'If you don't manage diabetes, it will manage you': type two diabetes self-management in rural Australia.

Abstract

The aim of this research was to investigate the barriers to effective type two diabetes self-management faced by people in rural and remote areas of Australia. This research is timely for several reasons including the current rise in the prevalence of type two diabetes across the world (International Diabetes Federation [IDFJ, 2009), and data supporting the fact that that type two diabetes is poorly managed, especially in rural and remote contexts (Australian Institute of Health and Welfare [AIHW]. 2008a). Specifically, the research presented in this thesis aimed to identify barriers to effective self-management in rural and remote areas, to develop a tool for the measurement of these barriers, and to determine the importance of barriers to self-management in diabetes-dependant quality of life in both rural and urban populations. A mixed methods framework was adopted to address the aims of this research. This approach involved two separate but related data collections and three separate data analyses. Study 1 utilised the methods proposed by Braun and Clarke (2006) in order to conduct a thematic analysis regarding barriers to self -management. Semi-structured interviews with health professionals (n=18) and people with type two diabetes (n=10), and one focus group with people with type two diabetes (n=8) provided the data for this thematic analysis. A socio-ecological framework was used to organise identified themes. Results of Study 1 were subsequently used to inform the development of a survey for collecting quantitative data, which were used in Study 2 and Study 3. Study 2 used Principal Components Analysis to validate an adapted measure of barriers to effective type two diabetes self-management in a mixed rural and urban population (n=326). Study 3 utilised univariate and multivariate analyses to investigate both the demographic predictors of barriers to self-management, and the barrier predictors of diabetes-dependant quality of life in rural and urban populations. Study 1 identified barriers to effective self-management at intrapersonal, interpersonal, organisational and societal levels of influence. Across all levels of influence, the difficulty of maintaining lifestyle changes was emphasised. Results of Study 2 indicated that the adapted survey was valid in a mixed rural and urban population. Age, number of complications and remoteness were identified as significant predictors of various barriers to self-management in Study 3. Diabetes-dependant quality of life was similar in the rural and urban populations. Psychosocial barriers to management were the only significant predictor of diabetes-dependant quality of life in the rural population, while depression, psychosocial barriers and self-monitoring barriers were significant predictors of diabetes-dependant quality of life in the urban population. The research presented in this thesis identified barriers to effective type two diabetes self-management in rural and remote areas of Australia, and indicates that, of the barriers identified, psychosocial barriers are the most important in predicting diabetes-dependant quality of life in both rural and urban populations. These results have useful implications for provision of care in that they lend support to the principle that psychological and social factors must be taken into consideration if the goals of type two diabetes self-management, specifically improving quality of life, are to be realised across settings.