Acta Diabetologica

, Volume 56, Issue 2, pp 145–150 | Cite as

The utopia of research: epistemology of patient education

  • Marina TrentoEmail author
Part of the following topical collections:
  1. Health Education and psycho-social aspects

This is not a science like any other: it cannot be communicated in any way, but like the flames that spread from a flickering fire, a spark that suddenly emerges from long discussion sessions on the issue and a life shared with others, it can take strength from itself.

Plato, Letters VII in Works.


Traditionally, researchers have thought of chronic illness as having a course that waxes and wanes but patients who live with the disease may not have the same point of view [1]. In particular, chronic illness has an ever changing perspective that challenges patients to give meaning to their experience [2]. The person with a chronic illness lives in a double dimension of remembered health and current disease, so that the measure of wellness is determined by comparing the experience of what is known and understood about illness and vice versa [2, 3, 4]. Consequently, such a perspective of chronic disease contains elements of both illness and wellness. It involves beliefs,...


Patient Education Pedagogy Health Behavior Epistemology Diabetes Mellitus 



The author thanks Mr. Julian Hoskins for his linguistic advice and editing of this article.

Compliance with ethical standards

Conflict of interest

The author declares no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Lorig K, Holman H, Sobel D et al (2000) Living a healthy life with chronic conditions, 2nd edn. Bull, Palo AltoGoogle Scholar
  2. 2.
    Paterson BL (2001) The shifting perspectives model of chronic illness. J Nurs Scholarsh 33:21–26. CrossRefGoogle Scholar
  3. 3.
    Gumuchian ST, Peláez S, Delisle VC et al (2016) Exploring sources of emotional distress among people living with scleroderma: a focus group study. PLoS One 23(11):e0152419. CrossRefGoogle Scholar
  4. 4.
    Vassilev I, Rogers A, Sanders C et al (2014) Social status and living with a chronic illness: an exploration of assessment and meaning attributed to work and employment. Chronic Illn 10:273–290. CrossRefGoogle Scholar
  5. 5.
    Williams A, Sethi B, Duggleby W et al (2016) A Canadian qualitative study exploring the diversity of the experience of family caregivers of older adults with multiple chronic conditions using a social location perspective. Int J Equity Health 2:15:40. Google Scholar
  6. 6.
    Biro D (2012) An anatomy of illness. J Med Humanit. 33:41–54. CrossRefGoogle Scholar
  7. 7.
    Bateson G (1980) Mind and Nature: a necessary unity. Toronto. Bentan BooksGoogle Scholar
  8. 8.
    Newman S, Steed L, Mulligan K (2004) Self-management interventions for chronic illness. Lancet 364:1523–1537CrossRefGoogle Scholar
  9. 9.
    Ausili D, Rossi E, Rebora P et al (2018) Socio–demographic and clinical determinants of self–care in adults with type 2 diabetes: a multicentre observational study. Acta Diabetol 55:691–702. CrossRefGoogle Scholar
  10. 10.
    Wilski M, Tomczak M (2017) Comparison of personal resources in patients who differently estimate the impact of multiple sclerosis. Ann Behav Med 51:179–188. CrossRefGoogle Scholar
  11. 11.
    Casey D, Murphy K, Lawton J et al (2011) A Longitudinal qualitative study examining the factors impacting on the ability of persons with T1DM to assimilate the Dose Adjustment for Normal Eating (DAFNE) principles into daily living and how these factors change over time. BMC Public Health 30:11,672. Google Scholar
  12. 12.
    Jahedi L, Downie SR, Saini B et al (2017) Inhaler technique in asthma: how does it relate to patients’ preferences and attitudes toward their inhalers? J Aerosol Med Pulm Drug Deliv 30:42–52. CrossRefGoogle Scholar
  13. 13.
    Kiesewetter I, Schulz C, Bausewein C et al (2016) Patients’ perception of types of errors in palliative care - results from a qualitative interview study. BMC Palliat Care 11:1–12. Google Scholar
  14. 14.
    Rees J, Chilcot J, Donnellan W et al (2018) Exploring the nature of illness perceptions in people with end-stage kidney disease. 44:19–29.
  15. 15.
    Rees S, Williams A (2009) Promoting and supporting self-management for adults living in the community with physical chronic illness: a systematic review of the effectiveness and meaningfulness of the patient-practitioner encounter. JBI Libr Syst Rev 7:492–582Google Scholar
  16. 16.
    Hesselink G, Flink M, Olsson M et al (2012) Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers. European HANDOVER Research Collaborative. BMJ Qual Saf 21 Suppl 1:i39–i49.
  17. 17.
    Bodenheimer T. Lorig K, Holman H et al (2002) Patient self-management of chronic disease in primary care. JAMA 288:2469–2475CrossRefGoogle Scholar
  18. 18.
    Foucaud J, Bury JA, Balcou-Debussche M et al (2010) Éducation thérapeutique du patient. Modèles, pratiques et évaluation. Saint-Denis. Inpes, coll. Santé en Action. Saint Denis. FranceGoogle Scholar
  19. 19.
    Vermeire E, Hearnshaw H, Van Royen P et al (2011) Patient adherence to treatment: three decades of research: a comprehensive review. J Clin Pharm Ther 26:331–342CrossRefGoogle Scholar
  20. 20.
    WHO Bureau Régional de l’Europe (1998) Therapeutic patient education: continuing education programmes for health care providers in the field of prevention of chronic diseases: report of a WHO working group. WHO Regional office for Europe, CopenhagenGoogle Scholar
  21. 21.
    Hurley L, O’Donnell M, O’Hara MC et al (2017) Is diabetes self-management education still the Cinderella of diabetes care? Patient Educ Couns 100:1957–1960. CrossRefGoogle Scholar
  22. 22.
    Mühlhauser I, Bruckner M, Berger D et al (1987) Evaluation of an intensified insulin treatment and teaching programme as routine management of type 1 (insulin-dependent) diabetes: the Bucharest-Dusseldorf Study. Diabetologia 30:681–690CrossRefGoogle Scholar
  23. 23.
    DAFNE Study Group (2002) Training in flexible, intensive management to enable dietary freedom in people with type 1 diabetes. Dose Adjustment for Normal Eating (DAFNE) randomised controlled trail. Br Med J 325:746CrossRefGoogle Scholar
  24. 24.
    Davies MJ, Heller S, Skinner TC et al (2008) on behalf of the Diabetes Education and Self Management for Ongoing and Newly Diagnosed Collaborative. Effectiveness of the diabetes education and Self Management for ongoing and newly Diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ 336:491–495. CrossRefGoogle Scholar
  25. 25.
    Deakin TA, Cade JE, Williams R (2006) Structured patient education: the diabetes X-PERT Programme makes a difference. Diabetic Med 23:944–954. CrossRefGoogle Scholar
  26. 26.
    Pétré B, Gagnayre R, De Andrade V et al (2017) From therapeutic patient education principles to educative attitude: the perceptions of health care professionals. A pragmatic approach for defining competencies and resources. Patient Prefer Adher 11:603–617. CrossRefGoogle Scholar
  27. 27.
    Norris SL, Lau J, Smith SJ et al (2002) Self-management education for adults with type 2 diabetes. Diabetes Care 25:1159–1171CrossRefGoogle Scholar
  28. 28.
    Norris SL, Zhang X, Avenell A et al (2004) Long-term effectiveness of lifestyle and behavioral weight loss interventions in adults with type 2 diabetes: a meta-analysis. Am J Med 15:762–774CrossRefGoogle Scholar
  29. 29.
    Loveman E, Frampton G, Clegg AJ (2008) The clinical effectiveness of diabetes education models for Type 2 diabetes: a systematic review. Health Technol Assess 12:1–116 iiiCrossRefGoogle Scholar
  30. 30.
    Charvala C, Sherr D, Lipman R (2016) Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient Educ Couns 99:926–994. CrossRefGoogle Scholar
  31. 31.
    Browne JL, Ventura A, Mosely K et al (2014) ‘I’m not a druggie, I’m just a diabetic’: a qualitative study of stigma from the perspective of adults with type 1 diabetes. BMJ Open 4:e005625. CrossRefGoogle Scholar
  32. 32.
    Trento M, Passera P, Borgo E et al (2004) A 5-year randomized controlled study of learning, problem solving ability and quality of life modifications in people with type 2 diabetes managed by group care. Diabetes Care 27:670–675CrossRefGoogle Scholar
  33. 33.
    Raballo M, Trevisan M, Trinetta A et al (2012) A study of patients’ perceptions of diabetes care delivery and diabetes. Propositional analysis in people with type 1 and 2 diabetes managed by group or usual care. Diabetes Care 35:242–247. CrossRefGoogle Scholar
  34. 34.
    Trento M, Borgo E, Kucich C et al (2009) Quality of life, coping ability and metabolic control in patients with Type 1 Diabetes managed by Group Care and a carbohydrate counting programme. Diabetes Care 32:e134. CrossRefGoogle Scholar
  35. 35.
    Trento M, Merlo S, Durando O et al (2017) Self-management education and psychological support improve self-esteem in people with type 1 diabetes. Acta Diabetol 54:415–416. CrossRefGoogle Scholar
  36. 36.
    Mannucci E, Monami M, Dicembrini I, Piselli A, Porta M (2014) Achieving HbA1c targets in clinical trials and in the real world: a systematic review and meta-analysis. J Endocrinol Invest 37:477–495. CrossRefGoogle Scholar
  37. 37.
    Piccinino L, Griffey S, Gallivan J et al (2015) Recent trends in diabetes knowledge, perceptions, and behaviors: implications for national diabetes education. Health Educ Behav 42:687–696. CrossRefGoogle Scholar
  38. 38.
    Marianne EK, Wolff-Michael R (2010) Environmental education for social-ecological system resilience: a perspective from activity theory. Environ Educ Res 16:545–558. CrossRefGoogle Scholar
  39. 39.
    Dogra N, Giordano J, France N (2007) Cultural diversity teaching and issues of uncertainty: the findings of a qualitative study. BMC Med Educ 7:8CrossRefGoogle Scholar
  40. 40.
    Eastwood JL, Koppelman-White E, Mi M et al (2017) Epistemic cognition in medical education: a literature review. Int J Med Educ 8:1–12. CrossRefGoogle Scholar
  41. 41.
    Kinsella EA, Friesen F, Hodges B (2015) Reclaiming a theoretical orientation to reflection in medical education research: a critical narrative review. Med Educ 49:461–475. 51.CrossRefGoogle Scholar
  42. 42.
    Greenhalgh T, Wieringa S (2011) Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review. J R Soc Med 104:501–509. CrossRefGoogle Scholar
  43. 43.
    Lonka K, Lindblom-Ylanne S (1996) Epistemologies, conceptions of learning, and study practices in medicine and psychology. High Educ 31:5–24CrossRefGoogle Scholar
  44. 44.
    de Camargo KR (2002) The thought style of physicians: strategies for keeping up with medical knowledge. Soc Stud Sci 32:827–855CrossRefGoogle Scholar
  45. 45.
    Clandinin DJ, Cave MT (2008) Creating pedagogical spaces for developing doctor professional identity. Med Educ 42:765–770. CrossRefGoogle Scholar
  46. 46.
    Gordon J, Markham P, Lipworth W et al (2012) The dual nature of medical enculturation in postgraduate medical training and practice. Med Educ 46:894–902. CrossRefGoogle Scholar
  47. 47.
    Evans L, Trotter DR, Jones BG et al (2012) Epistemology and uncertainty: a follow-up study with third-year medical students. Fam Med 44:14–21Google Scholar
  48. 48.
    Wasserman JA (2014) On art and science: an epistemic framework for integrating social science and clinical medicine. J Med Philos 39:279–303. CrossRefGoogle Scholar
  49. 49.
    Tonelli MR (2001) The limits of evidenced-based medicine. Respiratory Care 46:1435–1440Google Scholar
  50. 50.
    Rogers WA (2004) Evidenced based medicine and justice: a framework for looking at the impact of EBM upon vulnerable or disadvantaged groups. J Med Ethics 30:141–145CrossRefGoogle Scholar
  51. 51.
    Becker HS, Geer E, Hughes (1962) Boys in white: student culture in medical school. University of Chicago Press, ChicagoGoogle Scholar
  52. 52.
    Sokol RG, Shaughnessy AF (2018) Making the most of continuing medical education: evidence of transformative learning during a course in evidence-based medicine and decision making. J Contin Educ Health Prof 38:102–109. CrossRefGoogle Scholar
  53. 53.
    Trento M, Gamba S, Gentile L et al (2010) Romeo: rethink organization to improve education and outcomes. A multicentre randomised trial of lifestyle intervention by group care to manage type 2 diabetes. Diabetes Care 33:745–747. CrossRefGoogle Scholar
  54. 54.
    Livingstone R (1953) What is education? BMJ ii:454–456CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Laboratory of Clinical Pedagogy, Department of Medical SciencesUniversity of TurinTorinoItaly

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