Self-management Experiences Among Men and Women With Type 2 Diabetes Mellitus

A Qualitative Analysis

Rebecca Mathew; Enza Gucciardi; Margaret De Melo; Paula Barata

Disclosures

BMC Fam Pract. 2012;13(122) 

In This Article

Methods

Our rationale for selecting this study technique was that there are limited studies that have focused on narrative accounts of how men and women experience self-care of their diabetes mellitus using a data-driven approach to their analysis. The ethics approval for this research study was obtained from the University Health Network Research Ethics Board in Ontario, Canada. The initial data collection for this study was completed between 2006–2007.

Study Design

This original research question is broad, so as to accommodate for inductive, data-driven thematic analysis. We chose this qualitative method of study in order to elaborate on the multi-dimensional aspects of diabetes self-management for men and women, and compare and contrast these experiences in order to better understand differences. Of note, this study was initially undertaken to examine differences in diabetes self-care among users and non-users of the Diabetes Education Center. While our study results are drawn from a secondary analysis we feel as though they can provide meaningful contribution to the current body of literature.

We utilized a self-management framework by Brewer-Lowry et al.[25] to direct our interview guide. This framework describes diabetes self-management as a series of intersections between various tasks (diet, physical activity, glucose monitoring at home, foot care, medications, and seeking medical care) and resources (self-care, informal, formal and medical care). This model is a clear example of the multi-faceted nature of diabetes self-management: struggles within a single domain can have substantial effects on both immediate and long-term outcomes in multiple areas. Brewer-Lowry et al. also discuss the various types of resources that patients with T2DM utilize in order to practice their self-care behaviors, such as family, friends, formal support and medical care. While this model was useful in directing our interview guide, our major themes were developed based on our inductive analysis and the emerging self-management issues identified by our study population.

Please see Appendix 1 for the detailed interview guide. Focus groups began with introductions and general discussions about life circumstances such as when participants were diagnosed, how long have they lived with diabetes and their motivation for participating in the focus group. The rest of the focus group was structured around a prepared list of open-ended questions regarding diabetes self-management issues that was developed into a topic guide to elicit discussion. The topic guide for the individual interviews was exactly the same as that for the focus groups. All focus groups and interviews were audio-recorded and subsequently transcribed into Nvivo 2.0. The interview transcripts were kept in password protected and secure hard drives at our research lab throughout all stages of data analysis to ensure confidentiality and data security. Following initial data collection, all identifying information of the participants was removed and objective identifiers were used on the transcripts to ensure anonymity.

Participant Recruitment

A research assistant identified eligible patients from the DEC's clinical charts and, using a standardized script, telephoned patients to inform them of the study. Because we had difficulty arranging a common time for all who were interested in participating in the focus groups, we offered those who were not able to attend the option to participate by phone in an individual interview. To those who agreed to participate in a focus group, a letter with details and a map was mailed and a reminder phone call was made the day before the focus group. For those who attended the focus group, consent forms were reviewed and signed, and for individuals participating in telephone interviews, consent was provided over the phone. A $25 honorarium was offered to cover travel and parking costs at the DEC. Of the 35 participants, nine engaged in telephone interviews and the remaining participants were engaged in focus groups of three to eight participants each based on participant availability.

Study Population

The sampling technique required every DEC participant who met inclusion criteria to be notified of the study and this database was used to ensure representative sampling of the population in a at the DEC, situated in a large, urban, culturally diverse city in Ontario, Canada. All participants had T2DM; first visited the DEC between October 2002 and December 2003; spoke, read, and wrote English; and were self-managing their diabetes. We excluded patients who were pregnant, and/or on dialysis. We conducted five focus group: one mixed sex group, two with only men and two with only women to allow for sex specific discussions. The focus groups were distributed in this manner to allow for sex-specific discussions of personal issues among participants that may not have surfaced if all groups were mixed-sex. Interviews lasted 1–2 hours and were held in one of the Diabetes Education Centers from which the participants had been initially recruited.

Data Analysis

The research team addressed issues of rigor and trustworthiness based on a quality framework outlined by Meyrick.[26] Our research team was composed of one academic expert in diabetes (EG), one practice expert (MD), one expert in qualitative research (PB) and a resident physician with a special interest in diabetes (RM). Three of the investigators (PB, MD, EG) performed the focus group and individual interviews but the transcripts had all identifying information removed so we were able to maintain confidentiality and anonymity during analysis. Our data analysis was made inductively as we created our initial themes without having a coding scheme in place.

We used thematic analysis to explore salient topics that emerged from the focus groups and interviews.[27] Our thematic analysis involved initial independent coding by three authors (EG, MD, PB). Seventy-eight codes were identified in the preliminary analysis of the transcripts. Codes were then clustered and used to form 13 preliminary sub-themes that integrated several of the originally identified codes and encompassed more general topics that were the focus of the transcripts. The preliminary sub-themes were then analyzed by sex where similarities and differences among men and women were examined and examples of these themes (i.e. direct quotations) were identified within the transcripts. Subsequently, word documents were created around each sub-theme with relevant quotations selected from the transcripts that highlighted the sub-theme. Further analyses led to the emergence of five overarching themes that illustrated the most significant and broad similarities or differences of diabetes self-management experiences between men and women. The five overarching themes identified were: identity and disclosure as a person living with diabetes, self-monitoring of blood glucose levels, struggles with diet and nutrition, utilization of diabetes resources and social supports. These themes are further elaborated upon in the results section and the relevant quotations used as support for the inclusion and development of the themes.

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