Reconceptualising Diabetes Care for People with Mental Illness: Institutional Ethnography

By Yuliya Knyahnytska.

Published by The International Journal of Health, Wellness and Society

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Higher predisposition and rates of type 2 diabetes (T2DM) in people diagnosed with severe mental illnesses (SMI) is well documented in the literature. Factors, such as proper nutrition, regular exercise, and medication compliance have been shown to be crucial to successful diabetes management in people with SMI. However, little is known about how the organization of diabetes care impacts service provision for populations with complex comorbidities. The vast majority of available research on diabetes management for people diagnosed with SMI is generated from the perspective of service providers and health care systems, which overlooks important contextual factors. Primary health care settings are seen and expected to be the prime locus of treatment for problems that are psychiatric and chronic in nature. These settings are well suited for handling the majority of patients and their mental health and medical problems where primary care is the first, and often only, point of contact with the health system. The purpose of this research is to analyze intersectional, structural, and discursive dimensions of diabetes management through critical qualitative inquiry, namely institutional ethnography (IE), for people with SMI within the context of primary care settings. The main focus of this paper is to demonstrate how the application of an alternative methodology, namely IE, offers a useful framework which can be incorporated into clinical practices to address the existent challenges in diabetic care for populations with complex needs. I will start with a brief overview of the current status of diabetes management for people with SMI, followed by an identification of gaps in current research and practices. I will conclude with a discussion on how this new body of knowledge may improve clinical diabetic care for people with severe mental illnesses.

Keywords: Population Health, Diabetes Type II, Diabetes Management, Mental Illness, Primary Care, Critical Social Theory, Alternative Conceptualizations, Institutional Ethnography, Health Systems, Quality of Care

The International Journal of Health, Wellness and Society, Volume 4, Issue 2, March 2015, pp.39-54. Article: Print (Spiral Bound). Article: Electronic (PDF File; 614.290KB).

Dr. Yuliya Knyahnytska

PhD candidate, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada