BackgroundLifestyle counselling is a pivotal aspect of diabetes care. But general practitioners (GPs) often have problems in finding their role in patients’ weight management. The aims of this study were to investigate the experiences of type 2 diabetes patients with lifestyle counselling from their GPs and to explore how patients’ preferences regarding counselling are embedded in the context of self-management and wider cultural aspects of nutrition.MethodsNarrative interviews were conducted with 35 people with type 2 diabetes aged between 35 and 77 years. The interviews were transcribed verbatim and analysed using the thematic framework method.ResultsMany patients had a strong feeling of personal responsibility for weight reduction as integral to diabetes self-management but found it difficult to integrate the changes their disease requires into their self-management activities. They attached great importance to their GPs’ advice on diet. While some patients appreciated direct communication, others regarded dramatic pictures as either unhelpful or offending. A serious problem was the incompatibility of the dietary recommendations with daily life resulting in a reluctance to adjust the whole diet to the needs of diabetes care.ConclusionsAmbivalence towards patient self-management and tensions between the necessary changes to patients’ lifestyles and their culture, makes the GP’s role difficult and full of conflict. Instead of focusing exclusively on the guidelines of diabetes management and provision of information, GPs should explore the patients’ capabilities of self-management through open communication and accept their patients’ wishes to protect nutrition as part of their culture.

Narrative identity has achieved a scientific status as an elaborate concept of the storied nature of human experience and personal identity. Yet, many questions remain as to its empirical substrate. By exploring the pragmatic aspect of narrative research interviewing, i.e., the performative and positioning aspects of the narrative situation and the narrative product, as well as its particular autoepistemological and communicative tasks, this article tries to bridge the gap between the theoretical concept of narrative identity and the act of constructing identity in research interviewing.Research data generated by autobiographical interviews are usually regarded and analyzed as monological narratives drawn from autobiographical memory. Narrative research interviewing, however, is always a dialogical, pragmatic activity: Narrator and researcher establish an interpersonal relationship made up of institutional, imaginative, socio-categorial and other communicative frames which are enacted by both partners during the interview. This pragmatic constitution of the interview as an interactive process calls for a communicative and constructivist approach to oral narratives which reveals different levels of the listener’s conceptions of himself or herself and the research situation in the narrator’s story. Along with the different voices and identity constructions, the narrator also constructs different recipients in his or her discursive positioning of the listener.By using the concept of positioning, we propose both a conceptual framework and the corresponding analytical tools for identifying textual indicators and contextual interpretative resources for a discursive approach to narrative identity constructions in research interviewing. This option allows insight into the strategies narrators employ to negotiate their identities in the situation itself, which may be fruitful for many research contexts that use the concept of narrative identity. (Narrative, Autobiography, Research Interviewing, Conversation Analysis)

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BackgroundPatients often seek other patients’ experiences with the disease. The Internet provides a wide range of opportunities to share and learn about other people’s health and illness experiences via blogs or patient-initiated online discussion groups. There also exists a range of medical information devices that include experiential patient information. However, there are serious concerns about the use of such experiential information because narratives of others may be powerful and pervasive tools that may hinder informed decision making. The international research network DIPEx (Database of Individual Patients’ Experiences) aims to provide scientifically based online information on people’s experiences with health and illness to fulfill patients’ needs for experiential information, while ensuring that the presented information includes a wide variety of possible experiences.ObjectiveThe aim is to evaluate the colorectal cancer module of the German DIPEx website krankheitserfahrungen.de with regard to self-efficacy for coping with cancer and patient competence.MethodsIn 2015, a Web-based randomized controlled trial was conducted using a two-group between-subjects design and repeated measures. The study sample consisted of individuals who had been diagnosed with colorectal cancer within the past 3 years or who had metastasis or recurrent disease. Outcome measures included self-efficacy for coping with cancer and patient competence. Participants were randomly assigned to either an intervention group that had immediate access to the colorectal cancer module for 2 weeks or to a waiting list control group. Outcome criteria were measured at baseline before randomization and at 2 weeks and 6 weeksResultsThe study randomized 212 persons. On average, participants were 54 (SD 11.1) years old, 58.8% (124/211) were female, and 73.6% (156/212) had read or heard stories of other patients online before entering the study, thus excluding any influence of the colorectal cancer module on krankheitserfahrungen.de. No intervention effects were found at 2 and 6 weeks after baseline.ConclusionsThe results of this study do not support the hypothesis that the website studied may increase self-efficacy for coping with cancer or patient competencies such as self-regulation or managing emotional distress. Possible explanations may involve characteristics of the website itself, its use by participants, or methodological reasons. Future studies aimed at evaluating potential effects of websites providing patient experiences on the basis of methodological principles such as those of DIPEx might profit from extending the range of outcome measures, from including additional measures of website usage behavior and users’ motivation, and from expanding concepts, such as patient competency to include items that more directly reflect patients’ perceived effects of using such a website.Trial RegistrationClinicaltrials.gov NCT02157454; https://clinicaltrials.gov/ct2/show/NCT02157454 (Archived by WebCite at http://www.webcitation.org/6syrvwXxi)

BackgroundMany patients with inflammatory bowel disease strongly believe that food or certain food products heavily influence the symptoms or even trigger acute flare-ups. Unfortunately, there is no generalizable information for these patients, and therefore no effective diet has been identified to date.MethodsThe narrative interviews we used for this study provide the basis for the German website www.krankheitserfahrungen.de. Maximum-variation sampling was used to include a broad range of experiences and a variety of different factors that might influence people’s experiences. The sample included men and women of different age groups and social and ethnic backgrounds from across Germany. The interviews were analyzed using grounded theory.ResultsFour interrelated categories emerged: managing uncertainty, eating: between craving and aversion, being different and professional help as a further source of uncertainty. The most important issue for our responders was the handling of uncertainty and to find a way between desire for, and aversion against, eating. Many participants described difficulties during formal social occasions such as weddings, birthdays, or when going out to a restaurant.ConclusionsMany of the experiences the participants reported in their daily struggle with food and their illness, such as cravings for and abstaining from certain foods, were rather unusual and often stressful. Because they decided not to go out in public any longer, some of the interviewees experienced even more social isolation than they did before. Health professionals need to become more involved and not only advice about food and eating, but also help their patients find strategies for avoiding social isolation.