Society for Medical Anthropology
Oral Presentation Session
Christopher Simpson (Vanderbilt University Medical Center)
Courtney VanHouten (IBM)
Research has shown that adherence to recommended therapy and self-care practices improves clinical outcomes in diabetes, yet adherence remains a challenge for patients. With a few exceptions, much of the research on adherence to therapy is focused on knowledge (e.g. health literacy and numeracy), skills (e.g. problem-solving), and other individual patient competencies. An emerging science of “patient work” complements existing adherence research by using established frameworks and methods for studying activities of workers (i.e. in business/industrial settings) to study the work of patients and caregivers, and how that work is organized and made reliable. Patient work is a construct that can accommodate research from a variety of disciplinary perspectives, including anthropology. We oriented our ethnographic study around the relationship between structure and practice, as characterized in organizational routines theory. We focused on the illness-related practices of 50 people with insulin-dependent diabetes, and our primary research questions were: 1) How are diabetes self-care routines aligned with other activities in everyday life? 2) What is the relationship between strongly aligned routines and diabetes self-care success? We identified artifacts, actors, spaces, and temporal structures serving as “microstructures” that structured the everyday practices of participants. We found that well-structured routines (i.e. microstructures that reliably supported self-care activities) were significantly related to better self-care outcomes as measured by the hemoglobin A1c test. We will discuss the use of routines theory in understanding diabetes self-care and reflect on the ethics and scalability of robust clinical engagement with patients to improve the structuring of everyday self-care practices.