Integrating the prevention and management of type 2 diabetes in real world settings.

Despite a vast amount of epidemiological data documenting the ‘epidemic’ of type 2 diabetes and extensive randomised controlled trials evidence of effective interventions, there is a contrast between this wealth of quantitative research and the relatively underdeveloped qualitative understanding of how type 2 diabetes impacts upon patients and health care professionals. We therefore seem no closer to understanding how to effectively tackle the massive burden this represents for both patients and the health service. The publications discussed here represent a body of work consisting of five first author publications (2005-2012) that explore interventions and patient and health professional perspectives regarding the prevention of and care management for type 2 diabetes. Two main methods are used in the studies represented by the papers. These are primary qualitative research (three publications) and evidence synthesis (two publications) for public health guidance. The qualitative methods used in two primary studies and one evidence synthesis allow the perspectives of service users and professionals to be assessed in relation to public health interventions and health care. The remaining evidence synthesis examines how large scale diabetes prevention interventions can be tailored for use in the community. A major theme that links the publications is transferability of care management and prevention ideals to life in the real world. The Chronic Care Model (CCM) provides an optimum framework for such adaptations. However, whilst NHS policies and the CCM focus on patient engagement, it is clear that much needs to be done in recognising and addressing the feasibility of prevention and care strategies in practice. The thesis discusses how disparities between idealism and the ‘life world’ of patients might be addressed, adding to current debates about shared understanding and the importance of taking into account behavioural influences that might undermine or enhance the achievement of shared goals.