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Western Journal of Nursing Research, Vol. 20, No. 6, 656-682 (1998)
DOI: 10.1177/019394599802000602

Contrasting Patient and Practitioner Perspectives in Type 2 Diabetes Management

Linda M. Hunt

School of Nursing, University of Texas Health Science Center

Nedal H. Arar

Anne C. Larme

Department of Orthodontics

Sally H. Rankin, Ph.D., R.N.-C., F.A.A.N.

University of California, San Francisco

Robert M. Anderson, Ed.D.

University of Michigan Diabetes Research and Training Center

Studies of self-care behaviors in the management of type 2 diabetes of ten focus on patient knowledge and montivation, without considering the role of practitioner orientations. Using an exploratory descriptive design, we conducted open-ended interviews with 51 type 2 diabetes patients and 35 practitionersfrom clinics in San Antonio and Laredo, Texas. We found critical differences between patient andpractitioner goals, evaluations, and strategies in diabetes management, especially regarding such key concepts as "control" and "taking care of self:" Practitioners' perspectives are rooted in a clinical context, emphasizing technical considerations, whereas patients'perspectives exist within a life-world context andforeground practical and experiential considerations. These result in very different approaches to treatment. Practitioners, presuming failed treatment indicates uncooperativeness, try to inform and motivate patients. The patients we interviewed, however, understood and were committed to type 2 diabetes selfcare, but lackedfull access to behavioral options due to theirpoverty and limited social power.


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