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The Role of Illness Beliefs and Social Networks in South Asian People with Diabetes: a Mixed Methods Study
[Thesis]. Manchester, UK: The University of Manchester; 2013.
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Abstract
Background: Diabetes is a serious condition affecting the UK South Asian (SA) population. Beliefs amongst a number of factors have been reported to impede on self-management behaviours. Social networks (SN) are known to be an important source of support for diabetes management. Yet little is known about how much and what types of diabetes ‘work’ is undertaken and the impact of SN in shaping beliefs about diabetes. The aim of this study was to explore and gain knowledge about the association between illness beliefs and SN in British SA adults with diabetes.Methods: A mixed methods approach was used. Firstly, a systematic review was conducted to assess the feasibility of using standardised questionnaires to measure diabetes-related beliefs in this target population. Secondly, using a cross-sectional design, a Postal Health Survey (PHS) explored illness beliefs (Brief Illness Perception Questionnaire-BIPQ) and health outcomes (health status, self-efficacy, normalisation and self-care) in a sample of (N=67) recruited using random, purposive and snowball sampling. A Social Network Survey Interview (SNSI) with (N=37) (who completed the PNS), identified SN in each participant’s network using concentric circles, and closed- questions on the amount of ‘work’ done by the network. A topic guide, specific to the aims of the Qualitative Study (QS) was embedded within the SNSI to explore the social, cultural and religious context related to diabetes management. Participants who completed the SNSI also completed the QS. Data was collected during 2010 and 2011. Results: Five studies meeting the review criteria were identified from the systematic review. The results supported the need to measure illness beliefs using standardised questionnaires. Certainsocialnetworkcharacteristics:sizeofthesupportnetwork, number of supportive females, practical and emotional work was related to diabetes- related beliefs. After multivariate analysis, emotional work remained a significant predictor of concern and emotional distress related to diabetes. The qualitative study identified six themes: fatalism, normalising diabetes, social networks, alternative food therapies, and travel back home to the East and religion related to beliefs and management practices. The QS also complemented and extended some of the findings of the cross-sectional study, related to social networks and fatalism beliefs. Conclusion: This study provides a unique contribution to the research on diabetes management in British SA, using a mixed methods approach. It has addressed the gap in knowledge with regards to illness beliefs about diabetes in British SA, as measured by five dimensions of the CS-SRM (Leventhal et al, 1980) and described the importance of the social context, particularly the family in being at the forefront of ‘work’ related to diabetes management. Future studies need to establish utility of the BIPQ in the UK South Asians to ensure it is appropriateness to the experience of diabetes in SA. Policy guidelines on diabetes may need to move beyond the notion of ‘self’ to include support and education for the SN, with a recognition of the impact of cultural and religious beliefs on diabetes management.