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Scand J Caring Sci. 2008 Sep;22(3):455-62. doi: 10.1111/j.1471-6712.2007.00551.x.

Repertoires of lifestyle change and self-responsibility among participants in an intervention to prevent type 2 diabetes.

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1
Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute (KTL), Helsinkí, Finland. piia.jallinoja@ktl.fi

Abstract

This paper analyses participants' accounts on their experiences of lifestyle change during and after the intervention to prevent type 2 diabetes. This paper explores whether the individual is seen as capable of autonomously seeking for a healthier lifestyle or as dependent on external controls and support. The study is based on focus group interview data collected among intervention participants one-and-a-half years after the intervention ended. Those who had been successful in the weight reduction and those whose weight had increased after the intervention were interviewed in separate interview groups. Both weight-losers and weight-gainers agreed with the health-related objectives of the intervention. Despite this agreement, we found three distinct repertoires concerning individuals' potential to proceed in and maintain lifestyle change. The hopelessness repertoire was used mainly by the weight-gainers to describe experiences where lifestyle change was seen to be very difficult. The struggle repertoire was used frequently especially by the weight-gainers but also by the weight-losers to describe struggling against external temptations and one's weaknesses. The self-governing individual repertoire was used most often by weight-losers to describe experiences where new, healthier lifestyle had to a significant extent become a routine and the individual was seen as in charge of his/her lifestyle. The study revealed that the interviewees hold an ambivalent stance towards self-responsibility. The individual was seen as both a sovereign actor and a dependent object of interventions. Most of our interviewees called for continuous controls and even surveillance but at the same time rejected the idea of authoritarian health education. This ambivalence was most clearly present in the struggle repertoire and could be a fruitful target of clarification in health interventions. For a major part of intervention participants, lifestyle change is characterized as a constant struggle and hence interventions should plan the continuation of a support system.

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