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. |