professionals, and examined the roles of municipalities, outpatient clinics, suppliers, and a medical device company. We gathered observations, diary-based interviews, and semi-structured interviews. We analyzed the material using Cultural-Historical Activity Theory (CHAT), a practice-oriented framework that looks at how people, tools, rules, and contexts interact. We mapped eight activity systems, including the core practice of regulating diabetes, and used CHAT tools to identify tensions and relationships within and between them. We found that portable glucose technology has transformed self-management: it enables people to monitor blood glucose throughout the day, but also makes daily regulation more complex by introducing many interacting factors. Clinical consultations have shifted from fixed instructions toward individualized guidance. Differences in how guidelines are understood among patients and those around them can cause confusion and judgment, and limited access to technology can hinder regulation. Overall, regulation is inherently complex. Perfect control would demand constant attention to many elements, which is not feasible while living a normal life. Self-management must be woven into everyday activities; when routines change, regulation must adapt, or actions that worked before may lead to unexpected glucose swings. Thus, even with progress in technology and knowledge, keeping blood glucose stable remains a delicate balance—though we identify opportunities to better support practice.
[This abstract was generated with the help of AI]
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