title: Patients have unwritten duties: experiences of patients with type 1 diabetes in health care.
abstract: OBJECTIVE
  To describe the perceptions and experiences of patients with type 1 diabetes, examine their duties and responsibilities for their own care and increase our understanding of the value-based role of patients in the changing healthcare environment.
  
  
  BACKGROUND
  Current type 1 diabetes care highlights the importance of self-care and of patient involvement, which implies the need to evaluate the patients' role. Little is known about patients' views about their own role, and related responsibilities and duties for their own care. This is essential if we are to promote efficient patient involvement.
  
  
  METHODS
  This study had a qualitative descriptive design.
  
  
  METHODS
  We conducted one-to-one themed interviews with 20 patients with type 1 diabetes during summer 2013 at a diabetes polyclinic in Finland. Data were analysed using inductive content analysis.
  
  
  RESULTS
  Patients with type 1 diabetes believed that their well-being and self-care required them to consider their own responsibilities and their duties towards themselves, family members, society and healthcare professionals. These duties were seen to have implications for care outcomes, quality of life, and effectiveness and economy in health care. However, patients' background, motivation, relationships with healthcare staff and patient counselling influenced whether they fulfilled those duties, which are all crucial elements in type 1 diabetes care.
  
  
  CONCLUSIONS
  Patient duties are significant for the well-being of patients with type 1 diabetes, but also for their successful involvement in their care. This study can be used to inform the development of individual care planning and support of patient involvement.
authors.affiliation: JAMK University of Applied Sciences, Jyväskylä, Finland.
authors.forename: Marina
authors.initials: M
authors.lastname: Hirjaba
authors.affiliation: Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Arja
authors.initials: A
authors.lastname: Häggman-Laitila
authors.affiliation: Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Anna-Maija
authors.initials: AM
authors.lastname: Pietilä
authors.affiliation: Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Mari
authors.initials: M
authors.lastname: Kangasniemi
mesh_terms: D000293:Adolescent; D000328:Adult; D003376:Counseling; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005260:Female; D005387:Finland; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D036301:Qualitative Research; D012648:Self Care / Q000523:psychology*; D055815:Young Adult
keywords: chronic illness; diabetes; duty; ethics; experiences; interview; nursing; patient; qualitative; responsibility