[New technology of diabetes management: learning together and in situation]. / Nouvelle technologie de gestion du diabète: apprendre ensemble et en situation.

The introduction of a new technology for the management of diabetes raises questions about their actual use. This is the case with the Freestyle Libre sensor, a tool that measures the interstitial glucose levels. Some studies have provided recommendations about its use, but little is known about how users learn to use it in the daily management of the disease. This ethnographic research explores this issue in the context of a summer camp for young people living with diabetes. The results describe three different levels (material, epistemic and moral) at which learning occurs. They show that its use requires an active appropriation process, the importance of a setting that promotes interactions between the participants and that the features of the tend to reconfigure the expert-lay person relationship.

L'introduction d'une nouvelle technologie de gestion du diabète soulève des questions sur son usage effectif. C'est le cas du capteur FreeStyle Libre, un outil mesurant la glycémie interstitielle. Des études ont fourni des recommandations sur son usage, mais on en sait peu sur la manière dont les usager-ère-s apprennent à l'utiliser dans la gestion quotidienne du diabète. Cette recherche ethnographique étudie cette question dans le cadre d'un camp d'été pour jeunes vivant avec un diabète. Les résultats décrivent trois niveaux différents (matériel, épistémique et moral) auxquels cet apprentissage se réalise. Ils montrent que son usage requiert un travail d'appropriation actif, l'intérêt d'un dispositif qui favorise les interactions entre participant-e-s et que les caractéristiques de l'outil tendent à reconfigurer la relation expert-profane.

Techno-social reconfigurations in diabetes (self-) care.

This article focuses on the ways in which a flash glucose monitoring system, FreeStyle Libre®, is introduced and used by people living with type 1 diabetes, their relatives and healthcare professionals. It draws on a multi-sited ethnography in a variety of clinical and daily situations, and on interviews with caregivers and people living with diabetes. We explore how the users develop knowledge-in-practice, and consider the use of self-management technologies to be largely dependent on locally grounded and situated care acts, and resulting from the relational, pragmatic and creative maneuvering of technology-in-practice. Our findings show that adjustments between users, their bodies and the technology are required, and show the reflexive work and practices of patients and relatives who learn to use the device in a proper way. Moreover, we reveal that practitioners see this technology as a tool that not only improves self-care practices but also clinical practices, and that wearing and using this new medical device may become a moral injunction for self-improvement. Our results illustrate the techno-social reconfigurations at work and the development of new ways of feeling, thinking and acting in diabetes (self-) care.

Meeting physicians' needs: a bottom-up approach for improving the implementation of medical knowledge into practice.

BACKGROUND: Multiple barriers to knowledge translation in medicine have been identified (ranging from information overload to abstraction of models), leading to important implementation gaps. This study aimed at assessing the suggestions of practicing physicians for possible improvements of knowledge translation (KT) effectiveness into clinical practice. METHODS: We used a mixed methods design. French- German- and Italian-speaking general practitioners, psychiatrists, orthopaedic surgeons, cardiologists, and diabetologists practicing in Switzerland were interrogated through semi-structured interviews, focus group discussions, and an online survey. RESULTS: A total of 985 physicians from three regions of Switzerland participated in the online survey, whereas 39 participated in focus group discussions and 14 in face-to-face interviews. Physicians expressed limitations and difficulties related to KT into their daily practice. Several barriers were identified, including influence and pressure of pharmaceutical companies, non-publication of negative results, mismatch between guidelines and practice, education gaps, and insufficient collaboration between research and practice. Suggestions to overcome barriers were improving education concerning the evaluation of scientific publications, expanding applicability of guidelines, having free and easy access to independent journals, developing collaborations between research and practice, and creating tools to facilitate access to medical information. CONCLUSIONS: Our study provides suggestions for improving KT into daily medical practice, matching the views, needs and preferences of practicing physicians. Responding to suggestions for improvements brought up by physicians may lead to better knowledge translation, higher professional satisfaction, and better healthcare outcomes.

Interaction analysis and psychology: a dialogical perspective.

Interaction analysis is not a prerogative of any discipline in social sciences. It has its own history within each disciplinary field and is related to specific research objects. From the standpoint of psychology, this article first draws upon a distinction between factorial and dialogical conceptions of interaction. It then briefly presents the basis of a dialogical approach in psychology and focuses upon four basic assumptions. Each of them is examined on a theoretical and on a methodological level with a leading question: to what extent is it possible to develop analytical tools that are fully coherent with dialogical assumptions? The conclusion stresses the difficulty of developing methodological tools that are fully consistent with dialogical assumptions and argues that there is an unavoidable tension between accounting for the complexity of an interaction and using methodological tools which necessarily "monologise" this complexity.