Physical activity in type 2 diabetes care: A critical narrative study

Based on numerous biomedical and epidemiological studies, physical activity (including exercise) is considered a ‘corner stone’ in type 2 diabetes care, and, as such, one of the starting points for and an important topic throughout medical treatmentBoth the origin and management of type 2 diabetes are strongly linked to physical (in)activity and extreme overweight. This means that healthcare professionals are instructed to stimulate physical activity among people who generally are not inclined to be active. The central aim of this dissertation is to provide in-depth insights into experiences with physical activity (as an aspect of care) and openings for ‘physical activity care’ for people with type 2 diabetes. These insights stem from several empirical studies using a qualitative narrative approach, which implies an explicit inclusion of the broader socio-political, research, and healthcare context to understand how these contexts affect the experiences of healthcare professionals and people with type 2 diabetes. As indicated in the subtitle, this dissertation is critical towards (im)possibilities and understandings offered by the broader context. As such, the purpose is to provoke thought and discussion on the topic of physical activity in healthcare to contribute to further improvements in care for people with type 2 diabetes. To do so, I primarily used a narrative methodological approach to collect and analyse data as well as in the writing process. I conducted in-depth interviews with people diagnosed with type 2 diabetes and healthcare professionals, and observed them in different healthcare settings. During the analysis, the focus was on both the content (‘what’) and form (‘how’) of the data. Overall, four main theoretical lenses, ranging from critical macro-levels to narrative micro-levels, guided me throughout this study. This dissertation is divided into three parts that present empirical studies on the policy and healthcare context, individual experiences, and openings to improve physical activity counselling and treatment, respectively. Most of these chapters are written together with other authors. Each part ends with an intermezzo to offer additional insights into experiences of people with type 2 diabetes with physical activity in- and outside the care context, and new thoughts on physical activity counselling, created in partnership with a small group of healthcare professionals. In the final chapter, I offer a narrative reflection on all findings together to provide input for further thought and discussion on the topic of physical activity in type 2 diabetes care. First, I reflect on what can be learned about physical activity (care) experiences from people with type 2 diabetes and healthcare professionals. Second, I reflect on what openings created by extended talking and walking practices can add to improving physical activity care. Third, I reflect on how the broader socio-political, research and care context can further support the improvement of physical activity care for people with type 2 diabetes. To conclude, I argue that it is important ‘to think with’ stories. With topics as complex and intricately interwoven in all aspects of our life such as physical activity and health(care), stories of those (most) involved provide us with an opportunity to be taken by surprise, to have our own (professional-personal) story contradicted, to be argued with, to be provided with confirmation or to interrogate what might easily be taken for granted. To make room for these stories in care, policy, research and beyond, it is necessary to hear these stories and think along with them. Above all, it requires us to accept contradicting and complex experiences, or even better, to actively search for stories that challenge mainstream thoughts and to embrace these as opportunities to try to further improve personal and professional lives.