How do UK general practice staff understand and manage pre-diabetes? A focus group study.
Barry E., Greenhalgh T.
BACKGROUND: Preventing type 2 diabetes is a national priority; one aspect is the identification and active management of prediabetes through lifestyle change. AIM: To explore what primary care clinicians understood by 'pre-diabetes', how they communicated this diagnosis to people, how they delivered lifestyle advice and their views on barriers to lifestyle change. DESIGN & SETTING: Three focus groups were undertaken with 25 individuals from primary care teams (GPs, nurses, healthcare assistants) in a deprived and ethnically diverse part of London. METHOD: Recordings were transcribed verbatim and analysed thematically before integrating social and behavioural science theories. RESULTS: Focus groups participants described four main influences on their management of prediabetes in the consultation: social determinants, clinical aspects of diagnosis and management, patient motivation and behaviour change, and long-term care. Since most felt unable to address social determinants such as poverty, discussions with patients tended to focus on attempts to change individual behaviours and achieve particular numerical targets, with limited attention to the social context in which behaviours would play out. CONCLUSION: Type two diabetes prevention efforts in general practice may fail to do justice to the upstream causes of this disease. A narrow focus on numerical targets and decontextualized behaviours overlooks the social complexity of human behaviour and lifestyle choices. Within the consultation we recommend greater attention to discussing the social context and meaning of particular behaviours. Beyond the consultation, collaboration between primary care clinicians, public health and local governments is required to address community-level constraints to behaviour change.