Julia Lawton

‘We should change ourselves, but we can't’: accounts of food and eating practices amongst British Pakistanis and Indians with type 2 diabetes

Objective(s). To look at food and eating practices from the perspectives of Pakistanis and Indians with type 2 diabetes, their perceptions of the barriers and facilitators to dietary change, and the social and cultural factors informing their accounts. Method. Qualitative, interview study involving 23 Pakistanis and nine Indians with type 2 diabetes. Respondents were interviewed in their first language (Punjabi or English) by a bilingual researcher. Data collection and analysis took place concurrently with issues identified in early interviews being used to inform areas of investigation in later ones. Results. Despite considerable diversity in the dietary advice received, respondents offered similar accounts of their food and eating practices following diagnosis. Most had continued to consume South Asian foods, especially in the evenings, despite their perceived concerns that these foods could be ‘dangerous’ and detrimental to their diabetes control. Respondents described such foods as ‘strength-giving’, and highlighted a cultural expectation to participate in acts of commensality with family/community members. Male respondents often reported limited input into food preparation. Many respondents attempted to balance the perceived risks of eating South Asian foodstuffs against those of alienating themselves from their culture and community by eating such foods in smaller amounts. This strategy could lead to a lack of satiation and is not recommended in current dietary guidelines. Conclusions. Perceptions that South Asian foodstuffs necessarily comprise ‘risky’ options need to be tackled amongst patients and possibly their healthcare providers. To enable Indians and Pakistanis to manage their diabetes and identity simultaneously, guidelines should promote changes which work with their current food practices and preferences; specifically through lower fat recipes for commonly consumed dishes. Information and advice should be targeted at those responsible for food preparation, not just the person with diabetes. Community initiatives, emphasising the importance of healthy eating, are also needed.

Vulnerability and access to care for South Asian Sikh and Muslim patients with life limiting illness in Scotland: prospective longitudinal qualitative study

Objectives To examine the care experiences of South Asian Sikh and Muslim patients in Scotland with life limiting illness and their families and to understand the reasons for any difficulties with access to services and how these might be overcome. Design Prospective, longitudinal, qualitative design using in-depth interviews. Setting Central Scotland. Participants 25 purposively selected South Asian Sikh and Muslim patients, 18 family carers, and 20 key health professionals. Results 92 interviews took place. Most services struggled to deliver responsive, culturally appropriate care. Barriers to accessing effective end of life care included resource constrained services; institutional and, occasionally, personal racial and religious discrimination; limited awareness and understanding among South Asian people of the role of hospices; and difficulty discussing death. The most vulnerable patients, including recent migrants and those with poor English language skills, with no family advocate, and dying of non-malignant diseases were at particularly high risk of inadequate care. Conclusions Despite a robust Scottish diversity policy, services for South Asian Sikh and Muslim patients with life limiting illness were wanting in many key areas. Active case management of the most vulnerable patients and carers, and “real time” support, from where professionals can obtain advice specific to an individual patient and family, are the approaches most likely to instigate noticeable improvements in access to high quality end of life care. Improving access to palliative care for all, particularly those with non-malignant illnesses, as well as focusing on the specific needs of ethnic minority groups, is required.

Taking the biscuit? A discursive approach to managing diet in type 2 diabetes

Adopting and maintaining a healthy diet is pivotal to diabetic regimens. Behavioural research has focused on strategies to modify/maintain healthy behaviours; thus ‘compliance’ and ‘ noncompliance’ are operationalized by researchers. In contrast, discursive psychology focuses on the actions different accounts accomplish—in this case regarding diets. Using thematic discourse analysis, we examine dietary management talk in repeat-interviews with 40 newly diagnosed type 2 diabetes patients. Women in our study tended to construct dietary practices as an individual concern, while men presented food consumption as a family matter. Participants accounted for ‘cheating’ in complex ways that aim to accomplish, for instance, a compliant identity. Discursive psychology may facilitate fluidity in our understandings of dietary management, and challenge fixed notions of ‘compliant’ and ‘non-compliant’ diabetes patients.

“It’s No Skin off My Nose”: Why People Take Part in Qualitative Research

In this article, the authors analyze participants’ accounts of why they took part in a repeat-interview study exploring newly diagnosed patients’ perceptions of diabetes service provision in Lothian, Scotland. The study involved three semistructured in-depth interviews with each patient (N = 40), which spanned a year. The authors provide a thematic discursive analysis of responses to the question, Can I ask you what made you decide to part in the study and why you’ve stayed involved over the past year? The main themes are (a) recruitment within health contexts (“the nurse said it would help”), (b) altruism (“if it can help somebody”), (c) qualitative research being seen as inherently innocuous (“nothing to lose”), and (d) therapeutic aspects of interviewing (“getting it off my chest”). The analysis contributes both to the qualitative literature about generic research participation and to a germinal literature exploring qualitative health research participation.

Diabetes Service Provision: a Qualitative Study of Newly Diagnosed Type 2 Diabetes Patients' Experiences and Views

Aims  To explore newly diagnosed Type 2 diabetes patients’ views about Scottish diabetes services at a time when these services are undergoing a major reorganization. To provide recommendations to maximize opportunities brought by the devolvement of services from secondary to primary healthcare settings.

Gaining and maintaining consent: ethical concerns raised in a study of dying patients.

This article provides a frank discussion of the practical and ethical issues that emerged during the process of setting up and conducting a participant observation study within an inpatient hospice. A general overview of the participant observation approach is used to prefigure a discussion of its strengths and weaknesses when employed as a research and evaluation tool among palliative care populations. Although participant observation provided a flexible and viable means of collecting data in the hospice, it also created a number of dilemmas that in many cases could not be satisfactorily resolved. Difficulties arose, in particular, with obtaining informed consent from patients and assuming that consent remained valid after patients had deteriorated physically and mentally. Further complications stemmed from the role conflict and ambiguity inherent within an approach that requires a researcher to work simultaneously as a participant and as an observer.

Structured Type 1 Diabetes Education Delivered Within Routine Care Impact on glycemic control and diabetes-specific quality of life

OBJECTIVE To determine whether improvements in glycemic control and diabetes-specific quality of life (QoL) scores reported in research studies for the type 1 diabetes structured education program Dose Adjustment For Normal Eating (DAFNE) are also found when the intervention is delivered within routine U.K. health care. RESEARCH DESIGN AND METHODS Before and after evaluation of DAFNE to assess impact on glycemic control and QoL among 262 adults with type 1 diabetes. RESULTS There were significant improvements in HbA1c from baseline to 6 and 12 months (from 9.1 to 8.6 and 8.8%, respectively) in a subgroup with suboptimal control. QoL was significantly improved by 3 months and maintained at both follow-up points. CONCLUSIONS Longer-term improved glycemic control and QoL is achievable among adults with type 1 diabetes through delivery of structured education in routine care, albeit with smaller effect sizes than reported in trials.

The framing of social class distinctions through family food and eating practices

Drawing on two qualitative studies which looked at diet, weight and health from a social class perspective, we use Bourdieus theory of habitus to help explain the different food and eating practices undertaken by families with young teenagers. Whilst the families displayed considerable reflexivity when making decisions about what to eat on a daily basis, the analysis highlighted that everyday behaviours are still bounded by distinctions of taste, according to social position. The paper includes an examination of the relationships between different forms of capital and whether form or functionality is prioritised within families. We show the importance of temporal frameworks when interpreting classed food and eating practices.

Diabetes service provision: a qualitative study of the experiences and views of Pakistani and Indian patients with Type 2 diabetes

Aims  To explore Pakistani and Indian patients’ experiences of, and views about, diabetes services in order to inform the development of culturally sensitive services.

Colonising the future: temporal perceptions and health‐relevant behaviours across the adult lifecourse

Abstract Health promotion is premised upon a proactive approach to health and its management, one that requires a future-orientated outlook, in which the threats of (future) ill-health can be anticipated and thereby mitigated. Despite this, little is known about the extent to which concerns about morbidity and mortality actually feature in peoples present and future perceptions of self, and whether such perceptions have any influence upon their present health-relevant behaviours. By drawing upon interviews with 55 people aged 26–81, this article highlights the central role that embodiment plays in the mediation of health promotion messages. The embodied experience of ill-health, it will be shown, is an important, underlying prerequisite for perceiving a future in which (further) ill-health is anticipated. This pivotal finding will be used to illuminate the observation that, when lifestyles are changed to concur with professional recommendations, these changes tend to be reactive in nature.