The influence of population-based factors on self-care of patients with diabetes mellitus

Abstract

“Diabetes poses a special challenge because it is possibly under-diagnosed, and subjected to the ‘rule of halves’ – only half of all cases of diabetes are diagnosed, only half of those diagnosed treated, and only half of those having treatment are managed effectively” (McKinlay & Marceau, 2000: 758). Globally, diabetes is a leading cause of death and a major source of morbidity. Clinical investigations of diabetes are fundamentally limited because they do not address the socially-constructed patterns of consumption, lifestyle, and its manifestation in individual behaviour as well as the differences between social groups, while the traditional sociological study of diabetes as an experiential phenomenon provides limited insight into material processes by which the social world is formed (Timmermans & Haas, 2008).

This qualitative population-based study explored the influence of selected population-based factors on self-care of patients with diabetes mellitus. The study was conducted at seven primary health care clinics in the district of Tshwane, Gauteng Province, South Africa. Fifteen focus groups, seven full and eight small or mini groups, were facilitated, with an average size of five participants per group at the seven selected clinics. Seventy two adults with diabetes mellitus participated in the study; 20 males and 52 females with ages ranging from 30 to 87. The development of the topics for the focus group discussion schedule was informed by the literature, the conceptual framework and the theories. The final topics emerged from the pre-testing of the focus group discussion schedule during a pilot study. The study explored the population-based factors that might determine sustainable diabetes self-care management. The focus was on the role of social integration and its interrelationship with demographic and social changes. These factors were utilised to facilitate the empirical research process by means of the focus groups, while other possible related factors were identified from the responses.

The ethical clearance process for the study was four-fold: the research proposal was approved by the Faculty of Humanities; the research instruments of this qualitative study were approved by the Ethics Committee of the Faculty of Health Sciences at the University of Pretoria as part of the research protocol for the Diabetes Lifestyle Research study at the Kalafong Academic Hospital; the written preliminary permission was required from the clinic managers of each of the seven primary health care district clinics; and the ethical clearance of the combined Ethical Committee of the Tshwane District Health and Gauteng Provincial Health Authorities.

The focus groups discussions were mainly conducted in English and Afrikaans; and recorded, transcribed, coded, and analysed by the researcher. In the analysis the researcher maintained an emphatic stance of seeking an understanding through the eyes of the research participants that indicated the study was in tune with interpretivism. A three-pronged theoretical approach was followed, namely a multi-level heuristic framework, a health behavioural model and a social theory. The rich text data provided multiple observations and possible meanings. The experiences viewed by the participants reflect the difficulty of persons with diabetes to accept the diagnosis as a lifelong condition. The emotional and psychological burden of diabetes is reflected in the complexity of the socio-geographic networks that include all their relationships, as well as home and living environments. The findings suggest that knowledge about diabetes and the empowerment through social support are predictors of sustained self-care management. The perceptions about diabetes in particular and health beliefs in general are determining factors regarding the participants’ reasoning about their present quality of life and future life with diabetes. The complexity of diabetes self-care management is reflected in the Trinity of the three themes namely ‘Diabetes Health Beliefs’, the ‘Socialising’ patterns of persons living with diabetes and the ‘Experiencing of Diabetes’. The Trinity of Themes is the final strategic outcome that prioritises the multiple observations and the essential meanings in the data and strategically focuses the parameters of this study. The Trinity of Themes also serves as the pathway towards sustainable diabetes self-care management. The main limitation of the study is that the findings cannot be generalised to the rest of the South African population because the study included only people with diabetes who live in the district of Tshwane in Pretoria and who make use of public primary health care facilities. The main significance of this study is the theoretical engagement of sociology with the discipline of social epidemiology; as well as the clinical complications of ineffective self-care management of diabetes. The population-based perspective rather than an individual perspective towards diabetes self-care management distinguishes this study from previous studies done in either sociology or the health sciences.