Out of control? A qualitative study of diabetes management among Pakistani migrants in North-West England

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Abstract

Type 2 diabetes (henceforth referred to as diabetes) is frequently making the headlines of prominent public health journals; it is an increasing challenge for many health systems, as populations grow older. Epidemiological evidence shows that Pakistani patients are at higher risk of developing the condition and also experience increased morbidity. In this thesis I do not attempt to uncover the reasons for this, but rather concentrate on the lived experience of diabetes. I spent three months in a town in North-West England, where I visited both patients and health care providers to build a picture of what diabetes is; what it means in everyday life. I adopt a praxiographic approach similar to Mol (2001) to highlight the complexity present in diabetes care and engage with some topical discourses. Based on my fieldwork I propose that diabetes is not a static entity, but rather a dynamic process that the patient negotiates with their everyday lives. Patients must learn how to change their practices and adopt new ones in order to live together with the condition. However changing practices may have deeper implications for identities, with diet forming the link to home and the concept of exercise not being present. Practices are therefore situated in broader frameworks of values and meanings and educational initiatives may need to take this into account. However even where practices are altered bodies remain unpredictable; they may not behave in the way we expect them to. Similarly life events are also unpredictable and in this way the importance attributed to diabetes may change through time. Diabetes changes the patient, but the patient also changes diabetes. Therefore although medically it is seen as one disease, diabetes is in fact multiple.