O manejo da responsabilização em grupos com pessoas com diabetes mellitus

Abstract

In contemporary society, the meaning of diabetes mellitus is associated with a pathological conception, linked to the idea of deficiency and individual responsibility. Consequently, people with diabetes are constantly being called to respond for the appearance of illness or the complications of non-adherence to prescribed forms of care by health professionals. Therefore, the aim of this study was to understand how people with Type 2 diabetes mellitus and their caregivers and / or companions manage the process of accountability in a situation of group interaction. Discursive Psychology, a British proposal for conducting discourse analysis, inspired by social constructionist epistemology was adopted as the theoretical and methodological framework. Five workshops were performed and 25 people (middle-aged adults and seniors from 30 to 70 years) both male and female with Type 2 diabetes mellitus and their caregivers or companions (family, friends, and neighbors), users of services of a Basic Family Health attended. The steps of our analysis were: a) transcripts of the conversations of the group, b) curious, attentive and interrogative reading of the material collected, c) identification of excerpts from conversations that were related to the process of accountability, d) identification of excerpts that illustrate different discursive strategies related to the process of accountability, and e) analysis of the use of discursive strategies for managing accountability. The focus was to understand the role of discursive strategies and their effects on interaction during the conversations of the groups. Through analysis, two discursive strategies were named according to their role in the interaction: 1) "Blaming others: Assigning responsibility to others" and 2) "Blaming oneself." The latter strategy had two distinct movements, so they were categorized into two sub-strategies: "Taking responsibility: the use of other forms of care" and "Taking responsibility: the getting used to living with diabetes." Throughout the analysis, we observed that the discursive strategies allowed participants to put themselves discursively into interactional context in order to present themselves as people who take care of health and manage possible charges. In addition, through analysis, Accountability was understood as something discursively constructed and directly related to situational demands of the interactive context and socio-cultural expectations and not as something that can be defined as an internal psychological construct, as a process decision-making nor as causal attribution. This study therefore invites critical reflection on ways to talk about diabetes and its impact on the lives of people with the disease, their caregivers and health professionals.