Exploring the self-management experiences of adults with Type 2 diabetes in Wales through the lens of Interpretative phenomenological analysis

Abstract

Background: Wales has the highest prevalence of type 2 diabetes (T2D) in the UK, and complications arising from diabetes have been reported to have a considerable rise in new cases of diabetic retinopathy and toe, leg, and foot amputations, resulting in substantial morbidity, mortality, and socio-economic burden. However, considerable evidence suggests that timely diagnosis and appropriate self-care can prevent or delay the advancement of complications of T2D. Research in other contexts has highlighted a range of factors influencing self-management of T2D, including patients' awareness of the disease, perceptions, beliefs, sociocultural issues, financial issues, and social support and healthcare resources. Nevertheless, recent literature has revealed a paucity of research focusing on the personal-level experiences of people regarding diabetes self-management. Considering the increased incidence of diabetes cases in Wales, the lower uptake of diabetes services and resources, and differences in the Welsh health system from the UK (i.e., diabetes service provision through health boards, the rural nature of Wales), the exploration of the personal experiences of diabetes self-management amongst adults with T2D was crucial to understanding their self-care behaviours.
Aims: To undertake an in-depth exploration of the self-management experiences of adults with T2D in Wales and the factors that influence their self-care practices and behaviour modification processes.
Methods: Following the methodological framework by Arksey and O'Malley (2005), which included: identifying the research question; identification of relevant studies; study selection; charting the data; collating, summarising, and reporting the study results; and consultation with research stakeholders (optional), a scoping review of the literature was conducted in order to map the current literature on diabetes self-management in order to identify the research gap and refine the research question. Ten in-depth qualitative interviews with patients over 18 years old living with T2D were undertaken. Moreover, a participatory workshop with six diabetes stakeholders was conducted to discuss the primary study findings and generate potential solutions to improve diabetes care in Wales. For a scoping review, data was analysed using thematic analysis, while interview and workshop data were analysed using an interpretative phenomenological analysis (IPA).
Findings: The scoping review highlights the importance of understanding the experience of T2D people at the individual level, highlighting the context-specific nature of diabetes management and self-care, and the need for exploration of diverse perspectives in diabetes care. The findings indicate that patients’ self-care behaviours were influenced by a number of factors, including personal, sociocultural, and the health system. Healthcare providers’ provision of diabetes care and support also appeared to be restricted due to several factors, such as a lack of appropriate care pathways and fragmentation in diabetes care delivery. Additionally, patient-provider communication, patient-provider relationships, a combination of interpersonal and inter-professional provider factors, and a traditional medical model adopted by the Welsh healthcare system seem to have influenced the practice and quality of the diabetes service delivered.
Conclusion: It is apparent that the increased incidence of uncontrolled T2D is not merely due to the poor self-care behaviours of patients but also due to patient provider factors, constraints in diabetes service delivery, and inadequate self-care support provision due to increased demand and limited resources. The evidence produced could assist in developing, revising, and updating diabetes programmes and policies to improve diabetic patients' self-management skills and the quality of diabetes care, as well as facilitate changes in self-management support provision in Wales.

Date of Award	4 Dec 2024
Original language	English
Awarding Institution	Bangor University
Supervisor	Sion Williams (Supervisor) & Simon Bishop (Supervisor)