Facilitating narrative medical discussions of type 1 diabetes with computer visualizations and photography Brian K. Smith a, * , Jeana Frost b , Meltem Albayrak c , Rajneesh Sudhakar d a Colleges of Information Sciences & Technology and Education, The Pennsylvania State University, 301D Information Sciences & Technology Bldg, University Park, PA 16802, USA b Medical Information Systems Unit, Boston University, USA c College of Education, The Pennsylvania State University, USA d Princeton Consultants, USA Received 13 October 2005; received in revised form 7 March 2006; accepted 12 March 2006 Abstract Objective: Patient-centered approaches to medicine suggest the need for physicians to become more aware of concerns and needs expressed in patient narratives. However, patients and physicians have different goals and discourse styles during consultations. We attempt to bridge these differences by providing patients with ways to collect, visualize, and describe behavioral and biomedical data. Methods: We describe an intervention where individuals with type 1 diabetes photograph health-related behaviors. These images and blood glucose records are displayed in computer visualizations and used during patient–physician interviews. Results: Qualitative analyses of interview data with patients who photographed their lives suggest the range of difficulties associated with diabetes self-management. The visualizations helped them articulate concerns about stress, peer relations, and unhealthy routines. Conclusion: Interventions that combine biomedical and biopsychosocial data during patient–physician consultations may be beneficial for patients, helping them reflect on correlations between behaviors and health. Physicians are provided with contextual evidence to better understand patient issues around diabetes management. Practice implications: We suggest that this and similar interventions could be used as an occasional diagnostic to help patients articulate stories of their health-related practices. Annotated archives of photographs and glucose data may also be useful tools for sharing diabetes experiences with newly diagnosed patients. # 2006 Elsevier Ireland Ltd. All rights reserved. Keywords: Diabetes; Photography; Narrative-based medicine; Patient–physician communication 1. Introduction Initiatives such as biopsychosocial [1], patient-centered [2], and narrative medicine [3] suggest the importance of eliciting and attending to patients’ viewpoints on their illnesses during health diagnoses. The life experiences, living situations, behaviors, and beliefs of patients influence their health and ability to adhere to medical recommenda- tions. Patient-centered approaches suggest that personal stories provide insight into these behavioral and social factors and that careful listening to these stories may enhance clinical diagnoses and therapeutic suggestions [4,5]. Patient narratives typically emphasize social difficulties and the impact of illness on their lives [6,7]. These biopsychosocial issues are useful for practitioners to understand, but they lack the objective, empirical data that are also important when making medical diagnoses, suggesting a disconnect between the knowledge valued by patients and their physicians [3,8–13]. Physicians have been encouraged to develop their communicative and listening practices [14,15], but patients can also be supported to incorporate biomedical data into their health stories. We developed an intervention based on two assumptions. First, the ability to adopt and adhere to healthy routines is www.elsevier.com/locate/pateducou Patient Education and Counseling 64 (2006) 313–321 * Corresponding author. Tel.: +1 814 863 0012; fax: +1 814 865 5604. E-mail address: bsmith@ist.psu.edu (B.K. Smith). 0738-3991/$ – see front matter # 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2006.03.011