Type two diabetes and eye health

Abstract

This thesis contributes to the understanding of how people with Type 2 Diabetes (T2D) negotiate self-care and management of diabetes and eye health. The study aims to deliver an Enhanced Diabetic Optometric Practice (EDOP) which involves a graphic portrayal of diabetic retinopathy, as it manifests itself in the eye and in the patient’s own eyes, whereby retinal images will be discussed within a normal optometric practice environment. This PhD research study used the qualitative method of thematic and Foucauldian discourse analysis (FDA) to investigate if an EDOP is able to heighten the participant’s concern of sight loss and thus lead to better diabetic control, and improved self-motivation and management. The research progressed in three stages; Study (1) A systematic review and meta-synthesis of qualitative research investigating the barriers to self-care for people with T2D, Study (2) A qualitative analysis of diabetes self-help literature and eye health, and Study (3) Evaluation of an Enhanced Diabetic Optometric Practice (EDOP). A review of the literature evaluates research in the field of optometry and ophthalmology with regard to the use of retinal images for educating people with T2D about their diabetes and the ocular complications. The findings of the three studies revealed, valuable insight into the barriers and constraints to self-care that people with T2D routinely face, enabling greater understanding of how to facilitate effective diabetes self-management Study (1). Study (2) discerned that self-help texts cannot facilitate the empowerment of people with diabetes who aspire to selfregulation, as they are constrained by the dominant compliant discourse of the expert-patient relationship. Finally, in Study (3) EDOP, optometrists can provide an enhanced optometric service, educating and motivating people with T2D to better self-care practices. This thesis concludes that the optometrist, by way of the EDOP and the pertinent threat of sight loss can assist people with T2D to gain the confidence to apply the skills to effective self-management and so prevent blindness.