The Development of a New Theoretical Framework to Explore Type 2 Diabetes Self-Management Behaviours in UK South Asian Patients: Recommendations for Healthcare Practice.

Type 2 diabetes (T2D) is a significant public health concern with a high prevalence within the UK South Asian (SA) population. T2D is predominantly managed by lifestyle behaviours such as diet, exercise, medication and self-monitoring of blood glucose. Previous research has highlighted that SA people’s self-management behaviours might be influenced by cultural and religious influences that in turn may explain substandard clinical T2D outcomes in this group. However, it is not clear how cultural and religious factors act on such self-management behaviours. Previous research has not explored how to specifically help SA people create sense, meaning or how to acknowledge such cultural and religious influences relevant to their T2D management. This PhD aimed to understand self-management behaviours of SA individuals with T2D. This PhD thesis presents a number of studies which each explore specific aspects of the influences of T2D self-management in the SA population. New evidence has been created through the completion of a meta-synthesis, which reconstructed and reanalysed previous literature on SA patients’ self-management behaviours. In addition, three qualitative Grounded Theory (GT) studies explored multiple perspectives of those involved with T2D care for the SA population: this included one study with health professionals working in T2D care, a second study conducted with SA patients diagnosed with T2D, and a third study which explored family members perspectives of living with and supporting another SA family member with T2D. Each study offers unique contributions to the evidence-base and creates new knowledge, to develop a thorough and comprehensive understanding of the overall PhD aim. The individual GT studies and the meta-synthesis were integrated to produce a higher-order Grounded Formal Theory (GFT). A subsequent validation study was completed to ratify the development of the GFT. Utilising the GFT and validation study, the final study describes the development of a training intervention which utilised participatory research processes and aimed to implement the new evidence-based GFT into an applied setting with the objective of improving health professional T2D communication and care practices. The findings of this PhD explore a range of psychological and behavioural variables relevant to each study, to the final GFT, and these were subsequently used in the development of a health professional intervention. The PhD findings are discussed with relevance to previous literature and specific contributions to new knowledge. Overall, diabetes self-management in SA’s is influenced by multiple factors, including health professional interactions and the perceived relevance of advice received; the patient’s psychological understanding, alongside their acceptance of, T2D as part of their identity; and their family’s role in supporting their decisions for implementing healthcare advice. The findings are discussed with reference to psychological theories. In addition, this PhD necessitates a holistic approach to understanding self-management in the SA community, and the findings have been fully integrated to present a GFT to explain SA T2D self-management behaviours fully. Furthermore, aspects of the GFT have been developed further and have informed a practice-based health professional training intervention, to help health professionals understand SA patients’ perspectives of T2D, which recognise social-cultural influences on behavioural decisions. Strengths and weakness of the PhD are acknowledged, and the relevance of this research to the real world applied T2D settings is highlighted, alongside a call for further research to develop this research further