The Internal Realities of Individuals With Type 2 Diabetes: Mediators Influencing Self-Management Beliefs via Grounded Theory Approach

Wrangling Diabetes: Illuminating the Latent Processes That Impact Diabetes Self-Management Behaviors

PURPOSE

The purpose of this study is to discern the mechanisms that impact diabetes self-management from the perspective of individuals living with diabetes.

METHODS

Using a critical realist perspective, this qualitative descriptive study enrolled 54 individuals living with diabetes who had been exposed to diabetes self-management education and support within the previous 3 years. Focus groups were conducted between January and March 2021. Reflexive thematic analysis was used to develop themes and subthemes.

RESULTS

The overarching theme was wrangling diabetes: getting in control. Enablers to getting in control included professional and informal support and constant reassurance that they were on the right track. Individual-level barriers to getting in control included competing priorities, difficult emotions, and financial concerns. Health system barriers included inconsistent messaging from providers, lack of care coordination, and insurance driving treatment decisions. The latent force underlying these barriers was the limited agency individuals with diabetes had in reference to self-management behaviors.

CONCLUSIONS

Although the health care system ostensibly wants individuals to be in control of and responsible for managing their diabetes, system-level structures and processes do not allow for some people living with diabetes to effectively self-manage.

Zain AZ. The external realities of people with type 2 diabetes-Understanding disease perspective and self-management behaviour via Grounded Theory Approach

BACKGROUND

Qualitative strategies can uncover the relationship between the external realities of people living with type 2 diabetes (T2D) and the barriers that are associated with disease self-management. Information from in-depth interviews (IDI) and focus group discussions (FGD) can be used to devise psychological models that could potentially facilitate behaviour changes in people with T2D. We aim to identify salient factors that govern the external realities of people with T2D in relation to disease management.

METHODS

A qualitative study was conducted at a regional primary care clinic in Malaysia using a Grounded Theory Approach. People with T2D were recruited through purposeful sampling to determine their living experiences with the disease. A total of 34 IDIs with 24 people with T2D and 10 health care professionals, followed by two FGDs with people with T2D, were conducted.

RESULTS

Three major processes that arbitrate self-management practices include- 1) external reality, 2) internal reality, 3) mediators of behaviour. Within the context of external reality, three important sub-themes were identified-intrinsic background status, personal experience, and worldview. Lifestyle habits of persons with T2D play a central role in their disease management. Another common recurring concern is the issue of a low-quality food environment in the country. More importantly, individuals with T2D have a high degree of expectations for a more person-centered approach to their illness.

CONCLUSIONS

We identified modifiable and non-modifiable behavioural factors that influence the daily living environment of people with T2D. This information can be used to customize the management of T2D through targeted behavioural interventions.