Conflicting Logics in a Changing Action Space: Challenges Related to Type 1 Diabetes in Work Life

Abstract

Well-being at work is important to quality of life. However, reconciling work and diabetes management is often challenging; failing to do so threatens the well-being of people with type 1 diabetes (T1D). We explored the mechanisms underlying diabetes-specific challenges at work using theories of logics, involvement, and action space. Thematic analyses of two data sets, consisting of interviews with adults with T1D (n = 22) showed that people with T1D experience a conflict between two logics linked to diabetes and work, owing to the contradictory demands of work life and diabetes management. Individuals’ ability to lower the priority of work tasks—shifting them from their main to a side involvement so as to properly manage T1D—helps resolve the conflict, as does being able to create an enabling action space for diabetes management at work. These insights can inform interventions targeting the well-being of workers with T1D.

Keywords

diabetes mellitus type 1 self-management work qualitative research interviews Europe

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References

American Diabetes Association. (2005). Defining and reporting hypoglycemia in diabetes: A report from the American Diabetes Association Workgroup on hypoglycemia. Diabetes Care, 28(5), 1245–1249.

Balfe

Brugha

Smith

Sreenan

Doyle

Conroy

(2014). Why do young adults with type 1 diabetes find it difficult to manage diabetes in the workplace? Health Place, 26, 180–187. https://doi.org/10.1016/j.healthplace.2013.12.016

Beatty

J. E.

Joffe

(2006). An overlooked dimension of diversity: The career effects of chronic illness. Organizational Dynamics, 35(2), 182–195. https://doi.org/https://doi.org/10.1016/j.orgdyn.2006.03.006

Blumer

(1969). Symbolic interactionism: Perspective and method. University of California Press.

Bose

(2013). Promoting successful diabetes management in the workplace. International Journal of Workplace Health Management, 6(3), 205–226. https://doi.org/10.1108/IJWHM-11-2010-0037

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Campbell

Pound

Pope

Britten

Pill

Morgan

Donovan

(2003). Evaluating meta-ethnography: A synthesis of qualitative research on lay experiences of diabetes and diabetes care. Social Science & Medicine, 56(4), 671–684.

Chiang

J. L.

Kirkman

M. S.

Laffel

L. M. B.

Peters

A. L.

(2014). Type 1 diabetes through the life span: A position statement of the American Diabetes Association. Diabetes Care, 37(7), 2034–2054. https://doi.org/10.2337/dc14-1140

Cho

N. H.

Shaw

J. E.

Karuranga

Huang

da Rocha Fernandes

J. D.

Ohlrogge

A. W.

Malanda

(2018). IDF diabetes atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Research and Clinical Practice, 138, 271–281. https://doi.org/https://doi.org/10.1016/j.diabres.2018.02.023

10.

Cleal

Poulsen

Hannerz

Andersen

L. L.

(2015). A prospective study of occupational status and disability retirement among employees with diabetes in Denmark. The European Journal of Public Health, 25(4), 617–619. https://doi.org/10.1093/eurpub/cku240

11.

Cleal

Willaing

Stuckey

Peyrot

(2019). Work matters: Diabetes and worklife in the second diabetes attitudes, wishes and needs (DAWN2) study. Diabetes Research and Clinical Practice, 150, 90–98. https://doi.org/10.1016/j.diabres.2019.02.025

12.

de Wit

Trief

P. M.

Huber

J. W.

Willaing

. (2020). State of the art: Understanding of, and integration in, the social context and diabetes care. Diabetic Medicine, 37, 473–482. https://doi.org/10.1111/dme.14226

13.

Dray-Spira

Herquelot

Bonenfant

Gueguen

Melchior

(2013). Impact of diabetes mellitus onset on sickness absence from work—A 15-year follow-up of the Gazel occupational cohort study. Diabetic Medicine, 30(5), 549–556.

14.

Ervasti

Virtanen

Pentti

Lallukka

Tinghög

Kjeldgard

Mittendorfer-Rutz

Alexanderson

(2015). Work disability before and after diabetes diagnosis: A nationwide population-based register study in Sweden. American Journal of Public Health, 105(6), e22–e29. https://doi.org/10.2105/AJPH.2015.302646

15.

Gannik

(1999). Situationel Sygdom. Fragmenter Til En Social Sygdomsteori Baseret På En Undersøgelse Af Ryglidelser [

Situational disease—Elements of a social theory of disease, based upon a study of back trouble

]. Det Samfundsvidenskabelige Fakultet.

16.

Gannik

(2002). Situational disease: Elements of a social theory of disease based on a study of back trouble. Scandinavian Journal of Primary Health Care, Supplement, 20(1), 25–30. https://doi.org/10.1080/028134302317310741

17.

Goffman

(1963). Behavior in public places, notes on the social organization of gatherings. Free Press of Glencoe.

18.

Hakkarainen

Moilanen

Hanninen

Heikkinen

Rasanen

(2016). Work-related diabetes distress among Finnish workers with type 1 diabetes: A national cross-sectional survey. Journal of Occupational Medicine and Toxicology, 11, Article 11. https://doi.org/10.1186/s12995-016-0099-4

19.

Hakkarainen

Sund

Arffman

Koski

Hänninen

Moilanen

Räsänen

(2017). Working people with type 1 diabetes in the Finnish population. BMC Public Health, 17(1), Article 805. https://doi.org/10.1186/s12889-017-4723-8

20.

Hansen

U. M.

Cleal

Willaing

Tjornhoj-Thomsen

(2018). Managing type 1 diabetes in the context of work life: A matter of containment. Social Science and Medicine, 219, 70–77. https://doi.org/10.1016/j.socscimed.2018.10.016

21.

Hansen

U. M.

Skinner

Olesen

Willaing

(2019). Diabetes distress, intentional hyperglycemia at work, and glycemic control among workers with type 1 diabetes. Diabetes Care, 42, 797–803. https://doi.org/10.2337/dc18-1426

22.

Heinrichs

Vu-Eickmann

Hummel

Gholami

Loerbroks

(2018). What are the perceived influences on asthma self-management at the workplace? A qualitative study. BMJ Open, 8, Article e022126. https://doi.org/10.1136/bmjopen-2018-022126

23.

Heins

J. M.

Arfken

C. L.

Nord

W. R.

Houston

C. A.

McGill

J. B.

(1994). The Americans with disabilities act and diabetes. Diabetes Care, 17(5), Article 453. https://doi.org/10.2337/diacare.17.5.453a

24.

Hinder

Greenhalgh

(2012). “This does my head in.” Ethnographic study of self-management by people with diabetes. BMC Health Services Research, 12, Article 83. https://doi.org/10.1186/1472-6963-12-83

25.

Hinds

P. S.

Vogel

R. J.

Clarke-Steffen

(1997). The possibilities and pitfalls of doing a secondary analysis of a qualitative data set. Qualitative Health Research, 7(3), 408–424. https://doi.org/10.1177/104973239700700306

26.

Hsieh

H. F.

Shannon

S. E.

(2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. https://doi.org/10.1177/1049732305276687

27.

Iavicoli

Gambelunghe

Magrini

Mosconi

Soleo

Vigna

Trevisan

Bruno

Chiambretti

A. M.

Scarpitta

A. M.

Sciacca

Valentini

(2019). Diabetes and work: The need of a close collaboration between diabetologist and occupational physician. Nutrition, Metabolism and Cardiovascular Diseases, 29, 220–227. https://doi.org/10.1016/j.numecd.2018.10.012

28.

Irwin

(2013). Qualitative secondary data analysis: Ethics, epistemology and context. Progress in Development Studies, 13(4), 295–306. https://doi.org/10.1177/1464993413490479

29.

Loerbroks

Nguyen

X. Q.

Vu-Eickmann

Krichbaum

Kulzer

Icks

Angerer

(2018). Psychosocial working conditions and diabetes self-management at work: A qualitative study. Diabetes Research and Clinical Practice, 140, 129–138. https://doi.org/10.1016/j.diabres.2018.03.023

30.

Maahs

D. M.

West

N. A.

Lawrence

J. M.

Mayer-Davis

E. J.

(2010). Epidemiology of type 1 diabetes. Endocrinology and Metabolism Clinics of North America, 39(3), 481–497. https://doi.org/10.1016/j.ecl.2010.05.011

31.

Malterud

Siersma

V. D.

Guassora

A. D.

(2016). Sample size in qualitative interview studies: Guided by information power. Qualitative Health Research, 26(13), 1753–1760. https://doi.org/10.1177/1049732315617444

32.

Marcovecchio

M. L.

(2017). Complications of acute and chronic hyperglycemia. US Endocrinology, 13(1), 17–21. https://doi.org/10.17925/USE.2017.13.01.17

33.

McQuoid

Welsh

Strazdins

Griffin

A. L.

Banwell

(2015). Integrating paid work and chronic illness in daily life: A space-time approach to understanding the challenges. Health Place, 34, 83–91. https://doi.org/10.1016/j.healthplace.2015.04.001

34.

Mol

(2008). The logic of care, health and the problem of patient choice. Routledge.

35.

Nexø

M. A.

Pedersen

Cleal

Bjorner

J. B.

(2019). Increased risk of long-term sickness absence, lower rate of return to work and higher risk of disability pension among people with type 1 and type 2 diabetes mellitus: A Danish retrospective cohort study with up to 17 years’ follow-up. Diabetic Medicine, 37, 1861–1865. https://doi.org/10.1111/dme.14203

36.

Nexø

M. A.

Watt

Cleal

Hegedüs

Bonnema

S. J.

Rasmussen

Å. K.

Feldt-Rasmussen

Bjorner

J. B.

(2015). Exploring the experiences of people with hypo- and hyperthyroidism. Qualitative Health Research, 25(7), 945–953. https://doi.org/10.1177/1049732314554093

37.

Nielsen

H. B.

Ovesen

L. L.

Mortensen

L. H.

Lau

C. J.

Joensen

L. E.

(2016). Type 1 diabetes, quality of life, occupational status and education level—A comparative population-based study. Diabetes Research and Clinical Practice, 121, 62–68. https://doi.org/10.1016/j.diabres.2016.08.021

38.

Nielsen

M. B. D.

Rugulies

Hjortkjaer

Bültmann

Christensen

(2012). Healing a vulnerable self: Exploring return to work for women with mental health problems. Qualitative Health Research, 23(3), 302–312. https://doi.org/10.1177/1049732312468252

39.

Ogundipe

Blandford

Ogundipe

(2006). A survey of the impact of insulin-treated diabetes on employment. The Internet Journal of Endocrinology, 2.

40.

Rasmussen

O’connell

Dunning

Cox

(2007). Young women with type 1 diabetes’ management of turning points and transitions. Qualitative Health Research, 17(3), 300–310. https://doi.org/10.1177/1049732306298631

41.

Ruggiano

Perry

T. E.

(2019). Conducting secondary analysis of qualitative data: Should we, can we, and how? Qualitative Social Work, 18(1), 81–97. https://doi.org/10.1177/1473325017700701

42.

Ruston

Smith

Fernando

(2013). Diabetes in the workplace—Diabetic’s perceptions and experiences of managing their disease at work: A qualitative study. BMC Public Health, 13(1), Article 386. https://doi.org/10.1186/1471-2458-13-386

43.

Szabo

Strang

V. R.

(1997). Secondary analysis of qualitative data. Advances in Nursing Science, 20(2), 66–74.

44.

Weijman

Ros

W. J.

Rutten

G. E.

Schaufeli

W. B.

Schabracq

M. J.

Winnubst

J. A.

(2005). The role of work-related and personal factors in diabetes self-management. Patient Education and Counseling, 59(1), 87–96. https://doi.org/10.1016/j.pec.2004.10.004

45.

Young

Waclawski

Young

J. A.

Spencer

(2013). Control of type 1 diabetes mellitus and shift work. Occupational Medicine, 63(1), 70–72. https://doi.org/10.1093/occmed/kqs176