The Ethos of Health Policies in the Grip of Lay Anticipation: The Case of Therapeutic Education for People Living with Type 2 Diabetes in Cameroon

Abstract

Therapeutic education is an integral part of health promotion. It is an ancient and innovative approach to care, the result of a slow but steady evolution of public health practice around the world. Despite the fluctuating semantics in different paradigms, the goal of this approach is the quality of life of the person living with type 2 diabetes. To achieve this goal, a synergy of actions of all actors involved in the educational care approach and a promotion of community participation are necessary. Unfortunately, empirical evidence has shown a mismatch between the practices of expert and lay actors in the management of type 2 diabetes. The objective of this study is to analyse the therapeutic education practices of these two categories of actors. A qualitative descriptive study was conducted using documentary research, direct observation and in-depth semi-structured interviews. The target population consisted of lay actors (people living with diabetes, peer educators and family caregivers) and expert actors (health care providers, managers of diabetes care centres) according to our selection criteria. The field data was subjected to content analysis. The results showed that there were opposing pairs of actions, notably hospital-centred practices versus advanced therapeutic education practices. The medical approach versus the anthroposocialmedical approach to therapeutic education. Finally, the logic of expert actors is opposed to that of lay actors in educational care. An integration of the living environment and an effective focus on the person living with type 2 diabetes could improve community participation in the implementation of public health policies.