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Table 2 Three meta-narratives of pre-diabetes

From: How are health-related behaviours influenced by a diagnosis of pre-diabetes? A meta-narrative review

Question Biomedical Psychological Social realist
How has the problem been conceptualised by the authors? Pre-diabetes is a biomedical condition that is a precursor for diabetes. Pre-diabetes is an objective risk state. People require a perception of high risk and knowledge to change their lifestyles and reduce their diabetes risk. Social context has a role to play in changing behaviours within the individual. Development of type 2 diabetes is a complex process influenced by multiple social, cultural and environmental factors. The term ‘pre-diabetes’ is (at least in part) a socially constructed and value-laden category that obscures these wider determinants.
People can reduce their risk by changing their lifestyles in a prescriptive way.
How has the problem been theorised? Chronic disease develops in a linear fashion (genetic predisposition to risk state to established disease). Psychological models of health-related behaviour (especially Leventhal’s self-regulatory model of illness behaviour and the health belief model). Sociological models of the interaction between agency (individual behaviour and choices) and wider social influences (structure), especially Bourdieu’s notion of habitus (internal predispositions shaped by cultural experiences).
What methods have been used to research the problem? Questionnaires and semi-structured focused interviews. Semi-structured interview and focus group studies seeking data on psychological factors (attitudes, perceptions, concerns and barriers to change or engagement). Questionnaire studies of attitudes, stage of change, self-reported behaviours, risk assessment and disease knowledge. Interviews and ethnographic studies seeking a rich picture of how wider social and cultural influences affect individual decision-making and action. Lifestyles are viewed as social practices with cultural meaning and moral worth.
What instruments have been used to measure key variables or influences? Quantitative scales and questionnaires. Qualitative data from focus groups. Quantitative scales and questionnaires. Qualitative data from focus groups. Critical ethnography, analysis of individual narratives (e.g. of family life) and analysis of wider cultural storytelling narratives (e.g. of diaspora or oppression).
What are the main findings? A diagnosis of pre-diabetes is sometimes (but not always) accepted and seen positively as prompting behavioural change. People with pre-diabetes do not always perceive themselves at high risk of developing type 2 diabetes, even when they know the risk factors. Social context has an important role to play in changing lifestyles. Perceptions and actions are socio-culturally framed.
Lifestyle change is possible only when (and to the extent that) the individual’s social context, culture, and material and economic situation support particular behaviours.
What conclusions are drawn from the findings? Diabetes prevention can be improved through individual lifestyle education. This should focus on improving knowledge. Diabetes prevention can be improved through lifestyle change by increasing risk perception and knowledge. However, social context is an important determinant of individual behavioural change. Diabetes prevention through individual lifestyle education will have limited impact unless wider socio-cultural, environmental and material influences are addressed.