Institutional role conflict in the digital age: The case of diabetes management at school

• Type of Material: Article
• Authors: Cassidy Puckett, Emory University; Jenise C Wong, University of California San Francisco; Sloan Talbot, Emory University; Hyojin Jennifer Min, University of California San Francisco; Nora Chokr, University of California San Francisco
• Language: English
• Date: 2023-06-01
• Publisher: Published by Elsevier Ltd
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ssmqr.2022.100215
• Title of Journal or Parent Work: SSM - Qualitative Research in Health
• Volume: 3
• Grant/Funding Information: This material is based upon work supported by the National Institute of Health (NIH) Project K23DK107894. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of supporting parties.
• Keywords: Diabetes; Student role; Sick role; Medical technology; Institutional conflict
• Research Categories: Health Sciences, Public Health; Sociology, General

Abstract

As the prevalence of pediatric diabetes grows and new technologies to manage diabetes emerge, there is increasing concern about consistency in health management across institutional settings, particularly in schools. While much is known about barriers at school, there are still gaps in understanding the institutional dynamics that shape health management in this setting. Using focus groups with 19 youth with type 1 diabetes (T1D) and applying institutional role theory, we find healthcare providers’ recommendations conflict with school rules and norms, making it difficult to enact both the “sick role” and the “student role.” These conflicts elicit negative responses from teachers and peers and stigmatize youth with T1D in school. Caregiver involvement often heightens rather than ameliorates conflict and teachers do not intervene in effective ways. Ultimately, youth must manage conflicts and stigma. By reframing challenges in health management as institutional role conflict, this paper contributes to sociological research by highlighting the importance of institutional roles, especially beyond healthcare. More broadly, the study suggests health research and policy should investigate how to better align institutional roles—rather than relying on youth and their families—to support health management of chronic illnesses across institutional settings.