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Parents' discursive resources: Analysis of discourses in Swedish, Danish and Norwegian health care guidelines for children with diabetes type 1
Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för vårdvetenskap på avancerad nivå.ORCID-id: 0000-0003-3792-6600
Nordic School of Public Health, Gothenburg.
Nordic School of Public Health, Gothenburg.
Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för vårdvetenskap på avancerad nivå.ORCID-id: 0000-0003-3702-8202
2012 (Engelska)Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, nr 2, s. 363-371Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The incidence of diabetes type 1 in children, the most common metabolic disorder in childhood, increases worldwide, with highest incidence in Scandinavia. Having diabetes means demands in everyday life, and the outcome of the child's treatment highly depends on parents' engagement and involvement. The aim of this study was to explore and describe discourses in health care guidelines for children with diabetes type 1, in Sweden, Norway and Denmark during 2007-2010, with a focus on how parents were positioned. As method a Foucauldian approach to discourse analysis was applied, and a six-stage model was used to perform the analysis. The findings shows a Medical, a Pedagogic and a Public Health discourse embedded in the hegemonic Expert discourse. The Expert discourse positioned parents as dependent on expert knowledge, as recipients of education, as valuable and responsible for their child's health through practicing medical skills. This positioning may place parents on a continuum from being deprived of their own initiatives to being invited to take an active part and could result in feelings of guilt and uncertainty, but also of security and significance. From this study we conclude that guidelines rooted in the Expert discourse may reduce opportunities for parents' voices to be heard and may overlook their knowledge. By broadening the selection of authors of the guidelines to include patients and all professionals in the team, new discourses could emerge and the parents' voice might be more prominent. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

Ort, förlag, år, upplaga, sidor
2012. Vol. 26, nr 2, s. 363-371
Nyckelord [en]
Diabetes type 1, Discourse analysis, Expert discourse, Guidelines, Parents' voice
Nationell ämneskategori
Omvårdnad
Forskningsämne
VÅRD- OCH HÄLSOVETENSKAP, Vårdvetenskap
Identifikatorer
URN: urn:nbn:se:hv:diva-3964DOI: 10.1111/j.1471-6712.2011.00942.xISI: 000304000000020Scopus ID: 2-s2.0-84861006995OAI: oai:DiVA.org:hv-3964DiVA, id: diva2:474154
Tillgänglig från: 2012-01-09 Skapad: 2012-01-09 Senast uppdaterad: 2019-06-03Bibliografiskt granskad
Ingår i avhandling
1. Fathers involved in children with type 1 diabetes: finding the balance between disease control and health promotion
Öppna denna publikation i ny flik eller fönster >>Fathers involved in children with type 1 diabetes: finding the balance between disease control and health promotion
2013 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background:

Type I diabetes is a chronic disease that places great demands on the child and family. Parental involvement has been found to be essential for disease outcome. However, fathers’ involvement has been less studied, even though high paternal involvement has been correlated with less disease impact on the family and higher quality of life among adolescents.

Aim: The overall aim of the study was to explore and analyze constructions of fathers’ involvement in their child’s everyday life with type 1 diabetes from an ecological and health promotion perspective. Four specific aims were applied: 1) explore and describe discourses in health care guidelines for children with type 1 diabetes in Nordic countries, focusing on parents' positioning (I), 2) analyze how Swedish pediatric diabetes teams perceived and discussed fathers’ involvement in the care of their child with type 1 diabetes, and to discuss how the teams’ attitudes toward the fathers’ involvement developed during a focus group process (II), 3) explore and discuss how fathers involved in caring for their child with type 1 diabetes experience support from their pediatric diabetes team in everyday life with their child (III), and 4) analyze how involved fathers to children with type 1 diabetes understand their involvement in their child’s daily life and to discuss their perceptions from a health promotion perspective (IV).

Material and methods: A qualitative and inductive approach was applied. Data were collected and analyzed during 2010-2012. The sample consisted of three pediatric guidelines originating from Norway, Denmark and Sweden (I), three Swedish pediatric diabetes teams (PDTs) (II), and 11 (III) and 16 (IV) fathers of children with type 1 diabetes who scored high involvement on the Parental Responsibility Questionnaire. Data were collected through repeated focus group discussions with the PDTs (II), online focus group discussions (III) and individual interviews (III, IV) with the fathers. Three analysis methods were applied: analysis of discourses (I), Constructivist Grounded Theory (II, III) and content analysis (IV).

Findings: The findings illuminated the complex interaction between the pediatric guidelines, the PDTs and the fathers. Fathers highly involved in their child’s daily life experienced different levels of tension between the general recommendations and their personal experiences of living with a child with type 1 diabetes (III). The fathers regarded their involvement in their child’s diabetes care as additional to their general parenting, and a fine balance was identified between a health promotion perspective and a controlling involvement. The common denominator between the highly involved fathers was their use of parental leave (IV). The PDTs initially perceived fathers’ involvement as gendered and balanced on the mother’s agement, but as focus was set on fathers’ engagement the PDTs increased their awareness of this and started to identify and encourage their engagement II). At the macro-level, parents’ voices were diminished in Nordic pediatric diabetes guidelines in favor of an expert discourse (I).

Conclusions: Fathers’ involvement concerning a child with type 1diabetes is constructed in a complex way, based on an interaction between the fathers’ perceptions of their additional involvement and the support provided by the PDTs; the PDTs’ perceptions of the fathers’ involvement; and how parents/fathers are constructed in pediatric diabetes guidelines. In order to promote the health and well-being of children with type 1 diabetes, fathers’ involvement needs to be taken into account in the pediatric guidelines as well as in clinical practice. 

Ort, förlag, år, upplaga, sidor
Gothenburg: Nordic School of Public Health, 2013. s. 60
Serie
NHV rapporter, ISSN 0283-1961 ; 2013:1
Nyckelord
children, fathers’ involvement, health promotion, pediatric diabetes team, type 1
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Forskningsämne
VÅRD- OCH HÄLSOVETENSKAP, Folkhälsovetenskap
Identifikatorer
urn:nbn:se:hv:diva-5808 (URN)978-91-86739-48-5 (ISBN)
Disputation
Nordic School of Public Health, Box 12133, 402 42 Göteborg (Svenska)
Opponent
Handledare
Tillgänglig från: 2014-01-16 Skapad: 2013-12-17 Senast uppdaterad: 2015-03-04Bibliografiskt granskad

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Boman, ÅseDahlborg Lyckhage, Elisabeth

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