Abstract
BackgroundPeople with diabetes and severe mental illness (SMI) experience poorer outcomes than those with diabetes alone. To improve outcomes, it is necessary to understand the difficulties that people with SMI experience in managing their diabetes.AimsTo identify barriers and enablers to effective diabetes self‐management experienced by people with SMI and type 2 diabetes.MethodQualitative methodology using semi‐structured interviews was employed. Development of the interview topic guide and analysis of the transcripts were informed by the Theoretical Domains Framework for behaviour change, which consists of fourteen theoretical domains that have been found to influence behaviour.ResultsFourteen people with SMI and type 2 diabetes took part in the study. Participants considered diabetes self‐management to be important, were aware of the risks of poor diabetes control but struggled to follow recommended advice, particularly if their mental health was poor. Support from family and health professionals was considered an important enabler of diabetes self‐management.ConclusionsNew approaches are required to support diabetes self‐management in people with SMI. This study identified some of the important domains that may be targeted in new interventions.
Highlights
People with severe mental illnesses (SMI) such as schizophrenia and bipolar disorder experience health inequalities,[1] among which is a twofold increased risk of type 2 diabetes compared with the general population.[2,3]
Service users were eligible for the study if they were aged 18 years and over, had a diagnosis of type 2 diabetes and SMI, were able to speak English and were considered by their care co-ordinator or psychiatrist —based on a clinical team review in consultation with the psychiatrist and wider multidisciplinary team— to be well enough to give consent to take part in an interview
Mental health professionals were considered an important source of diabetes support by nine participants, for example by checking blood glucose levels, providing advice or reminding them to attend appointments
Summary
People with severe mental illnesses (SMI) such as schizophrenia and bipolar disorder experience health inequalities,[1] among which is a twofold increased risk of type 2 diabetes compared with the general population.[2,3] Prevalence of diabetes in people with SMI is approximately. Effective control of type 2 diabetes requires performance of several self-management tasks, which include taking medication, following a healthy diet, taking regular exercise, performing foot care and. A brief description of the domains is included in the interview topic guide in Appendix A This framework was used to help ensure that the interviews would capture a comprehensive range of potential factors that could act as barriers or enablers of participants’ diabetes self-management behaviour. The interview topic guide (see Appendix A) included questions based on each of these 14 domains but was semi-structured, allowing the interviewer and interviewee flexibility to explore issues in further detail
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