Actor-Network theory; diabetes; self-care management; evidence-based healthcare; situated knowledge; sociocultural psychology; healthcare practitioners; tool-supported practices; chronic disease; knowledge translation in medicine; social interactions
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The pace of development of new or updated knowledge has accelerated in modern medicine. As a result, Knowledge Translation in Medicine (KTM) plays an important role in ensuring effective high quality healthcare, as well as patients’ safety. However, the amount of available new information makes it difficult for busy physicians to identify important information. This creates what is referred to as a know-do gap, i.e., a gap between findings in clinical research and actual healthcare practice. The wish to address this scientific, health and social issue in an interdisciplinary perspective is at the origin of the creation of the research group I-KnoT (“Improving health Knowledge Translation”).Assuming that an interdisciplinary approach to KTM may renew our understanding of processes of “knowledge translation”, this research project draws on sociocultural psychology and science and technology studies to reframe mainstream research into KTM. Considering that human cognition is a situated practice, these complementary approaches both focus on the tools that mediate human activity. Our assumption is then that conceiving knowledge as a situated practice mediated by tools enables us to renew the understanding of the processes of “knowledge translation” and possible gaps.Concretely, this research project concerns “know-do-gaps” in the field of diabetes and considers: (a) gaps between professional designers and healthcare practitioners; (b) gaps between healthcare practitioners and patients. We assume that these gaps are good indicators to understand more general processes involved in gaps in “knowledge translation”. Diabetes appeared to be an appropriate research field since the patients’ self-management of diabetes and their relationship with healthcare practitioners heavily rely on the use of various tools which are expected to enhance efficient and effective care and self-care. The production and use of these tools, that we call Diabetes Self-Management Tools (DSMT), are central to this research project. By linking elements from sociocultural psychology and Actor-Network Theory, we propose a provisional conceptualisation of these specific DSMT by identifying four main functions: semiotic, epistemic, relational and boundary. These functions are not given but are developed through their use in context. We provisionally refer to the tools which integrate these four functions by the generic notion of “Semio-Epistemic Transactional Tools” (SETT). Our empirical goal is to grasp the process of knowledge translation (and its possible gaps) by starting from the design of DSMT and then by examining their use in specific contexts. Our question is then: How do Diabetes Self-Management Tools gain semiotic, epistemic, relational and boundary functions pertaining to SETT? Our goal is to put this provisional conceptualisation of SETT to the test and to improve it so as to gain a better and renewed understanding of difficulties in knowledge translation in the (self-)management of chronic diseases in general.The research plan consists of three studies: Study 1 focuses on the use of DSMT by 6 professions of healthcare practitioners involved in diabetes care. Study 2 focuses on the learning of DSMT by two groups of diabetic patients: “newcomers” (Type I diabetic teenagers who started a diabetes in the year preceding the data collection) and “oldtimers” (who started it within two years or more before the data collection). Study 3 concerns the design of DSMT by professional and lay designers. In order to examine situated knowledge and practices, we resort to qualitative methods: semi-directed interviews, an original method called “instruction to a double” and ethnographic observations in a sport camp for teenagers living with diabetes.Through the case of diabetes, this research project intends to contribute to a better understanding of knowledge translation and its implementation, in clinical and healthcare practices in general. Its relevance and originality are scientific, practical and social, since it addresses an issue of high importance in healthcare.