Funded byRichard Benjamin Trust
Type 2 diabetes is estimated to affect 2.35 million people in the UK with more than 400,000 undiagnosed. Having a family history of diabetes (one or more first degree relatives with diabetes) increases an individual’s risk by two to five times (Harrison et al., 2003). However, to date, family histories of diabetes have received less attention than other diseases.
This project takes a social psychological approach using social representations theory which emphasises the group and identity dimensions of thought and behaviour. Semi-structured interviews will be conducted with ‘at risk’ individuals and their first-degree relatives. Thematic analysis will identify within-group (intra-family) and between-group (inter-family) differences in representations. The study will produce a theoretically grounded psychological ‘underpinning’ for the design of interventions with ‘at risk’ families in the future.
This research takes a family perspective for two reasons. Firstly, the relational structure of diabetes is distinctive. It can occur simultaneously across generations, with siblings and children affected before, or in addition to parents. This ‘horizontal’ structure may confound traditional vertical patterns of familial disease in heart disease or cancer, where parents tend to be affected first. Secondly, family histories of disease have a collective aspect, as the product of family systems and relationships. Families share stories, knowledge and experiences concerning their diabetic risk which can result in shared norms (or indeed conflict). If family histories are to be used clinically as motivational tools, the familial dimension requires further investigation. We need to understand why individuals and families with family histories both respond to current lifestyle and medical edicts, but also why and how they resist them.
This project will draw on recent developments in social representations theory that have emphasised the social identity and group dimension of representations. It adds a group dimension by studying representations of diabetes and family histories within families. This does not imply all members of the family will have similar representations of diabetes, nor interpret their family history in a similar way. However, looking for a common categorization scheme which is shared, not consensual (Clémence, 2001), will help identify where families position themselves in relation to core representations of diabetes, framed through ubiquitous media coverage of genetics and the ‘obesity epidemic’.
a) To investigate the social representations of diabetes, inheritance and genetics amongst family members with familial diabetes risk
b) To explore the utility of social representations theory in explaining identity positioning within and between self-defining sub-groups (e.g. families)
c) To feed back findings into clinical recommendations for family history interventions with ‘at risk’ families
Much lay family history research has been conducted with unrelated individuals. This qualitative design uses both individuals and families as the units of analysis (n=30):
a) Initial participant (IP) interviews with ‘at risk’ individuals with a first degree relative with Type 2 diabetes
b) First degree relative (FDR) interviews, nominated by each IP
Families from different socio-economic status (SES) groups will be sampled as SES is strongly associated with diabetes risk (Harrison et al., 2003). Participants will create a ‘family map’ of diabetes followed by a semi-structured interview, which will be thematically analysed (using NVivo) by family group as well as individually.
Using family history to identify and intervene with individuals and families ‘at risk’ of Type 2 diabetes is a potentially cheap and effective preventive strategy that could be delivered within primary care (GP level). The outcomes of this study will provide a theoretical ‘underpinning’ for the development of future clinical interventions.
Clémence, A. 'Social positioning and social representation'. In Representations of the social: Bridging theoretical traditions, Deaux, K. and Phiolgene, G. (eds.), 2001:, 83-95. Oxford, Blackwell.
Harrison, T. A., Hindorff, L. A., Wines, K. H., Bowen, D. J., McGrath, B. B., & Edwards, K. L.. 'Family history of diabetes as a potential public health tool,' American Journal of Preventive Medicine, 2003, 24(2):, 152-159.
Qureshi, N., & Kai, J., 'Informing patients of familial diabetes mellitus risk: how do they respond? A cross-sectional survey,' BMC Health Services Research, 2008, 7(8): 37-42.