The Social Construction of Quality Diabetes Care Appointments in Primary Care by Adults with Mild-to-Moderate Learning Disabilities, Their Supporters and Healthcare Professionals

Questions have been raised over the quality of healthcare including primary care diabetes services for adults with learning disabilities. Despite numerous proposals and policies aimed at improving the quality of healthcare services for people with learning disabilities, little is known about what constitutes quality care from the perspective of key stakeholders. This thesis aimed to: i) explore the social construction of ‘quality care’ in terms of diabetes primary care appointments by adults with mild-to-moderate learning disabilities, those who support their diabetes management and healthcare professionals; ii) reveal any similarities and differences in the ways in which these different stakeholders constructed quality care; and iii) explore the social construction of responsibility for the provision of quality diabetes care appointments for this population. A discursive psychological analysis was conducted on twenty semi-structured interviews: eight adults with mild-to-moderate learning disabilities and diabetes, seven supporters and five healthcare professionals. The research demonstrated that different stakeholders drew on some common ideas to construct quality diabetes care appointments, notably that appointments should fulfil their purpose, stakeholders should fulfil their respective roles and responsibilities and that successful appointments are informed by medical and/or experiential knowledge. Stakeholders also drew on differential repertoires around the relationship between independence and quality diabetes care and practicalities and constraints in the provision of quality diabetes care. Different stakeholders were constructed as having different responsibilities. People with learning disabilities were often positioned as having a limited level of responsibility whilst others were positioned as accountable. Quality care was flexibly constructed to perform identity management for the speaker, to attribute responsibility and to justify care which deviated from recommended quality guidance for diabetes care. Likewise, responsibility for quality care was flexibly taken up and attributed. The findings of this thesis have implications for ongoing discussions about the nature of quality care for people with learning disabilities in diabetes services and beyond