Response to diagnosis of pre-diabetes in socioeconomically deprived areas: a qualitative study

Abstract

BackgroundDiabetes prevention is a key priority for the NHS, with a particular focus on populations at highest risk. The NHS Diabetes Prevention Programme (NHS DPP) has been introduced, offering a course of dietary and lifestyle education to individuals with pre-diabetes. However, concerns about the NHS DPP include: (1) the possible unintended consequences of labelling more people with a ‘pre-condition’; (2) the possibility of worsening health inequalities as people in socioeconomically deprived areas tend to access behaviour-change programmes less readily; (3) the appropriateness of an intervention focused on individuals versus population-wide public health policy interventions.AimTo explore the experience of diagnosis of pre-diabetes, and understand the barriers and facilitators to uptake of the NHS DPP for people living in socioeconomically deprived areas.Design & settingA qualitative study was undertaken. Participants with pre-diabetes were recruited from practices serving socioeconomically deprived areas of Sheffield, UK.MethodSemi-structured interviews were conducted and continued until data saturation (23 participants). Thematic analysis of data was undertaken.ResultsBoth healthcare context and an individual’s personal and community context shaped response to diagnosis and likelihood of engaging with the NHS DPP. Patient activation was a useful concept in understanding response. Whether or not people participated in the NHS DPP, being diagnosed with pre-diabetes tended to provoke some degree of dietary change and did not cause significant anxiety for most. However, there were multiple barriers to engaging with the NHS DPP for this patient group.ConclusionDiagnosing pre-diabetes can provoke an individual positive response, but the sociocultural environment often limits an individual’s ability to engage with the NHS DPP or make lifestyle change.

Consequences of a Diagnostic Label: A Systematic Scoping Review and Thematic Framework

“…Upon receipt of a diagnostic label, 52% of included studies from an individual's perspective reported a need to change their cognitions and emotions. Included studies reported individuals described adaptive (e.g., using humour) and maladaptive (e.g., suicidality) coping mechanisms ( 46 , 48 , 50 , 57 , 61 , 67 – 69 , 71 , 74 , 82 , 85 , 88 , 98 , 105 , 107 – 109 , 111 , 112 , 114 , 136 , 138 , 139 ), adapting to new condition-specific knowledge ( 62 , 79 , 87 , 88 , 121 ), rejecting negative perceptions ( 50 , 51 , 70 , 104 , 138 ), and accentuating positive elements of the condition ( 51 , 52 , 61 , 86 , 105 , 111 ). These adaptations were reported to be centred around living fulfilling lives post diagnostic labelling ( 70 , 83 , 88 , 107 ).…”

“…As a result of the diagnostic label, individuals in the included studies reported similar, increased , and decreased emotional support . Some individuals reported others became more emotionally and physically distant, either overtly or covertly, and more stigmatising ( 48 , 51 , 56 , 69 , 71 , 73 – 76 , 81 , 88 , 89 , 105 , 107 , 108 , 133 , 134 , 136 , 138 ) following label disclosure, some experienced breakdowns of romantic relationships and marriages ( 52 , 66 , 105 , 107 ), and some perceived a reduction in support from healthcare professionals following diagnostic labelling ( 46 , 56 , 86 , 106 , 132 , 133 , 136 , 139 ). In contrast, others indicated no change or an increase in support from family, friends, and communities, reporting acceptance, tolerance, and strengthened relationships ( 31 , 46 , 48 , 50 , 55 , 57 , 68 , 69 , 73 , 74 , 86 , 91 , 105 , 107 , 113 , 130 , 134 , 138 , 140 ).…”

“…Beneficial behaviour modifications included greater ownership of health ( 51 , 82 , 109 , 136 ) and positive changes to physical activity practises, dietary choices, self-awareness, and risk management ( 48 , 50 , 51 , 55 – 57 , 59 , 62 , 67 , 81 – 83 , 87 , 88 , 104 , 105 , 107 , 109 , 113 , 136 , 138 ). While detrimental behaviour modifications were reported as activity restriction ( 46 , 51 , 66 , 88 , 105 , 107 , 112 , 133 ), reduction in employment and educational opportunities ( 63 , 81 , 107 , 133 , 138 ), and withdrawal from social interactions and relationships ( 51 , 61 , 66 , 74 , 75 , 81 , 95 , 96 , 105 ).…”

Facilitators and Barriers to Uptake of Community-Based Diabetes Prevention Program Among Multi-Ethnic Asian Patients With Prediabetes

“…So, I thought probably this would not fit me very well because I do exercise on my own … doctors are the subject matter expert. They can give medical advice and tell you what you should do and you take their advice seriously (13) In the midst of the program, if we encounter any problems, health (related) people or at least the doctor might be able to advise us (29).…”

Preventive Metformin Monotherapy Medication Prescription, Redemption and Socioeconomic Status in Hungary in 2018–2019: A Cross-Sectional Study

“…Regarding lifestyle modifying interventions against T2DM development Gray et al demonstrated that patients from socioeconomically deprived groups were less likely to take up offers of these preventive measures [ 17 ]. In a qualitative study based on semi-structured interviews with 23 prediabetic patients from the most deprived practices of Sheffield (UK) it was showed that personal, social, and environmental factors hindered people to make lifestyle changes [ 18 ]. It is reasonable to suppose that socioeconomic factors may also have a reasonable effect on preventive medication with metformin, but no studies addressing directly this issue can be found.…”