title: Revealing the hidden agency of children in a clinical setting.
abstract: BACKGROUND
  Interactions with children in clinical settings are often criticized because parents and medical professionals speak for children rather than to them. Such approaches do not take the agency of children into account.
  
  
  OBJECTIVE
  First, to examine how children enact agency in a clinical encounter and draw lessons from this to improve health-care practices for children and, second, to explain how looking at agency might help to move the participation agenda forwards.
  
  
  METHODS
  A qualitative study incorporating a range of methods, including participant observation, interviews and focus group discussions.
  
  
  METHODS
  Three hospitals in the Netherlands.
  
  
  METHODS
  Children with diabetes type 1, between 8 and 12 years (n = 30), parents (n = 22) and medical professionals (n = 16).
  
  
  RESULTS
  Children do not simply accept the recurrent health education from medical professionals. Instead, they attribute their own personal meaning to their disease and treatment. Drawing from their years of experience with the disease and health care and the image of a passive and vulnerable child, they actively find ways to balance personal goals with medically defined goals.
  
  
  CONCLUSIONS
  Efforts to facilitate child participation should be based on insights into the ways in which children enact agency in the clinical encounter. Our data show that children already participate in health care and that their enactment of agency is based on a practical logic. Understanding of children's current participation and agency is needed to more successfully attune their treatment to their daily lives with diabetes. This is crucial for the success of treatment and the well-being of children.
authors.affiliation: Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, the Netherlands.|Athena Institute, Free University, Amsterdam, the Netherlands.
authors.forename: Christine
authors.initials: C
authors.lastname: Dedding
authors.affiliation: Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Ria
authors.initials: R
authors.lastname: Reis
authors.affiliation: Sint Lucas Andreas Hospital, Amsterdam, the Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: Wolf
authors.affiliation: Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Anita
authors.initials: A
authors.lastname: Hardon
mesh_terms: D000884:Anthropology, Cultural; D002648:Child; D003142:Communication; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D009426:Netherlands; D010290:Parents; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012648:Self Care
keywords: agency; children; diabetes; participation