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Saúde e Sociedade

Print version ISSN 0104-1290On-line version ISSN 1984-0470

Saude soc. vol.28 no.3 São Paulo July/Sept. 2019  Epub Oct 07, 2019

http://dx.doi.org/10.1590/s0104-12902019180070 

Articles

Diary as a device in multicenter research

aUniversidade Federal de São Paulo. Instituto Saúde e Sociedade. Departamento de Saúde, Clínica e Instituições. Santos, SP, Brasil. E-mail: luciane.pezzato@unifesp.br

bUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Política, Gestão e Saúde. São Paulo, SP, Brasil. E-mail: botazzo@usp.br

cUniversidade Estadual de Campinas. Faculdade de Ciências Médicas. Departamento de Saúde Coletiva. Campinas, SP, Brasil. E-mail: slabbate@lexxa.com.br


Abstract

This article is linked with a multicenter study conducted from 2013 to 2015 in four different scenarios or cities: São Paulo, Campinas, Ribeirão Preto, and Recife. It aims to present the use of Research Diary (RD) as a device of the Institutional Analysis, which made it possible to explore different dimensions of experiences of diary researchers and restore the analysis of the implications that have occurred in the movements provoked in and through the experiences of this multicenter project. The use of research diary in fieldworks was common practice among project team members. The production of records as diaries, from the perspective of Institutional Analysis, made it possible to analyze the implications of the researchers, opposing the idea of subject neutrality in the research. As an interventional device, research diaries allowed an articulation between diary researchers of the four scenarios with their different knowledge and experiences, in daily buccal health, triggering heterogeneities and encouraging them to write, reflecting on their activities in the clinic, and above all, to share the writing of these experiences with others, which has had an effect on the clinical innovation processes.

Keywords: Diaries; Public Health; Buccal Health; Institutional Analysis

Resumo

Este artigo vincula-se a uma pesquisa multicêntrica realizada entre 2013 e 2015 em quatro diferentes cenários: São Paulo, Campinas, Ribeirão Preto e Recife. Tem como objetivo apresentar o diário de pesquisa como um dispositivo da Análise Institucional, que possibilitou explorar diferentes dimensões do vivido pelos diaristas-pesquisadores, bem como restituir a análise de implicações que se cruzaram nos movimentos provocados nas e pelas experienciações deste projeto multicêntrico, registradas nos diários. O uso de diário no trabalho de campo foi prática corrente entre os membros da equipe do projeto. A produção do registro em forma de diários, na perspectiva da Análise Institucional, possibilita a análise das implicações dos pesquisadores, opondo-se à ideia de neutralidade do sujeito na pesquisa. Como dispositivo da intervenção, os diários de pesquisa permitiram a articulação entre os diaristas-pesquisadores dos quatro cenários com seus diferentes saberes e experiências, no cotidiano da saúde bucal, acionando heterogeneidades e os provocando a escreverem, refletindo sobre suas atividades na clínica e, sobretudo, a compartilharem a escrita dessas experienciações vividas com os demais, o que produziu efeitos nos processos de inovação da clínica.

Palavras-chave: Diários; Saúde Coletiva; Saúde Bucal; Análise Institucional

Introduction

The multicenter research, from which this article was written, aimed to propose a technological innovation in the production of buccal health care. Initially, the team developed the following study questions: Is it possible to organize the work of buccal health care based on a clinical method? Could care include buccal health consultation, as performed in other clinical practices? Is it possible to provide care to a patient without necessarily performing surgical-restorative procedures?

These questions constituted the project challenge and the main determinant of project successes and failures. First, a “diagnosis of the situation” was obtained, or the “state-of-the-art” dental practice, based on the fact that the current care model in the Brazilian public health system reproduces, in an uncritical manner, even in the Brazilian Unified Health System (SUS), the reference dentistry practice of private offices, turning the patient-professional relationship and the patient and his/her illness into a private issue. This construction would still support the ideals in dentistry profession. Since the beginning of the Health Reform in the 1980s, the dental care model and, to a certain extent, care to dental patients, have been considered inadequate and obsolete, of poor coverage and service offering, with a focus on selected age groups, high technological density, and surgical-restorative care, an issue that has been consistently debated in the specialized literature (Amorim; Souza, 2010; Faccin; Sebold; Carcereri, 2010; Garrafa, 1993; Pezzato; L’Abbate; Botazzo, 2013; Pires; Botazzo, 2015).

For the team, the main objective was to experience the possibilities of expanded buccal health practice in primary health care (PHC), in the perspective of integrality, specifically to propose new technologies for buccal health care, understand the clinic as a pedagogical locus, investigate how the demand for buccal health services or needs are built in the perspective of the subject-patient, and analyze the model of buccal health care in SUS, based on the Guidelines for the National Buccal Health Policy. This multicenter study was developed in four distinct fields: public health services in São Paulo (capital), in Campinas and Ribeirão Preto (municipalities of the State of São Paulo), and in a unit of the Family Health Program (FHP) in Recife, Pernambuco.

The concept of buccality ensured potential theoretical contributions to this project and the clinical practice. It emerged as a mobilizer to reorganize buccal health work by proposing a new method to produce meetings and subjectivity and adjust care provision. Buccality is understood as the ability of a mouth to act as a mouth, that is, to perform without limitation the actions for which it is anatomically able (Botazzo, 2008). Therefore, it means thinking of the human mouth in its social and psychic dimension, a territory with an inexhaustible ability to “have the most distinct or the broadest forms of symbolization, an object that emerges as an icon of itself” (Botazzo, 2000, p. 57). An articulation with the clinical work was allowed due to a theoretical arrangement that ensures the normal and pathological categories of this scope, surpassing the reductionist conceptions of dental injury, with the competent definition of buccal norm and normality, thus proceeding to reinsertion of the buccal cavity in the body (Botazzo, 2006; Fonsêca et al., 2016). Finally, after overcoming such barriers, which have a linguistic and organizational nature, a clinical method can be adopted to constitute buccal patients (Barros; Botazzo, 2011).

In the monitoring and evaluation stage of this multicenter study, different qualitative approaches were proposed, such as action research, intervention research, and ethnomethodology, using multiple techniques: (total, participant) observation, interviews, focus groups, and regardless of the knowledge production technology, the development of a research diary was recommended as a device for the production of institutional arrangements and define the researcher’s place in the research context, as opposed to researcher neutrality.

Since the initial formulation of the project, a diary was considered a device, “something like a skein” that could be produced in different ways, with specific directions given by the researchers (Deleuze, 1999, p. 155).

Thus, research diary - a procedure widely used in ethnography and Institutional Analysis (IA) (Pezzato; L’Abbate, 2011) - should be a common practice among the researchers of this study. Similarly, all recorded information would be used in reporting and support the analysis and interpretation of results.

The purpose of this study was to analyze the use of a research diary (RD) as an IA device to explore different dimensions of situations experienced by the diary writers/researchers and the implications from the experiences recorded in diaries in this multicenter project.

The proposal of diaries, also as a writing exercise, is associated with what Foucault (2004, p. 151) states about it,

a personal exercise performed by and for itself as a disparate art of truth; or, more precisely, a rational way to combine the traditional authority of something already said with the singularity of the truth in it and the particularity of the circumstances that determine its use.

In this sense, as stated by Dias (2016, p. 113), “self-writing as a practice is a tool in research diary,” which supports our proposal of using a diary as a research device, true “machines that help see and speak” (Foucault apud Deleuze, 1999, p. 155).

The text starts with a discussion about the concept of device in philosophy and human sciences, and then presents the perspective of a diary in this study. After that, it discusses the concept of implication and analysis of the inferences of diary writers after diary reading, promoting an understanding of innovation processes in the production of buccal health care.

What do we mean when we say device?

First, it is important to highlight the polysemy of this term and its use in the scientific literature. A quick search shows different meanings and uses of ‘device.’ In the 1960s, Foucault used it to refer to sexuality, characterizing one of the first uses of this term in his extensive production. In fact, chapter IV, volume I, of The History of Sexuality is named: Part IV - The Deployment of Sexuality. However, Foucault (1999) does not use the term extensively in this narrative.

How is device used in contemporary scientific literature? A random search on databases of studies shows articles using device with different meanings, resulting in the following descriptors: device for septal occlusion, woman’s body, analysis, self-feeding, maternity, sustainability, load, intermittent pneumatic compression, orthopedic fixation, management, infantilization, etc. It shows the semantic weight of the term and how ‘device can be used in multiple daily phenomena.

Considering the common uses and meanings, and Foucault’s appropriation of the term, the following questions emerge: What exactly did he mean by device? And what do we understand from that? Extensive appropriations or subsumptions of the term have been observed, increasing the semantic dispersion already seen in the literature.

Then, a device could mean something ‘not abstract’ or a ‘historically situated network of knowledge/power relations’ (Fanlo, 2011, p. 2), a device that ‘rationally impacts the field of forces where it is inserted” (Veinmann, 2006, p. 17), a focus of device signification on the structure of society and the disciplinary component (Pogrebinschi, 2004, p. 191), or on care technologies, such as therapy follow-up in mental health services, which acts as a clinical device ‘for the construction of networks that can supersede asylums’ (Palombini, 2006, p. 117). Deleuze refers to device as ‘something like a skein, a multilinear set’ that is ‘comprised of lines of a different nature’ or containing ‘visible objects, formulable statements, the forces in action, the subjects in position are like vectors or tensors’ (Foucault apud Deleuze, 1999, p. 155).

These combined discursive products indicate increasing signification; however, as usually seen in these cases, the focus of the narrative is lost and, at the end, the structure referred to in the beginning becomes distant, without any relation to the original statement.

Of all contributions reviewed, Giorgio Agamben’s insight seemed the most appropriate for this discussion. Agamben, at a conference held in Brazil in 2005, added new and surprising elements to the understanding of the enunciation and theory experienced by Michel Foucault, providing an innovative reading focused on the concept of device, considering its condition of possibility.

Agamben (2005) highlights the definition of technical terms used in philosophical statements takes three distinct and complementary directions: they refer to the homologous relations between dispositif and apparatus, then the similarity or proximity between device and the Latin word dispositio, and finally refers to positivity.

When Agamben places semantic proximity between device and Latin dispositio, the dispositions of soul or character confirm the possibility of certain arrangements to function according to an internal disposition or even as something disposed or inclined to specific achievements; also here, there is homology between the categories analyzed by him. Likewise, machines, apparatuses or devices must function according to the way they are arranged, that is, built for a purpose.

Finally, the concept of positivity will be discussed. In The Archeology of Knowledge, Foucault (1985, p. 317) highlights that it is the first of the categories aligned with what he called thresholds, and positivity is one of them, which would mean the moment of the object when captured in its existence, considering it as something positive and certain in its construct process, which can then be empirically apprehended, enjoying its own autonomy and existence, external to the consciousness of the researcher. Agamben emphasizes exactly this point, addressing the homologous relationship between the positivity category according to Foucault and Jean Hyppolite, to ensure precision and relevance to its significant content. This explanation is eloquent and seeks to describe the meaning of positivity.

And what would be the meaning of positive,

if not the meaning provided, something that seems to impose itself from outside on reason; […] implies feelings that are more or less imprinted on souls by constraint; […] for the theoretical reason, positive represents what is imposed from outside on thought and that it must passively receive, also for the practical reason positive represents an order […] an authority that imposes from outside what is not included in its reason. (Hyppolite, 1971, p. 35-36)

This way, positivity merges with Augusto Comte’s concept of positive - the given, the right, the measurable, the apprehensible, the predictable, considering that “the true positive spirit consist especially of seeing to foresee” (Comte, 1978, p. 49) - and with Durkheim’s concept of social fact, two possibilities of dialogue that, at first, were unconceivable. Considering that a social fact is “any way of acting, whether fixed or not, capable of exerting over the individual an external constraint […] over the whole of a given society whilst having an existence of its own, independent of its individual manifestations” (Durkheim, 1978, p. 11).

Agamben is again considered to end this narrative, as he said at a conference held in 2005:

If “positivity” is the name that, according to Hyppolite, the young Hegel gives to the historical element - loaded as it is with rules, rites, and institutions that are imposed on the individual by an external power, but that become, so to speak, internalized in the systems of beliefs and feelings - then Foucault, by borrowing this term (later to become “device”), takes a position with respect to a decisive problem, which is actually also his own problem: the relation between individuals as living beings and the historical element. By “the historical element,” I mean the set of institutions, of processes of subjectification, and of rules in which power relations become concrete. (Agamben, 2005, p. 10-11)

In an interview conducted in 1977, Foucault said:

I understand by the term “device” as a sort of - shall we say - formation which has as its major function at a given historical moment that of responding to an urgent need. Device thus has a dominant strategic function […] and it is part of a game of power […] What I’m trying to pick out from this term is, firstly, a thoroughly heterogeneous ensemble consisting of discourses, institutions, architectural forms, regulatory decisions, laws, administrative measures, scientific statements, philosophical, moral and philanthropic propositions - in short: the said as much as the unsaid. Such are the elements of the device. The device itself is the system of relations that can be established between these elements. (Foucault, 1994, p. 299-300)

Then, according to Foucault, devices are apparatuses and objects to perform according to their intended purpose, all of them existing outside the subject, just as capitalism is a device, as well as sexuality, buccality, madness, asylum, medicine, torture, prison and… diary.

A device is also, pertinently, a tool concept for analysis used by a socio-analyst. According to Lourau (1993, p. 30), the method of intervention used in socio-analysis1 “consists in creating a device for collective social analysis […]. When I talk about socio-analytic work, I mean the need, the attempt to put the device on the scene.” That is, in IA, from a device, things are put into operation and situations articulate heterogeneous elements, triggering functioning modes that will produce some effects.

Research diary in research: “how to do research”

Writing a diary is a technique widely used in qualitative studies, in their different theoretical and methodological approaches. According to Pezzato and L’Abbate (2011), a diary is an intervention tool used by institutional analysts that helps “make one see” conflicting and complex situations in the daily life of the institution being analyzed.

Diaries have also been used in other areas, such as in the daily life of many people, often becoming a lifestyle. Recording events or moods, feelings, perceptions, and reflections is an ancient practice and has become the subject of interpretation since classical antiquity. Foucault (2004) highlights a clear pedagogical position of a subject who must write in order to have clear ideas, an activity that would be a type of self-control, control of psychological drives through the exposure in the recorded material. Writing, in contrast, allows an individual, by recording the activity, to organize one’s ideas and perceptions and communicate them to others:

Here self-writing is clearly in a relation of complementarity with anachoresis: it eliminates the dangers of loneliness; it gives a possible look on what made us do or think; the fact of writing has the role of someone who accompanies us, as it promotes human respect and shame… (Foucault, 1994, volume IV, p. 415)

As stated by Dias (2016, p. 115), inspired by the essay proposed by Foucault (2004), writing on a diary is

like a modifying experience of oneself […]. It means that a diary may have writings and practices to help one see and talk about what happens in research and in the territories of formation open to reinvention of itself and the world.

However, writing, recording in a diary, and making notes have always “constituted a material memory of things read, heard or thought, […] raw material for writing more systematic treaties, […] a material for exercises to be carried out frequently: reading, rereading, meditating, conversing to oneself and others” (Foucault, 2004, p. 147-148).

In this sense, a diary brings, exactly, implied writing, it works or materializes as a device that is, at the same time, a research and pedagogical device, since the researcher writes his reflections, analyses, emotions, descriptions of experiences in the research activities and his own life, allowing others to interact with these records and, consequently, reflect, build other relations and networks between what is written and not written, between what was experienced and not experienced. With a diary, a moment of privilege in the study is when a researcher, or the “adult subject” according to Remi Hess, through self-writing, reviews one’s projects and perspectives of formation, because every research project has a pedagogical component.

One learns in the act of producing knowledge, which is the same as pedagogical autopoiesis or pedagogy in autopoiesis! It is the intensity in a subject’s life, a moment, an essential stage of a research project (Hess, 2009, p. 86).

For Lourau (2004b, p. 276), diary writing highlights the hidden dimension of research, leading the diary writer/researcher to walk through the ‘labyrinth of how to do research.’ The author proposes a diary as a “strategy for the collectivization of experiences and analyses” of researchers involved in investigation (Lourau, 1993, p. 85). For him, a diary questions the researcher “neutrality” exposing the researcher’s daily experiences and concrete institutional fragilities. This is how it can be a “strategy for the collectivization of experiences and analyses” of diary writers/researchers involved in investigation.

In order to start a discussion about the use of field diary in research, Lourau (2004b, p. 273) analyzes two diaries of Bronislaw Malinowski2 to present an implication analysis technique. Similarly to narratology,3 he proposes three instances of these diaries: “1. The narrator: the ethnographer, writing a field diary; 2. The implied author, exposing in his diary concerns of an ethnologist, a philosopher, a writer; and 3. The real author of the intimate diary. Possibly, such instances have interference from each other, since both diaries were written in parallel, without “one inside and one outside the ethnographic account”, as proposed by Lourau (2004b, p. 273, bold letters added).

In this sense, we consider that there is not one inside and one outside the diary produced by the research diary writers in this study. The writers, respecting their own singularities, the different places they occupy, and their experiences, wrote in the diary about the relationships they built and kept with the institutions. Institutions are always present in the research contexts and professional and personal activities,4 and analyzing implications “means, above all, talking about the institutions around us” (Monceau, 2010, p. 14).

As a device, research referred to a number of alternative realities that transformed “the alleged horizon of the real, the possible, the impossible” (Baremblitt, 2002, p. 135) which, after being written, read, reread and discussed, became the material of analysis and reporting, and above all, the implication analysis of research diary writers.

In IA, the concept of implication refers to the relations built with institutions, since “exploring an implication means talking about the institutions around us. […] it shows that what an institution sees in us is always an effect of collective production of values, interests, expectations, desires, beliefs that are intertwined in this relation” (Romagnoli, 2014, p. 47).

By proposing implication as a new paradigm, Lourau (2004a) categorizes implications into primary and secondary implications. Primary implications are related to the researcher regarding his research object, the research institution, and the social demands. Secondary implications are the epistemological implications, writing and other forms of research dissemination. Therefore, an implication may have five different forms.

According to Lourau (2004a), IA involves an implication analysis, and not just implication, since implication is not a question of will, but of analysis of the places one occupies or seeks to occupy.

Also according to Lourau (1993), an implication analysis represents the “scandal of Institutional Analysis,” as it questions the sacred and unquestionable place of so-called experts.

In some of his books, Lourau published excerpts from the diaries he wrote while producing theoretical reflections that were the subject of these works. These diaries show the affective, ideological and professional dimensions (Barbier, 1985) of the author’s own implication (Lourau, 1988, 1994, 1997). In this study, these dimensions were analyzed using the records from dairies and were shared and discussed at in-person seminars.5

Research diary was proposed to the group of researchers in the beginning of the project to meet the particularities of each researcher and each field, and to enable future analysis. At first, the diaries were restricted to each researcher. Later, they were shared in small groups and, only in the third stage of the study, the monitoring and evaluation stage, they were collectively available at in-person seminars. No periodicity was established for the records; each researcher wrote at one’s own rhythm and highlighting one’s own singularities, allowed each of them to set one’s own path, writing style, and marks.

In this sense, the excerpts, written fragments of the dairies, were identified according to each one’s role in the research. Then, in the four loci where the study was developed, this study had 14 research diary writers who embraced the writing experience and diary production, among them, two university professors, two postgraduate students, three trainees attending a dentistry course, three dentists from the School Health Center and four dentists from SUS services.

The text yet to come: analysis of implications

The implication analysis presented below has no intention to reach finitude; it rather aims to ensure continuity, that is, further analysis of produced dairies. For this reason, excerpts were selected which show different dimensions of the experiences of research diary writers. Could other dimensions be identified? Certainly yes, but we wanted to identify from the records what touched us in different ways, interacting with the three diary instances proposed by Lourau (2004b) as a technique of implication analysis: the narrator, the implied author, and the real author.

As Passos and Barros (2009, p. 175) stated, “the diary text presents its own production, releasing itself from the pretention of definitive knowledge about the object.”

Each excerpt of the diaries was full of meanings resulting from the experiences of research diary writers, at different intensities, because “the researcher, besides his body and his instruments, cannot avoid using everything that goes on in his head” (Lourau, 2004b, p. 267). It happened to some research diary writers, who freely reproduced their personal feelings - not often considered in research - an intimate writing resulting from research experience. As reported by Lourau (2004b), the real author:

It is a good time to write a diary. The moment we start writing about what we are thinking and feeling, without having to worry about reading, reviewing or adjusting the text. (Diary of dentist from School Health Center-1, July 27, 2013)

I went there to talk to them to find out why S., even after being discharged, returned. They surprised me with two small gifts and two warm hugs! At that moment, I was really touched because they said they wanted to return everything I did for them. (Diary of post-graduate student, October 10, 2013)

Based on Rodrigues (1997, p. 195), if dairies are seen as a device that causes “disruption of historical continuities,” it can act in research as an instituting dimension that can eliminate territories, create unconceivable connections that “will assume a temporary form resulting from a confrontation between strategies on a battlefield.” Then, we can say the diary device was managed but also managed the events in the process related to the experiences during and outside the study, in the confrontation with the desire to control what is recorded and what is not recorded, what is inside the text and outside the text, and what is yet to come in the text.

During the process, we were faced with questions regarding the theoretical-methodological approach adopted in this study, as written by one of the professors in his diary, defining the implied author, the one who reflects, exposes himself after being pressured for the research results, showing that there are different theoretical-methodological conceptions among the researchers and some of the professionals invited to participate in this study.

I show that because it is a qualitative social study, the more unforeseen or “undesirable” events occur, the greater the richness of our study; in a project like this one, if these events do not occur, it does not produce fruits; unlike controlled studies, where uncontrolled events should be avoided; in our case, the more events the better; we were open to any result and whatever was produced should be interpreted; that was the difference. Even with all these limitations, I think they are critical for this project, if I cannot remove immediate resistance we cannot think of a project that aims to generate “universal” care methodologies and techniques. (Diary of university professor-1, February 20, 2013)

The same concern appears in this excerpt of one of the researchers, who ended her diary record early in the research activities, also exposing her methodological doubts regarding the diary writing and what kind of relation she should establish with her experience in the study, that is, the implied author, “sorry if it is more like a testimonial than a diary, but it was from the heart!” (diary of post-graduate student, February 27, 2013).

Intervention research is open to innovation and does not operate with the idea of controlled and delimited data, which generated resistance in some participants who were used to more conservative methodologies. However, this fact led to analyses, marking different places of speech, knowledge, powers and desires, as explained in the diary of two daily writers/researchers as the narrator, showing distance and resistance to what the study proposed, a classical confrontation with the hegemonic dental practice: “Why bother to invent it, they are all the same” (diary of dentist-1, School Service, 2013); “I’ve learned social dentistry, it’s the same thing” (diary of dentist-2, School Service, 2013).

The narrator can be highlighted as the one who describes what is happening around and not what is happening to him, observed in the diary of a diary writer who claims to understand what the study proposed, is willing to adapt her clinical practice, but cannot move on from her established place: “I understood the definitions of the project theoretical framework, I just find it difficult to use them in the routine practice of the FHP dental surgeon” (diary of the dentist from the Family Health Strategy (FHS)-1, February 22, 2013).

Her writing shows some resistance to move from her place of power historically built for the dental surgeon, propose actions outside the dentist chair, meet people and their buccality and see that all of it should also be part of her practice as an FHS dentist.

These excerpts explain the game of power between the instituted and the instituting dimensions, present in the intervention field, causing disruptions and eliminating consolidated territories of the daily practice of health services.

Other diary writers/researchers, also in the same instance - the narrator -, wrote in their dairies about their challenges to implement an expansion in their daily practice, exposing their concerns and creating cracks in the instituted dimension.

I can’t see just a decayed tooth, put a tooth bandage and that’s it. So the ASB said that there are faster dentists, and I said: “Can you just refrain from telling the child’s mother about her real situation?” She agreed, but said: “But it wastes more time” and added: “Each professional is a different dentist, with own profile.” (Diary of the dentist from the Family Health Strategy (FHS)-2, March 8, 2014)

The students of […] presented the PTS; it is the case of a 14-year-old diabetic girl with severe kidney disease. It was a good presentation. At the end, they presented short-, medium- and long-term actions, where they had several actions involving different professionals: psychologist, endocrinologist, proposal to have a connection with the C.S. [Health Center] with pediatrics. After the presentation, I asked myself why it had no referral to a dentist. The students were surprised and said they had not thought about it. (Diary of the dentist from the Family Health Strategy (FHS)-2, March 14, 2014)

I found the requirement boring and even silly, but I did as he asked and, at the end, the result was positive because I built a connection with the patients outside the office and they ended up interacting with me during the visits (although I was silent, sitting alone in the back of the room, where the physician put my chair…) [laughs]. (Diary of post-graduate student, October 10, 2013)

These diary excerpts showed the required battles to be faced in order to create possible connections in research, professional or institutional contexts. Together, these records are about the challenges of dealing with the theoretical-methodological framework of the project, which used buccality as the structuring concept. In other words, it seems that understanding buccality (as a conceptual novelty that explains the integration of its anatomical-functional dimension and, at the same time, its privileged place in the formation of the human psyche) and seeing its practical content is not only a linguistic operation, but also some reorganization at the subjective and institutional level.

In the diary device, in its power to help see and speak, the obstacles to creating different ways of insertion in the daily practice of dental education gain visibility, as written by a diary writer/researcher - a trainee and undergraduate student who presented her concerns - the implied author -, showing some effects from the experiences during the study. “It’s irritating,” she wrote, referring to the organization of clinics during their training process,

It is stressful to see the patient for years, to see the delay, the time that is wasted; since the beginning of the year I have tried to make a partial denture and then I wonder, you know: “why can’t it work out?” It’s too much bureaucracy. Too much… the patient has to come to this clinic so many times. (Diary of a trainee, June 5, 2013)

Just as it was reported in the diary of another researcher - the implied author - an emblematic problem that has existed since the start of SUS is: how to establish other types of operation in the teaching-service-community relationship?

I agree with… [the dentist of the denture service], SUS is a field of research and training, yes, but the dialogue with the reality of services is very important for the implementation of our project. I realized that they [administrators] had not read about the project and if they were concerned, it was just to know what would depend on them to happen. (Diary of a university professor-2, June 12, 2013)

Another challenge refers to the act of writing, which has an effect on the research diary writers - the implied author - during the meetings with other research participants:

How many senses and meanings. I did not see myself in the presentation I prepared, I did not recognize the product of my work, alienation. I choked! I also conduct the technological issues of work in buccal health, when F… was provocative and questioning and how we get on the wave without questioning the senses and meanings. (Diary of university dentist, July 27, 2013)

When I heard about collective anamnesis, I was very afraid of not being able to handle the group. Then, after participating in a group with the teacher, I realized that we have conditions […]. In the beginning everything will be more difficult but it will get better over time. (Diary of dentist trainee, December 3, 2013)

As Abrahão (2004, p. 98) states:

Writing can be the passport to help us understand the world, reflect about life. The lines written on a piece of paper cross time, flow in the imagination, can be read and reread. Often while rereading we find something that we did not capture in the first time, but which is deeply interesting and innovative.

Writing was a challenge imposed on and assumed by all 14 diary writers/researchers.

Final considerations

The RD device acted as a machine that produced heterogeneous effects in the researchers and the study. The diaries constituted an intervention device with potential to articulate different people, in different places, with different knowledge and experiences, including the daily buccal health. They also triggered modes of operation that caused the researchers to reflect about what they were doing in the clinic, write about what they reflected and, above all, share what they wrote about their experiences, often showing resistance during the study and in our seminars. Then, effects were produced on the clinic innovation processes in the daily dental practice of these diary writers, creating internal connections with themselves, their discoveries, disappointments, impressions and among them.

Dairies were like a protected place for ‘free speaking,’ showing their concerns about the daily routine of services and their established relations with institutions, challenges, personal and professional news to reflect and share experiences, challenges with project implementation and negotiations with administration bodies, questionings, doubts, fear of the new, assumption of anxiety, willingness to give up, how real authors narrate their experiences in and with research, implied authors. They also showed achievements, powerful situations that gave strength to continue even with the existing challenges.

The diaries fulfilled their dual function: being self-writing and provide reflections about the work performed and its pedagogical content. As a self-writing, they revealed anguish, disagreements, ambiguities, but also the investigation of the unknown; and, as a reflection, they expressed the ability of subjects to unfold towards their objects and see themselves reconfigured.

Then, as a true machine to help seek and make, the diary as a device worked in different ways, causing tension, doubts, anxiety or fear, according to the experience of each researcher that used this device, which enabled an implication analysis, expand knowledge and powers, eliminate closed territories through expansion and improved visibility to the overimplication of researchers, bringing to the analysis situations that were natural so far.

Besides, in a very objective way, it brought fundamental elements for reporting and analysis of empirical findings of the study and, above all, dairies contributed to a better understanding of the mental architectures related to dental theories about buccal diseases, as one of the diary writers stated: “I’ve learned everything in social dentistry,” often due to the practical limits of attempted innovation, as highlighted in another diary: “Why bother to invent it,” referring to the production of health care within the concept of buccality.

Assuming the place of a writer as a political and methodological path is always a choice. In diary writing, we were able to invent, together, research practices of learning, writing, to create new meanings of doing and saying for the buccal health practice.

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1Argonauts of the Western Pacific and A Diary in the Strict Sense of the Term.

2For more information about the intervention method of socio-analysis, refer to Lourau (1993, 2014) and L’Abbate (2012).

3Narratology is the study of fiction and nonfiction narratives through their structures and elements.

4In Institutional Analysis, the concept of institution differs from that of an organization. For more details about the concept of institution in Institutional Analysis, the approach used in this text, refer to Lourau (2014).

5These seminars were methodologically considered as training seminars. Every research project was admitted to imply knowledge production throughout the process and that the participating subjects do not initially share the same theoretical assumptions; therefore, they do not share the same linguistic and representational framework. Such repertoire is a construct that had these in-person seminars as one of the loci.

Received: May 25, 2018; Accepted: July 16, 2018

Correspondence Luciane Maria Pezzato Rua Silva Jardim, 136. Santos, SP, Brasil. CEP 11015-020.

Authors’ contribution Pezzato and Botazzo wrote the article. L’Abbate revised the article and added content. The three authors contributed to final writing and revision of the article.

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