How are health-related behaviours influenced by a diagnosis of pre-diabetes? A meta-narrative review

Abstract

BackgroundSeveral countries, including England, have recently introduced lifestyle-focused diabetes prevention programmes. These aim to reduce the risk of individuals with pre-diabetes developing type 2 diabetes. We sought to summarise research on how socio-cultural influences and risk perception affect people’s behaviour (such as engagement in lifestyle interventions) after being told that they have pre-diabetes.MethodsUsing the RAMESES standards for meta-narrative systematic reviews, we identified studies from database searches and citation-tracking. Studies were grouped according to underlying theorisations of pre-diabetes. Following a descriptive analysis, the studies were synthesised with reference to Cockerham’s health lifestyle theory.ResultsIn total, 961 titles were scanned, 110 abstracts assessed and 35 full papers reviewed. Of 15 studies included in the final analysis, 11 were based on individual interviews, focus groups or ethnography and five on structured questionnaires or surveys. Three meta-narratives emerged. The first, which we called biomedical, characterised pre-diabetes as the first stage in a recognised pathophysiological illness trajectory and sought to intervene with lifestyle changes to prevent its progression. The second, which we called psychological, focused on the theory-informed study of the knowledge, attitudes and behaviours in people with pre-diabetes. These studies found that participants generally had an accurate perception of their risk of developing diabetes, but this knowledge did not directly lead to behavioural change. Some psychological studies incorporated wider social factors in their theoretical models and sought to address these through action at the individual level. The third meta-narrative we termed social realist. These studies conceptualised pre-diabetes as the product of social determinants of health and they applied sociological theories to explore the interplay between individual agency and societal influences, such as the socio-cultural context and material and economic circumstances. They recommended measures to address these structural influences on lifestyle choices.ConclusionsThe study of pre-diabetes to date has involved at least three research disciplines (biomedicine, psychology and sociology), which up to now have operated largely independently of one another. Behavioural science and sociology are increasing our understanding of how personal, social, cultural and economic aspects influence health-related behaviours. An interdisciplinary approach with theoretically informed multi-level studies could potentially improve the success of diabetes prevention strategies.Trial registrationProspero Registration Number: CRD42018088609.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1107-6) contains supplementary material, which is available to authorized users.

Response to diagnosis of pre-diabetes in socioeconomically deprived areas: a qualitative study

“…It is known that only approximately one-third of people identified as being at high risk of diabetes take up an offer of a lifestyle intervention programme, but there has been little exploration of reasons for this. 7,24 The findings in this current study highlight the complexity of the interplay between intrinsic personal factors and external social and environmental factors when making decisions about attendance at the NHS DPP. A recent study in New Zealand explored barriers and facilitators to dietary change in people with pre-diabetes who had been through a 6-month goal setting and dietary education programme.…”

“…A recent meta-narrative review by Barry et al 7 cautions that the biomedical paradigm (which views pre-diabetes as a reversible state of abnormal glucose metabolism that can be corrected by altering an individual patient's lifestyle) leads to policy that neglects to consider the complex sociocultural environment in which people live.…”

Risk perception of developing diabetes: A concept analysis

“…A recent systematic review of this concept concluded that there is a disconnect between actual and perceived diabetes risk and inconsistency of the measures used to calculate perceived diabetes risk among the studies 5 . A previous meta‐narrative of prediabetes supports the disconnect between actual and perceived diabetes risk in a population of persons with prediabetes 12 . It is important to increase risk perception and knowledge to promote lifestyle changes that may prevent diabetes 12 .…”

Transcultural Diabetes Care in The United States – A Position Statement by the American Association of Clinical Endocrinologists

“…More specifically, social capital can be protective for diabetes and obesity, but this is still poorly understood, particularly in the context of different education levels, socioeconomic classes, and cultures (301). For instance, in those with social capital that supports behavioral change, a diagnosis of prediabetes can lead to positive lifestyle change, but in those with inhibitions and decreased social capital, such as poor housing, low material wealth, unsupportive environments, and conflicting cultural influences, behaviors are unlikely to improve (302). Taylor et al (303) concluded that cultural competency training and experiential learning were the best ways to identify and address health disparities.…”