Experiences and expectations of structured education for type-2 diabetes management.

Objective: To explore what psychological factors might impact attendance of, and engagement with, structured education for Type-2 Diabetes (T2D). Design: A qualitative design using semi-structured interviews and thematic analysis. Participants: Twenty-one adults with T2D with varying exposure to structured education courses. Findings: Five themes with sub-themes were identified; ‘Stereotypes and stigma about T2D diagnosis’, ‘Self-management motivators and inhibitors’, ‘Facilitating engagement with structured education’, ‘Sharing experience’ and ‘The same ‘menu’ won’t work for everyone.’ ‘Stereotypes and stigma about T2D diagnosis’ included two sub-themes that reflect participants’ experience of T2D as stigmatising whether or not they identified as overweight or leading an unhealthy lifestyle. ‘Self-management motivators and inhibitors’ involved motivation to attend education courses being linked with a sense of personal responsibility, fear of negative consequences of poor self-management, and beliefs about ones’ ability to impact T2D progression. Despite high motivation, long term success at maintaining self-management practices was problematic. ‘Facilitating engagement with structured education’ discussed the language used and messages provided by group facilitators as important to aid engagement. A non-blaming, positive approach and non-authoritarian stance was important. ‘Sharing experiences’ covered the importance of being able to share the burden of T2D management and learn with others with the diagnosis. ‘The same ‘menu’ won’t work for everyone’ examined the differing needs of people with a T2D diagnosis and how education might be adapted and individualised. Implications: The themes are related to the Common Sense Model, self-efficacy, and the window of tolerance. Implications are discussed in terms of what different groups of health professionals might contribute to promoting attendance of courses. It is suggested that reducing stigma and improving self-efficacy may facilitate engagement. It is suggested that promotional messages might emphasise the emotional support and co-learning that occurs in courses as a way to facilitate uptake and engagement.