Self-Care in Young People With Diabetes: A Qualitative Exploration Using a Salutogenic Approach

Abstract

This thesis investigates experiences of self-care amongst young people with diabetes using a qualitative salutogenic approach. Diabetes self-care includes injecting insulin, counting carbohydrates, attending hospital check-ups and other activities to maintain stable blood sugar levels. Optimal blood sugar levels are not always easy for young people with diabetes to attain, placing them at increased risk of health complications. A lack of self-care has been assumed traditionally to indicate a lack of knowledge. This exemplifies a ‘deficit’ approach whereby efforts to improve self-care focus heavily on diabetes education to increase knowledge. However, there is a lack of evidence that young people lack diabetes knowledge or that education-only interventions are effective. This thesis applies salutogenesis as an alternative to the deficit approach in which young people are conceptualised as individuals and their capabilities are acknowledged. The empirical work undertaken includes: a meta-ethnography of the international qualitative literature, analysis of semi-structured interviews with young people living in a diverse urban area of the UK, defined as disengaged from diabetes self-care (N=14): and a qualitative study conducted with young people participating in novel salutogenic projects which focused on their capabilities rather than ‘correcting’ their deficits (N=5). Across the studies it was found that ‘identity work’ underpins young people’s experiences with diabetes self-care. Identity work is the continual negotiation of diabetes into self-concept (‘being’ identity) and diabetes self-care into daily life (‘doing’ identity). This involves navigating threats to and validators of identity within the home, the diabetes clinic, the school and the social environment, to achieve a sense of normality. Identity work is fluid and comprises three types: ‘forgetting diabetes’, ‘diabetes as dominating’ and ‘diabetes as routine’, each of which are associated with different levels of engagement with diabetes self-care. Participating in salutogenic projects enabled young people to better navigate identity work and thus integrate diabetes into both ‘being’ and ‘doing’ identity. This thesis demonstrates that diabetes self-care is a manifestation of young people’s ongoing identity work and that this identity work is modifiable. Further research should explore the way in which salutogenic projects can enhance engagement with diabetes self-care on a larger scale.