Thesis Format
Integrated Article
Degree
Doctor of Philosophy
Program
Health Promotion
Supervisor
Smith, Maxwell J.
2nd Supervisor
Shelley, Jacob J.
Co-Supervisor
Abstract
Global estimates suggest over 1.3 billion individuals will be living with diabetes by 2045, of which up to 96% of cases are type 2 diabetes (T2D), a disease that may be prevented or delayed. This research program explored the discourses of risk for T2D to understand how language use shapes how we come to understand, know (or not know) about risk for the disease, and the effect on how we are willing to prevent the disease. This research program consisted of three studies through the lens of: 1) primary care providers; 2) at-risk patients; and 3) Canadian policy. Foucauldian discourse analysis was applied utilizing thematic analysis to understand the discourses of risk for T2D. Study 1 included semi-structured interviews with primary care providers (n=14) working in a family health team. Findings suggest providers use the ‘prediabetes’ threshold to open up risk and preventative discourses but this can also delay communicating about risk for the disease until the threshold is reached. Study 2 included two focus groups and two interviews with patients who were told by a provider they were at a high-risk or had prediabetes. Findings suggest that patients use prediabetes to navigate their attendance to risk for the disease, but struggle with their understanding of the clinical purpose of prediabetes and how to reduce their risk for the disease. Study 3 included a discourse analysis of policy texts and the current Framework for Diabetes in Canada (n=7). Data were analyzed deductively through application of Carol Bacchi’s ‘what’s the problem represented to be’ framework. Findings suggest the problem of risk for T2D is represented as Canadians not being aware of risk factors for the disease and needing to be screened, identified, and educated about the risks for the disease. This was problematized as an individual’s problem to deal with their risk of T2D, rather than attending to the social and environmental conditions which create and maintain the risk. With rates of T2D expected to continue to increase in the future, there is a need to consider how language governs what we are willing to do to address risk for T2D.
Summary for Lay Audience
With rates of type 2 diabetes (T2D) expected to rise in the coming years, there is an urgent need to address ways to prevent the disease. A key component of prevention is detailing how risk for the disease is communicated by providers to at-risk patients, received by at-risk patients, and supported in policy frameworks and strategies. The intent of this research was to explore these facets of risk for T2D through three studies. The first study included interviews with 14 primary care providers (family physicians, nurse practitioners, dietitians, and a pharmacist) to explore how they communicate about risk to their patients. Findings from the first study indicate providers take a patient-centred approach to communicating about risk for the disease. This approach was guided by the use of the term prediabetes to define risk, symptoms (or lack thereof), time available, health literacy of the patient, risk factors (age and weight), and access to and delivery of preventative services. The second study included two focus groups with three people in each and two interviews with patients informed they are at-risk for T2D or have prediabetes and explored how they engage with and deal with their at-risk status. Patients used the term prediabetes in social gatherings to offset pressure to eat unhealthy foods, but concerns arose that the public may equate prediabetes as having diabetes. The third study analyzed policy documents related to risk for T2D (Framework for Diabetes in Canada), identifying areas where risk and prevention for T2D were located and discussed. Findings suggest the problem of risk for T2D is rooted in Canadians not being aware of the disease and needing to be screened, identified, and educated about the risks for the disease. This was problematized as an individual’s problem to deal with their risk of T2D, rather than attending to the social and environmental conditions which create and maintain the risk. Overall, exploring risk for T2D indicates many constraining and enabling factors impacting how individuals can communicate about, come to learn about, and engage in prevention.
Recommended Citation
Blunt, Wendy M. Ms., "A Critical Discourse Analysis of Risk for Preventing Type 2 Diabetes from Primary Care Provider, At-Risk Patient, and Canadian Policy Perspectives" (2024). Electronic Thesis and Dissertation Repository. 10359.
https://ir.lib.uwo.ca/etd/10359