IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v71y2010i3p486-493.html
   My bibliography  Save this article

How do structured education programmes work? An ethnographic investigation of the dose adjustment for normal eating (DAFNE) programme for type 1 diabetes patients in the UK

Author

Listed:
  • Lawton, Julia
  • Rankin, David

Abstract

Structured education programmes (SEPs) for patients with diabetes and other chronic diseases are being widely adopted across the UK and elsewhere. Trials suggest they are more efficacious than didactic approaches, with patients showing improvements in learning, blood glucose control and quality of life. However, the reasons for these improvements are not well understood. To establish how, and why, SEPs work, we undertook a qualitative investigation of the Dose Adjustment for Normal Eating (DAFNE) programme. DAFNE is a well-established SEP for type 1 diabetes patients in the UK, which teaches them to alter their insulin doses in order to improve dietary freedom and blood glucose control. Six five-day courses were observed and in-depth interviews conducted with 30 patients aged 18-59 years on completion of the courses. Prior to their courses, many patients had developed protective behaviours and risk-avoiding strategies, such as running blood glucose levels high to avoid hypoglycaemia, or low to avoid developing complications. Implementing the insulin dose adjustments recommended on the course often required patients to move out of comfort zones and take what they had perceived, initially at least, as risks. In order to understand and explain course dynamics and outcomes, we draw upon Adams' concept of the risk-thermostat - which presupposes that all individuals are equipped with an internal instrument by which they gauge and respond to risk - and add a corporeal dimension to it. In doing so, we highlight the dynamic ways in which (embodied) group interactions and experiences, and their enmeshment with other aspects of course delivery, such as educator surveillance and employment of course rules, helped to enhance learning and promote patients' transformations into insulin dose adjusting subjects. This included inter-corporeal processes through which patients recalibrated their risk thermostats in light of the insulin dose adjustment experiences of others.

Suggested Citation

  • Lawton, Julia & Rankin, David, 2010. "How do structured education programmes work? An ethnographic investigation of the dose adjustment for normal eating (DAFNE) programme for type 1 diabetes patients in the UK," Social Science & Medicine, Elsevier, vol. 71(3), pages 486-493, August.
    • Handle: RePEc:eee:socmed:v:71:y:2010:i:3:p:486-493
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(10)00360-6
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. anonymous, 1995. "Economist examines financial derivatives risk," Financial Update, Federal Reserve Bank of Atlanta, vol. 8(Jan), pages 1-4.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Vivien Coates & Geraldine Horigan & Marian Carey & Mark Davies, 2018. "Using qualitative data to enhance our understanding of the reasons young people decline Structured Diabetes Education programmes," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(15-16), pages 3139-3147, August.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Attar, Andrea & Campioni, Eloisa & Piaser, Gwenaël, 2018. "On competing mechanisms under exclusive competition," Games and Economic Behavior, Elsevier, vol. 111(C), pages 1-15.
    2. Dimitriou, Harry T. & Ward, E. John & Dean, Marco, 2016. "Presenting the case for the application of multi-criteria analysis to mega transport infrastructure project appraisal," Research in Transportation Economics, Elsevier, vol. 58(C), pages 7-20.
    3. Powell, J.H. & Mustafee, N. & Chen, A.S. & Hammond, M., 2016. "System-focused risk identification and assessment for disaster preparedness: Dynamic threat analysis," European Journal of Operational Research, Elsevier, vol. 254(2), pages 550-564.
    4. Veland, H. & Aven, T., 2013. "Risk communication in the light of different risk perspectives," Reliability Engineering and System Safety, Elsevier, vol. 110(C), pages 34-40.
    5. Alan M. Taylor, 2002. "A Century Of Purchasing-Power Parity," The Review of Economics and Statistics, MIT Press, vol. 84(1), pages 139-150, February.
    6. Molyneaux, Lynette & Brown, Colin & Wagner, Liam & Foster, John, 2016. "Measuring resilience in energy systems: Insights from a range of disciplines," Renewable and Sustainable Energy Reviews, Elsevier, vol. 59(C), pages 1068-1079.
    7. Bedford, Tim & Bayley, Clare & Revie, Matthew, 2013. "Screening, sensitivity, and uncertainty for the CREAM method of Human Reliability Analysis," Reliability Engineering and System Safety, Elsevier, vol. 115(C), pages 100-110.
    8. Casiday, Rachel Elizabeth, 2007. "Children's health and the social theory of risk: Insights from the British measles, mumps and rubella (MMR) controversy," Social Science & Medicine, Elsevier, vol. 65(5), pages 1059-1070, September.
    9. Barbara von Schnurbein, 2010. "The Core of an Extended Tree Game: A New Characterisation," Ruhr Economic Papers 0212, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    10. Hokstad, Per & Steiro, Trygve, 2006. "Overall strategy for risk evaluation and priority setting of risk regulations," Reliability Engineering and System Safety, Elsevier, vol. 91(1), pages 100-111.
    11. Bye, Rolf & Lamvik, Gunnar M., 2007. "Professional culture and risk perception: Coping with danger on board small fishing boats and offshore service vessels," Reliability Engineering and System Safety, Elsevier, vol. 92(12), pages 1756-1763.
    12. Osmundsen, Petter & Aven, Terje & Erik Vinnem, Jan, 2008. "Safety, economic incentives and insurance in the Norwegian petroleum industry," Reliability Engineering and System Safety, Elsevier, vol. 93(1), pages 137-143.
    13. von Schnurbein, Barbara, 2010. "The Core of an Extended Tree Game: A New Characterisation," Ruhr Economic Papers 212, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    14. R. Yamamoto & B. LeBaron, 2010. "Order-splitting and long-memory in an order-driven market," The European Physical Journal B: Condensed Matter and Complex Systems, Springer;EDP Sciences, vol. 73(1), pages 51-57, January.
    15. repec:zbw:rwirep:0212 is not listed on IDEAS
    16. Li, Jiawei & Pollard, Simon & Kendall, Graham & Soane, Emma & Davies, Gareth, 2009. "Optimising risk reduction: An expected utility approach for marginal risk reduction during regulatory decision making," Reliability Engineering and System Safety, Elsevier, vol. 94(11), pages 1729-1734.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:71:y:2010:i:3:p:486-493. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.