Abstract:

The constant increase in chronicity, which has become a distinctive feature of countries with advanced economic development, presents a crucial educational challenge: educating patients in the self-management of a disease that will impact on their entire existence. It has, in fact, been observed that therapeutic adherence significantly decreases along the duration of the disease over time. This bears relevant consequences on the health conditions of the subject and on the context, in both economic and social terms. Such phenomenon is amplified by a vision of healthcare solely centered on the medical response to a specific biological need. This prevents from understanding the complexity of the self-management practice and from considering the psycho and socio-material implications connected to it. Therapeutic education is thus reduced to a mere list of prescriptions unrelated to the patient’s own history and to the context in which he lives, therefore becoming difficult to comply with.

A representative case study is type 1 diabetes, a chronic disease with increasing incidence all over the world and in which the process of learning how to self-manage it, becomes essential for the survival of the individual. This paper intends to highlight how a socio-material approach on the self-management practices of the disease allows to identify new perspectives of educational action in the treatment of chronicity, starting from the results of a qualitative empirical research that intends to study the formative effects produced by the self-management practices on the adult diabetic patient.

The research is based on the experiences of adult type 1 diabetic patients, collected through in-depth interviews and analyzed by following the Actor-Network Theory, the theoretical and methodological reference framework for the investigation. It highlights the socio-material character of the self-management practice and the active role of artifacts within the intricate network of elements necessary for the practice itself, bringing into light the numerous formative and performative pressures they exert on the patient.

The self-management practice thus proves not only to be a useful medical treatment tool, but also a powerful and latent formative tool which often produces discomfort and impacts on the correct management of the disease, without the patient and the other subjects cooperating in the treatment of the disease being aware of it. The results of such research have made it possible to identify a specific space of pedagogical research that opens up new perspectives in educational care in chronicity. With this in mind, therapeutic education enhances its possibilities of intervention through theming and the work on the latent educational dimension of self-management practices, in a continuous recurrence of theory and practice.

Furthermore, the relational nature of self-management practices suggests the advisability of adopting a bio-psycho-socio-material logic of intervention, considering the active role of all human and non-human elements involved in the definition of the health of the subject. The work thus focuses on a widespread action with all the components of the network thus promoting the sustainability of the management of the disease with a reduction over time of the impacts generated on the social context.

Keywords:

Diabetes, Materiality, Actor Network Theory, Therapeutic education, Formative pressures.