This thesis explores pertinent issues regarding the psychological, social, and physical wellbeing of people living with type 1 diabetes. Chapter one presents a narrative systematic review of 22 studies concerning the psychosocial factors associated with repeat diabetic ketoacidosis (an acute and life-threatening complication of diabetes) in type 1 diabetes. Although considerable variance was noted across studies with regards to design, quality and outcomes measured, some consistent psychosocial factors were observed to be implicated in the cycle of repeat diabetic ketoacidosis. These comprised: female gender, adolescent to young adult age range, lower socioeconomic status, and poor mental health. Themes also emerged around ethnicity and, in children and young people, family, social and behavioural issues. However, firm conclusions could not be drawn about these additional themes due to particularly poor methodological rigour and scant research. Recommendations were made for enhanced monitoring and support for individuals within particularly ‘at risk’ groups.
Chapter two presents a grounded theory study exploring the personal impact of expert by experience activity on young adults living with type 1 diabetes. A theory of empowerment through expert by experience activity was developed, grounded in interviews with seven participants. The theory proposes that engagement in expert by experience activity empowers individuals psychologically, socially, and in their condition management; and may lead to increased confidence and autonomy across multiple areas of their lives. These findings, in addition to existing research demonstrating the service-level benefits of expert by experience involvement, may have important implications for diabetes services to support expanding their programme of expert by experience involvement to benefit all stakeholders.
Chapter three discusses further implications emerging from the first two chapters regarding future research, theory development, and clinical practice. It concludes with a reflective commentary on the research process.