Abstract
It is important to understand what people believe about diabetes because increasing lifespans have led to an increase in the prevalence of chronic health conditions (CHCs) such as this disease. The growing importance of modifiable risk factors, coupled with a greater focus on personal responsibility for health, has resulted in the blaming of individuals for CHCs that may be caused by factors such as inactivity and unhealthy diet. Many studies have investigated perceptions of management for people with CHCs. Studies of the perceptions ‘healthy’ individuals have of CHCs, however, have tended to focus exclusively on cause over management. Additionally, studies of ‘healthy’ individuals’ perceptions of people with CHCs have been criticised for using vignettes featuring fictional cases in order to manipulate disease variables.
The present study sought to investigate ‘healthy’ participants’ perceptions of responsibility for both cause and management of types 1 and 2 diabetes, using a mixed-methods approach involving video documentary material featuring real individuals with diabetes. Thirty-nine participants were asked to fill in components of the Illness Perceptions Questionnaire (IPQ-R) and the Mental Illness Attributions Questionnaire (MIAQ) adapted for types 1 and 2 diabetes, while ‘thinking aloud’, voicing their thoughts on each question. Participants also answered some semi-structured interview questions.
Independent t-tests identified significant differences in participants’ responses for type 1 diabetes compared to type 2. Participants were more likely to disagree with psychological and risk causes and social stigma for type 1 diabetes, while being somewhat neutral about them for type 2. Participants were more likely to agree with behavioural causes for type 2 than for type 1, and were more likely to agree with a genetic cause and treatment control for type 1 diabetes over type 2 diabetes. However, because a number of ambiguities within the questionnaires were noted by participants in the ‘think-aloud’ data, a greater focus is placed on the qualitative data (collected simultaneously).
Following inductive thematic analysis, four main themes were identified in the qualitative data: 1) knowledge of diabetes; 2) the power to influence diabetes; 3) limitations of responsibility/blame for diabetes; and 4) feelings towards individuals with diabetes. Participants’ knowledge of diabetes was generally medically accurate, and attributed type 1 diabetes to genetic causes and type 2 to lifestyle causes such as poor diet. Participants viewed both types of diabetes as incurable but controllable and believed that people with either type should be responsible for their health, as far as they were able. Participants generally felt positively towards the individuals featured in the videos if they perceived them as behaving appropriately in terms of the management of their condition (whether or not they held them responsible for the cause). These findings show that the way an individual manages their CHC is an important factor in determining ‘healthy’ others’ reactions to them. While participants in the present study were largely Western and university educated, the inclusion of perceptions of management and real individuals increases the present study’s ecological validity. Future research on perceptions of CHCs should include measurements of management perceptions.