Abstract
Globally, Type II Diabetes Mellitus (T2DM) is a common chronic disease, which, in recent years, has reached epidemic proportions and shows no sign of slowing. The disease, which is increasingly affecting adolescents, children, and indigenous and ethnic minority groups, is commonly associated with a wide range of serious acute and chronic physiological and psychological health conditions.
T2DM is treatable, but most people fail to maintain glycaemic control as it is highly reliant on their ability to adhere to a daily self-management regimen that is complex and often challenging to maintain. These challenges are usually increased by the influence of other factors, including the effects of other comorbidity and multimorbidity, and needing to simultaneously self-manage conditions. In recent years, a growing body of research has found people’s ability to self-manage T2DM, and other chronic conditions, can also be influenced by the effect the condition has on their self-identity. The aim of this thesis was to gain a greater understanding of how having T2DM and one or more other chronic conditions affect an individual’s self-identity and, in turn, their diabetic self-management practices.
A qualitative narrative research design was chosen. Forty individuals aged 25–65 years, who were diagnosed with poorly controlled T2DM and one or more other chronic health conditions, were recruited from a larger T2DM randomised controlled trial. Single, audio-taped telephone interviews were conducted and transcribed verbatim. Narratives within each transcript were identified, coded and analysed according to Riessman’s (1993, 2008a) thematic narrative analytical framework. The findings were also ‘mapped’ against Kralik, van Loon and Telford’s (2005) four phased conceptual transitional framework to gain a greater understanding of participants’ experiences and the study findings as a whole, and ascertain its clinical applicability for people diagnosed with T2DM and comorbidity or multimorbidity who struggled to maintain glycaemic control.
A collective story emerged, which found that the effect T2DM and comorbidity or multimorbidity had on participants’ self-identity was often profound, lasting and hindered their ability to self-manage T2DM and, at times, other conditions. The collective story plot followed a trajectory that encompassed three key stages that reflected participants’ experiences: a beginning: Life is different: the middle: Implementing prescribed self-management practices; and an end; Looking to the future Within the collective story three main stories were embedded. The first story, ‘The Visibility Level of T2DM,’ described the ways the visibility level of the disease significantly influenced the extent the disease affected participants’ self-identity and, consequently, their ability to self-manage the disease. When the disease was invisible, the threat to self-identity was usually minimal, but made it harder to self-manage the disease. Cultural and societal influences shaped the meanings participants assigned to the condition, which also influenced how they experienced the disease. Their personal coping strategies, the formal and informal support they received, and current or historical unresolved events, also influenced the meanings participants assigned to their condition.
The second story, ‘The Impact of Comorbidity and Multimorbidity,’ described the adverse effects other conditions frequently had on participants’ self-identity and the impact in further impeding their diabetic self-management efforts and, at times, other conditions, often for the same aforementioned reasons. The third story, ‘The Acceptance and Integration of T2DM and The Future,’ described the ways factors enabled or hindered participants to accept the condition. Most participants believed it was important that they accepted it, as it would enable them to self-manage the disease. However, participants who believed they had partially or fully accepted the disease, still struggled to self-manage the disease and maintain glycaemic control. How participants envisaged their future was highly dependent on the extent conditions affected their self-identity and life roles. Lastly, participants’ experiences matched many of the elements found within Kralik et al.’s (2005) framework, namely, health—illness transitions played an important, central role in participants’ lives, and were at the very core of who they were as individuals, and often influenced how they self-managed their diabetic and other condition(s).
This study found evidence that people diagnosed with T2DM may find it to be an intrusive, disruptive event in their lives, which could threaten their self-identity and make it more difficult to adjust to and self-manage the disease. The effect and reasons vary for complex multifactorial reasons. Key reasons include the effect of comorbidity or multimorbidity, the visibility level of conditions, the meanings people assign to each condition, and the support they receive.