Exploring the influence of culture on diabetes self-management: perspectives of Gujarati Muslim men

In this qualitative study I sought to explore the influence that culture has on diabetes (type 2) self-management for Gujarati Muslim men. In particular, I aimed to develop a theoretical understanding of this influence. I used an interpretive approach, which involved combining ethnographic and phenomenological methodologies. Interview and participant observation methods were used to capture data about the lived experiences of diabetes self-management, for a small number of Gujarati Muslim men. These accounts, along with further narrative data from significant others, were thematically analysed over several cycles. The cyclical nature of analysis enabled me to gain deeper and more meaningful insights into the influence that culture has on diabetes self-management. Also central to the research process and analysis, has been my journey and reflexive experiences as a researcher. The study has taught me much about myself, and I have changed and evolved as a response. Therefore the representations presented in this work are inseparable from me and my life, and I have endeavoured to reveal this within the thesis. The study was informed by a contemporary perspective on culture, in which culture is part of the self. A person's culture is in a constant state of flux, as the self continually recreates and negotiates the meaning of culture within the context of the present lived experience. Similarly, and in contrast to current health care policy, which frequently perceives self-management as a set of interjected behaviours, self-management was perceived as the ways in which the man chooses to incorporate his diabetes into the totality of his life. The synthesis of the literature with the findings, demonstrates that culture does not influence diabetes self-management in a rigid and prescriptive way, but instead culture and self-management are interwoven through the self. Since self-management is negotiated by the self and culture is part of the self, it is the self which connects and interweaves the two. The influence of cultural beliefs on diabetes self-management is negotiated by the self within a complex context of interacting factors. This complex context includes other aspects which are equally as important as culture in shaping self-management, such as material, structural and practical factors. Because culture exists within a shifting and fluid context, its influence on self-management is subject to change, negotiation and re-creation. The perspective I have fostered in this thesis, is a considerable move away from the essentialist perspective of culture, taken in much current health care policy and research. I present a challenge to the dominant perspective in which culture is often oversimplified and consequently blamed for deviant or noncompliant self-management behaviours. The subjective perspective of culture that I have adopted in this thesis, enables the realisation that culture influences self-management in neither homogenous nor deterministic ways