Date Presented 03/23/24
This Photovoice study explored subjective experience of managing Type 2 diabetes mellitus (T2DM) from the perspective of people with serious mental illness (SMI), to inform the development of a T2DM lifestyle intervention targeting clients with SMI.
Primary Author and Speaker: Laura N. Pavitt
Additional Authors and Speakers: Chinyu Wu, Bradley S. Tragord, Kimberly Bristow
PURPOSE: The life expectancy of people with serious mental illness (SMI) is 15-20 years shorter than the general population, primarily due to complications of chronic diseases such as type 2 diabetes mellitus (T2DM). To better understand health management needs of clients with SMI, the purpose of this study was to explore the subjective experience of T2DM self-management among people with SMI. The research question was, what facilitating factors and barriers were encountered by people with SMI while managing their T2DM?
DESIGN: This qualitative photovoice study recruited 10 participants from an integrated care clinic using these criteria: age 18 to 65 years, a SMI diagnosis, a hemoglobin A1C level of 5.7% or higher, and capability to complete all study tasks.
METHOD: Based on principles of community-based participatory research (CBPR), we provided cameras to participants to take photos about issues in the community. Participants completed three rounds of photo assignments and meetings. We used the SHOWED discussion guide to facilitate group discussions. All meetings were recorded and transcribed. Data were analyzed using grounded theory methods, including open coding, axial coding, and selective coding. A computer program, NVivo 14, was used to assist in data analysis.
RESULTS: Facilitating factors of T2DM management for people with SMI included maintaining mental wellness, self-efficacy, community resources, and peer education. Barriers included stress, mental illness symptoms, homelessness, and a lack of agency. Cultural upbringing was both a facilitating factor and a barrier. A preliminary theoretical structure was created to delineate the findings.
CONCLUSION: For people with SMI, it is critical to manage symptoms of mental illness to keep their T2DM in check. This study provides valuable information to develop a T2DM lifestyle intervention that will demonstrate the distinct value of occupational therapy in the care of clients with comorbid T2DM and SMI.
References
Brown, C., Stoffel, V. C., & Munoz, J. P. (Eds.). (2019). Occupational therapy in mental health: A vision for participation (2nd ed.). F. A. Davis.
Pyatak, E. A., Carandang, K., Vigen, C. L. P., Blanchard, J., Diaz, J., Concha-Chavez, A., Sequeira, P. A., Wood, J. R., Whittemore, R., Spruijt-Metz, D., & Peters, A. L. (2018). Occupational therapy intervention improves glycemic control and quality of life among young adults with diabetes: The Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) randomized controlled trial. Diabetes Care, 41(4), 696–704. https://doi.org/10.2337/dc17-1634
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Corbin, J., & Strauss, A. (2008). Basics of qualitative research: Techniques and procedures for developing grounded theory (3rd ed.). Sage Publications.
