Education and self-management for people newly diagnosed with type 2 diabetes: a qualitative study of patients' views.

OObjectives: We explored the perceptions, views and experiences of diabetes education in people with type 2 diabetes who were participating in a UK randomized controlled trial of methods of education. The intervention arm of the trial was based on DESMOND, a structured programme of group education sessions aimed at enabling self-management of diabetes, while the standard arm was usual care from general practices. Methods: Individual semi-structured interviews were conducted with 36 adult patients, of whom 19 had attended DESMOND education sessions and 17 had been randomized to receive usual care. Data analysis was based on the constant comparative method. Results: Four principal orientations towards diabetes and its management were identified: `resisters', `identity resisters, consequence accepters', `identity accepters, consequence resisters' and `accepters'. Participants offered varying accounts of the degree of personal responsibility that needed to be assumed in response to the diagnosis. Preferences for different styles of education were also expressed, with many reporting that they enjoyed and benefited from group education, although some reported ambivalence or disappointment with their experiences of education. It was difficult to identify striking thematic differences between accounts of people on different arms of the trial, although there was some very tentative evidence that those who attended DESMOND were more accepting of a changed identity and its implications for their management of diabetes. Discussion: No one single approach to education is likely to suit all people newly diagnosed with diabetes, although structured group education may suit many. This paper identifies varying orientations and preferences of people with diabetes towards forms of both education and self-management, which should be taken into account when planning approaches to education.

Safety and health in mines: the rise of bureaucracy in the coal mining industry and its results as evidenced by the public enquiry into an accident at Houghton Main Colliery

This thesis is concerned with certain aspects of the Public Inquiry into the accident at Houghton Main Colliery in June 1975. It examines whether prior to the accident there existed at the Colliery a situation in which too much reliance was being placed upon state regulation and too Iittle upon personal responsibility. I study the phenomenon of state regulation. This is done (a) by analysis of selected writings on state regulation/intervention/interference/bureaucracy (the words are used synonymously) over the last two hundred years, specifically those of Marx on the 1866 Committee on Mines, and (b) by studying Chadwick and Tremenheere, leading and contrasting "bureaucrats" of the mid-nineteenth century. The bureaucratisation of the mining industry over the period 1835-1954 is described, and it is demonstrated that the industry obtained and now possesses those characteristics outlined by Max Weber in his model of bureaucracy. I analyse criticisms of the model and find them to be relevant, in that they facilitate understanding both of the circumstances of the accident and of the Inquiry . Further understanding of the circumstances and causes of the accident was gained by attendance at the lnquiry and by interviewing many of those involved in the Inquiry. I analyse many aspects of the Inquiry - its objectives. structure, procedure and conflicting interests - and find that, although the Inquiry had many of the symbols of bureaucracy, it suffered not from " too much" outside interference. but rather from the coal mining industry's shared belief in its ability to solve its own problems. I found nothing to suggest that, prior to the accident, colliery personnel relied. or were encouraged to rely, "too much" upon state regulation.

Managers' personal values as drivers of corporate social responsibility

In this theoretical paper, motives for CSR are considered. An underlying assumption is that the commercial imperative is not the sole driver of CSR decision-making in private sector companies, but that the formal adoption and implementation of CSR by corporations could be associated with the changing personal values of individual managers. These values may find expression through the opportunity to exercise discretion, which may arise in various ways. It is suggested that in so far as CSR initiatives represent individuals' values, so the “responsibility” in evidence is less obviously “corporate.” Our emphasis on personal initiative is intended to counter a tendency to view the corporation as the agent, and may serve to remind us that individuals can, indeed, make a difference.

Contextualising accounts of illness:Notions of responsibility and blame in white and South Asian respondents' accounts of diabetes causation

We undertook a secondary analysis of in-depth interviews with white (n = 32) and Pakistani and Indian (n = 32) respondents who had type 2 diabetes, which explored their perceptions and understandings of disease causation. We observed subtle, but important, differences in the ways in which these respondent groups attributed responsibility and blame for developing the disease. Whereas Pakistani and Indian respondents tended to externalise responsibility, highlighting their life circumstances in general and/or their experiences of migrating to Britain in accounting for their diabetes (or the behaviours they saw as giving rise to it), white respondents, by contrast, tended to emphasise the role of their own lifestyle 'choices' and 'personal failings'. In seeking to understand these differences, we argue for a conceptual and analytical approach which embraces both micro- (i.e. everyday) and macro- (i.e. cultural) contextual factors and experiences. In so doing, we provide a critique of social scientific studies of lay accounts/understandings of health and illness. We suggest that greater attention needs to be paid to the research encounter (that is, to who is looking at whom and in what circumstances) to understand the different kinds of contexts researchers have highlighted in presenting and interpreting their data. © 2007 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Relationship status and identity construction in heterosexual women:A discourse analytic and personal construct study

This thesis reports the findings of three studies examining relationship status and identity construction in the talk of heterosexual women, from a feminist and social constructionist perspective. Semi-structured interviews were conducted with 12 women in study 1 and 13 women for study 2, between the ages of twenty and eighty-seven, discussing their experiences of relationships. All interviews were transcribed and analysed using discourse analysis, by hand and using the Nudist 6 program. The resulting themes create distinct age-related marital status expectations. Unmarried women were aware they had to marry by a ‘certain age’ or face a ‘lonely spinsterhood’. Through marriage women gained a socially accepted position associated with responsibility for others, self-sacrifice, a home-focused lifestyle and relational identification. Divorce was constructed as the consequence of personal faults and poor relationship care, reassuring the married of their own control over their status. Older unmarried women were constructed as deviant and pitiable, occupying social purgatory as a result of transgressing these valued conventions. Study 3 used repertory grid tasks, with 33 women, analysing transcripts and notes alongside numerical data using Web Grid II internet analysis tool, to produce principle components maps demonstrating the relationships between relationship terms and statuses. This study illuminated the consistency with which women of different ages and status saw marriage as their ideal living situation and outlined the domestic responsibilities associated. Spinsters and single-again women were defined primarily by their lack of marriage and by loneliness. This highlighted the devalued position of older unmarried women. The results of these studies indicated a consistent set of age-related expectations of relationship status, acknowledged by women and reinforced by their families and friends, which render many unmarried women deviant and fail to acknowledge the potential variety of women’s ways of living.

The role of personal values in corporate social entrepreneurship

The literature acknowledges a distinction between immoral, amoral and moral management (Carroll, 1987; Crane 2000). This paper makes a case for the manager as a moral agent, even though the paper begins by highlighting a body of evidence which suggests that individual moral agency is sacrificed at work and is compromised in deference to other pressures. This leads to a discussion of the notion of managerial discretion and an examination of a separate, contrary body of literature which indicates that some managers in corporations may use their discretion to behave in a socially entrepreneurial manner. The underlying assumption of the study is that CSR isn’t solely driven by economics and that it may also be championed as a result of a personal morality, inspired by an individual’s own socially oriented personal values. A conceptual framework is put forward and it is suggested that individuals may be categorized as Active or Frustrated Corporate Social Entrepreneurs; Conformists or Apathetics: distinguished by individualistic or collectivist personal values. In a discussion of the nature of values, this paper highlights how values may act as drivers of our behavior and pays particular attention to the values of the entrepreneur, thereby linking the existing debate on moral agency with the field of corporate social responsibility.

Personal values as a catalyst for corporate social entrepreneurship

The literature acknowledges a distinction between immoral, amoral and moral management. This paper makes a case for the employee (at any level) as a moral agent, even though the paper begins by highlighting a body of evidence which suggests that individual moral agency is sacrificed at work and is compromised in deference to other pressures. This leads to a discussion about the notion of discretion and an examination of a separate, contrary body of literature which indicates that some individuals in corporations may use their discretion to behave in a socially entrepreneurial manner. My underlying assumption is that CSR isn’t solely driven by economics and that it may also be championed as a result of a personal morality, inspired by employees’ own socially oriented personal values. A conceptual framework is put forward and it is suggested that individuals may be categorized as Active or Frustrated Corporate Social Entrepreneurs; Conformists or Apathetics, distinguished by their individualistic or collectivist personal values. In a discussion of the nature of values, this paper highlights how values may act as drivers of our behavior and pays particular attention to the values of the entrepreneur, thereby linking the existing debate on moral agency with the field of corporate social responsibility.

An exploratory analysis of corporate social responsibility:definitions, motives and values

Corporate Social Responsibility (CSR) is a multi-disciplinary subject and definitions vary with regard to the perceived scope or boundaries of the corporation’s responsibility. In this paper, corporate motives for CSR are explored, along with the notion of an altruistic ethical impulse among business leaders or managers, perhaps motivated by religious beliefs. It is suggested that the formal adoption of CSR by corporations could be associated with the changing personal values of managers and that there may be an association between different industries, the personal values of the managers who work in them and their commitment to CSR. This paper is preparatory to an empirical investigation that will address how corporate social responsibility (CSR) is interpreted and institutionalised by organisations, including an analysis of firms’ perceptions of the boundaries regarding where and to whom their corporate social responsibilities lie.