A. Ruston

Diabetes in the workplace - diabetic’s perceptions and experiences of managing their disease at work: a qualitative study

BackgroundDiabetes represents one of the biggest public health challenges facing the UK. It is also associated with increasing costs to the economy due to working days lost as people with diabetes have a sickness absence rate 2–3 times greater than the general population. Workplaces have the potential to support or hinder self- management of diabetes but little research has been undertaken to examine the relationship between work and diabetes in the UK. This paper seeks to go some way to addressing this gap by exploring the perceptions and experiences of employees with diabetes.MethodsForty three people with diabetes were purposively recruited to ascertain ways in which they managed their disease in the workplace. Semi-structured, interviews were undertaken, tape recorded and transcribed. Analysis was conducted using a constant comparative approach.ResultsAlthough respondents had informed managers of their diabetic status they felt that their managers had little concept of the effects of the work environment on their ability to manage their disease. They did not expect support from their managers and were concerned about being stigmatised or treated inappropriately. Work requirements took priority. They had to adapt their disease management to fit their job and reported running their blood glucose levels at higher than optimal levels, thereby putting themselves at higher risk of long term complications.ConclusionsLittle research has examined the way in which employees with diabetes manage their disease in the workplace. This research shows there is a need to increase the awareness of managers of the short and long term economic benefit of supporting employees with diabetes to manage their disease effectively whist at work. Employees may need individually assessed and tailored support on the job in order to manage their disease effectively.

Women's Interpretation of Cardiac Symptoms at the Time of Their Cardiac Event: The Effect of Co-Occurring Illness

Background: Women tend to access medical help for a myocardial infarction later than men and are at a disproportionate risk of dying or of suffering disability as a consequence. Co-morbidity is associated with delay but little is known how this affects decision making. Aim: To examine the effect of co-occurring chronic illness or infections on womens interpretation of their symptoms and action at the time of their cardiac event. Methods: Semi-structured interviews with 44 women admitted to 3 district hospitals following a cardiac event. For the purposes of analysis they were divided into those who arrived at the hospital within 12 h of onset of symptoms (< 12 hour group) and those who took more than 12 h (> 12 hour group). Findings: Women utilised their mental records of knowledge and experiences to make sense of their cardiac symptoms. The mental records of the < 12 hour group contained knowledge of symptoms and previous experiences relevant to cardiac problems. Those of the > 12 hour group contained knowledge and experience of recent and co-occurring chronic illnesses, this provided persuasive ‘evidence’ to suggest that their symptoms were normal or typical for their current state of health and resulted in delay. Conclusion: Womens decision making and timely access to medical help at the time of a cardiac event is influenced by their repertoire of knowledge and experience. Interventions need to be designed to capture the process of symptom recognition and the influence of co-morbidity.

Chronic illness, self-management, and technology: type 1 diabetes patients' views of the use of technology to communicate with health professionals about their disease

Purpose: Diabetes represents one of the greatest health challenges facing the UK. Telehealth is seen to have the potential to revolutionize health care provision by improving access for patients with chronic disease, reducing health care costs, and improving efficiency. There have been many trials of telehealth in the UK but these have typically failed to become part of routine health care, particularly for diabetics. Program design and implementation has not been grounded in an understanding about the ways in which patients manage their disease and perceive these new technologies. This study addresses this gap by gaining an understanding of the perceptions of patients with type 1 diabetes about how telehealth could be used as part of their health care. Patients and methods: Thirty-two people with type 1 diabetes were recruited from a database of insulin pump users, and in-depth telephone interviews were undertaken, tape recorded, and transcribed. Analysis was conducted using a constant comparative approach. Results: Although respondents used technology as part of their diabetes self-management, they considered that the use of telehealth, as part of their health care, was potentially of limited value. Three themes emerged from their discourses: (1) a need to be in control of their disease themselves and a lack of trust of health care professionals in this process; (2) the belief that the National Health Service routine IT systems were unable to support telehealth; and (3) the belief that face-to-face communication was vital in providing them with high-quality care. Conclusion: Telehealth is considered to be revolutionizing health care and shifting power between patients and health professionals; however, evidence of its effectiveness in delivering improved outcomes for diabetes is limited. The findings presented here suggest that there is a need to understand the context of patients’ self-management and their perceptions of their role in telehealth if it is to be successful.

'If you feel that nobody wants you you'll withdraw into your own': Gypsies/Travellers, networks and healthcare utilisation

Gypsies and Travellers are the unhealthiest group in British society, suffering from higher levels of physical and mental illness, lower life expectancy and with low levels of healthcare utilisation. They also continue to experience the highest level of prejudice and discrimination in society. While studies indicate that social networks play an important role in shaping health beliefs and the response to symptoms, evidence on the influence of networks on health is unclear and contradictory. This article draws on social network theory and research into the relation between discrimination and health to critically examine how networks mediate between collective experiences of racism and health-related behavior. Qualitative interviews with 39 adult Gypsies and Travellers were conducted in the South-East of England to explore the wider structural and institutional context and the influence those contexts play in shaping health beliefs and decisions whether to access formal health services. The findings indicate that the influence networks play in shaping health behaviour is dependent on the particular social context of the group and its status in relation to wider social structures, making generalization problematic.

The rise and fall of complementary medicine in National Health Service hospitals in England.

Whilst Complementary and Alternative Medicine (CAM) has never been systematically integrated into National Health Service (NHS) provision, there has been some limited evidence of a developing presence of CAM in NHS hospital based nursing and midwifery. This paper reports on a qualitative study that sought to document the nature and extent of such integrative practice in England, and the interpersonal and organisational factors that facilitated or impeded it. The data revealed a history in which attempts to integrate CAM had some initial success underpinned by the enthusiasm of individual practitioners and a relatively permissive organisational context. However, this was followed by a decline in service provision. The fact that the services were established by individuals left them vulnerable when more restrictive funding and governance regimes emerged. Whilst the data revealed a consistent story about CAM within the NHS, it must be recognised that the use of a snowball sample limits the generalizability of the findings.

Isolation: A threat and means of spatial control. Living with risk in a deprived neighbourhood

Place is an essential aspect of our identity and contributes to our ontological security. Who we are is shaped by and reflected in the places we occupy and the spaces we control. Places have both a topography of risk and of protection. They can be considered, on the one hand, as risk spaces containing differing levels of hazard and, on the other hand, as resource spaces with the goods and services needed to protect residents from harm. This paper draws on data from 10 focus groups of residents of highly deprived neighbourhoods and examines their experiences of living with risk. The data revealed that isolation encapsulated the way in which respondents lived with risk: isolation was identified as both a risk and a means of protecting their ontological security.

Encouraging and enabling low‐income owner‐occupiers to maintain their homes: An exploratory study

Purpose – The purpose of this paper is to show that owner occupation has become the prevailing tenure in the UK with owners increasingly being seen as holding primary responsibility for the condition of their properties. The UK has had a long tradition of public sector enforcement and grant‐led intervention to help preserve the nations private sector housing stock. Recent housing policy changes have subsumed earlier grant legislation and provided a general provision for “assistance” to help owner‐occupiers maintain and repair their own homes. Simultaneously, the role of local authorities continues to shift from provider to enabler of service, with greater discretion and an increased role for other agencies at local level.Design/methodology/approach – This paper shows the focus group discussions that were held in South London to explore what low‐income owner‐occupiers in an ethnically‐diverse area would find helpful from the local authority in carrying out maintenance and repair works to their homes.Findi...

Exercising for a healthy heart: A qualitative study of women's beliefs

Objective The aim of this study was to explore womens beliefs about exercise in relation to key messages about physical inactivity and coronary heart disease. Design This was a qualitative study using semi-structured interviews. Setting Cardiac and gynaecological units of three hospitals in different locations. Method Open-ended, semi-structured interviews were conducted with 50 women admitted with a cardiac related event or suspected cardiac event, and 33 women without manifest coronary heart disease who had been admitted to the same hospitals for routine elective surgery/procedures. Results Women related to exercise primarily in terms of losing weight, looking good, staying mobile and keeping fit generally. Moderate physical activity was considered best and there was a perception that activity inherent in womens domestic lives provided this. Women believed overexercise could be potentially harmful. Conclusion Key messages about physical activity and its importance in preventing coronary heart disease need to take into account womens ideas about the benefits and hazards of exercise.

Gypsies/Travellers and health: risk categorisation versus being ‘at risk’

Risk categorisation provides a routine and necessary contribution to the way people make sense of and impute predictability in a complex human world of which their knowledge is limited. It is a precursor to the development of risk management strategies. Risk categorisation schemes can vary depending on the underlying perspective and knowledge used in their construction. There are estimated to be between 120,000 and 300,000 Gypsies and Travellers in the United Kingdom. They have been categorised on the one hand as a group that is ‘at risk’ suffering wide-ranging inequalities and on the other they can be seen as the archetypical ‘other’ posing risks to normative stability. Public policies to manage their health risks have been limited in contrast to policies to address their ‘otherness’ status which have aimed to exclude, relocate and forcibly remove them from public space. Little is understood about the way in which Gypsies and Travellers categorise and manage the risks to their health within the context of adverse public policies. In-depth qualitative interviews were undertaken during 2010 and 2011 with 39 Gypsies and Travellers aged between 18 and 66 years comprising 20 females and 19 males living in an area of South East England. Respondents framed risk in terms of threats to their health, culture and traditional way of life and issues of trust were central to this. They sought to devise risk management strategies that would maintain boundaries between their community and outsiders who were perceived to be the source of risks to their health. A consequence of their risk management strategies was the potential perpetuation of threats to their health and well-being.

Personal responsibility for private sector housing renewal: Issues in health improvement

Objective To investigate current policy in respect of resourcing private sector housing renewal to promote healthy housing and communities. Design A qualitative study using focus group research investigating what low-income home owners would find helpful in carrying out maintenance and repair to their homes. Setting The focus groups were held in the area office of a South London (private sector housing) Renewal Area. Method Exploratory focus groups were held in 2003 to 2004, to represent low-income ethnically diverse home-owners within the Renewal Area. Results Respondents were open to looking at new ways of maintaining and repairing their homes, although tended to focus around their own needs rather than the works a local authority may strategically wish to see carried out in private housing sector to meet legal housing standards and promote healthy housing. Conclusion Local authorities need to be able to find new, evidence-based ways of supporting home-owners to carry out maintenance and repairs to their homes as part of a wider public health agenda.