Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
Can J Diabetes. 2018 Dec;42(6):595-602. doi: 10.1016/j.jcjd.2018.02.001. Epub 2018 Feb 6.
Diabetes is a leading cause of death and disability in Canada. The co-occurrence of mental illnesses and diabetes is well documented, with diabetes being 2 to 3 times more prevalent in individuals with mental illnesses when compared to the general population. In clinical practices, diabetes management practices continue to be based on the chronic disease model, which conceptualizes diabetes as a physiologic and behavioural deficiency; therefore, clinical and policy efforts are directed toward the enhancement of patient self-management techniques through compliance with pharmaceutical and lifestyle recommendations. Little attention has been given to the exploration of how well the biomedical model aligns with the everyday realities of individuals experiencing mental illness.
This project explored everyday experiences of diabetes self-management by those diagnosed with severe mental illnesses through the lens of critical ethnography.
This work demonstrated discordance between biomedical perspectives of diabetes management and the lived experiences of those with severe mental illness, such as schizophrenia spectrum, bipolar disorders and diabetes.
This work offers an alternative conceptualization of diabetes management that moves beyond idealized concepts of self-care to introduce the social realities of patients as they attempt to enact and negotiate medical directives. This understanding encourages a shift toward social and contextual understandings of the lived realities of patients. Attention to how social context informs patients' realities may assist in the development of new patient-oriented grounds for public health strategies and clinical practices and may challenge traditional understandings of compliance and noncompliance.
糖尿病是加拿大主要的死亡和残疾原因。精神疾病和糖尿病同时存在的情况已有充分记录，与一般人群相比，患有精神疾病的个体中糖尿病的患病率要高出 2 至 3 倍。在临床实践中，糖尿病管理实践仍然基于慢性病模式，该模式将糖尿病视为生理和行为缺陷；因此，临床和政策努力的方向是通过遵守药物和生活方式建议来提高患者的自我管理技术。很少有人关注生物医学模式与患有精神疾病的个体的日常现实之间的契合程度。
本项目通过批判民族志的视角探讨了被诊断患有严重精神疾病的个体的日常糖尿病自我管理体验。
这项工作表明，糖尿病管理的生物医学观点与严重精神疾病（如精神分裂症谱系、双相情感障碍和糖尿病）患者的生活体验之间存在不一致。
这项工作提供了一种替代的糖尿病管理概念化，超越了自我护理的理想化概念，引入了患者在试图实施和协商医疗指令时的社会现实。这种理解鼓励转向对患者生活现实的社会和背景理解。关注社会背景如何影响患者的现实情况，可能有助于为公共卫生策略和临床实践制定新的以患者为导向的基础，并可能挑战对依从性和不依从性的传统理解。
