定位差異：以糖尿病衛教佈署為例

Situating Differences: The Case of Health Education Deployments for Diabetes

要如何思考醫療擴張中的實作差異？定位這些實作差異的認識方式有何重要性？社會學參與其中，能學習到什麼並發揮什麼作用？本文以糖尿病衛教探索這些問題。台灣拓展糖尿病照護體制已逾二十年，在整體政策推動下，實作面卻有相當落差。本文汲取諸多探討差異的洞見：多元衛教經驗研究、醫療化與生命權力理論的差異轉向，與互動論及科技與社會研究的實作取徑，並由以實作體制分析描繪糖尿病衛教實作的啟蒙、成效、教練、團隊與健康佈署模式。本文分析其各自關注點、機制與效果，並釐清認識在地差異的認識佈署對促成不同佈署的意涵。藉此，本文指出體制分析與認識佈署概念如何定位各種差異，包括臨床認識實務、衛教文獻的脈絡化觀點，以及社會學研究的理論化前景與理論取徑。 How should researchers think about the differences in practices of medical expansion? What is the importance of the knowing practices for situating these differences? Being part of the practices, what can sociology learn and what difference can sociology make in these practices? This paper explores such issues in the case of diabetes health education. In Taiwan, while the nationwide Diabetes Shared Care Network was launched more than 20 years ago, its local performances and practices vary. Drawing on insights into differences from health education studies; the “turn to differences” in medicalization and bio-power theories; and interactionism and Science, Technology, and Society (STS), this paper uses regime of practice analysis to specify the deployments of enlightenment, efficacy, coaching, team, and health-oriented modes of health education. It particularly highlights the epistemic deployment for analyzing matters of concern, apparatuses, and effects of the deployments. This paper concludes by elaborating how the concept of epistemic deployment and regime of practice analysis help to specify the differences in messy clinical work, the contexts of health education, and the agenda for social theory