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An Investigation of Self-Care Practice and Social Support of Patients with Type 2 Diabetes in Saudi Arabia

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An Investigation of Self-Care Practice and Social Support of Patients with Type 2 Diabetes in Saudi Arabia An Investigation of Self-Care Practice and Social Support of Patients with Type 2 Diabetes in Saudi Arabia Sabah Ismile Alsomali A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy University of Salford School of Health and Society November 2018 Table of Contents Dedication .............................................................................................................................. i Acknowledgements .............................................................................................................. ii List of Figures .................................................................................................................... iii List of Tables ...................................................................................................................... iii List of Appendices ............................................................................................................... iv List of Abbreviations .......................................................................................................... vi Abstract .............................................................................................................................. vii INTRODUCTION ............................................................................................................... 1 CHAPTER 1: THE RESEARCH CONTEXT: SAUDI ARABIA AND T2DM TRENDS ............................................................................................................................................. 12 1.1. Introduction .................................................................................................................. 12 1.2. Overview of Saudi Arabia ............................................................................................ 12 1.2.1. Saudi Arabia: Summary ..................................................................................... 12 1.2.2. The religious and cultural background of Saudi Arabia .................................... 13 1.2.3. Saudi Culture and Islam ..................................................................................... 14 1.2.4. Gender Roles in Saudi Arabia ............................................................................ 16 1.2.5. Economic overview ............................................................................................ 18 1.2.6. Healthcare System in Saudi Arabia .................................................................... 18 1.2.7. Levels of Healthcare Services in the MOH ........................................................ 19 1.2.8. Diabetes Mellitus in Saudi Arabia ..................................................................... 20 1.2.9. Healthcare Services for Diabetes Mellitus Patients in Saudi Arabia ................. 21 1.3. The prevalence of T2DM and the pathophysiological processes seen in T2DM ......... 23 1.3.1. The prevalence of T2DM ................................................................................... 23 1.3.2. Pathophysiology of T2DM ................................................................................. 23 1.3.3. Prevalence of type 2 diabetes mellitus in Saudi Arabia ..................................... 25 1.3.4. Complications of type 2 diabetes in Saudi Arabia ............................................. 26 1.3.5. Diagnosis of Diabetes Mellitus in Saudi Arabia ................................................ 26 1.3.6. Risk factors for type 2 diabetes in Saudi Arabia ................................................ 27 1.3.7. DM management in Saudi Arabia ...................................................................... 31 1.4. Conclusion .................................................................................................................... 35 CHAPTER TWO: DIABETES SELF-CARE ACTIVITIES ........................................ 36 2.1. Introduction .................................................................................................................. 36 2.2. Defining self-care ......................................................................................................... 36 2.2.1. History of self-care ............................................................................................. 37 2.2.2. Empowerment: An overview ............................................................................. 38 2.2.3. Diabetes self-care activities ................................................................................ 39 2.2.4. Self-care Barriers................................................................................................ 39 2.2.5. Overall Impact of Diabetes ................................................................................ 47 2.3. Social Support .............................................................................................................. 48 2.3.1. Social support definition .................................................................................... 48 2.3.2. Sources of social support.................................................................................... 50 2.4. Social Support Network................................................................................................ 54 2.5. Adherence to T2DM self-care activities in Saudi Arabia............................................. 55 2.6. Conceptual Framework................................................................................................. 56 2.6.1. Self-efficacy theory: An overview ..................................................................... 56 2.6.2. Cohen’s social support theory ............................................................................ 59 2.6.3. Self-care, self-efficacy theory, and social support theory .................................. 60 2.7. Conclusion .................................................................................................................... 64 CHAPTER THREE: LITERATURE REVIEW............................................................. 65 3.1. Introduction .................................................................................................................. 65 3.2. Literature search strategies ........................................................................................... 65 3.3. Objectives of the comprehensive literature review ...................................................... 65 3.3.1. Research questions informed by the comprehensive literature review .............. 66 3.3.2. A comprehensive literature review .................................................................... 66 3.3.3. Search strategy and process................................................................................ 66 3.4. Appraisal and quality review of the studies.................................................................. 71 3.5. Summary of analysis of themes and findings from the literature review ..................... 79 3.6. Conclusion .................................................................................................................... 90 CHAPTER FOUR: METHODOLOGY .......................................................................... 92 4.1. Introduction .................................................................................................................. 92 4.2. Research philosophy ..................................................................................................... 92 4.2.1. Ontology ............................................................................................................. 93 4.2.2. Epistemology: pragmatism ................................................................................. 94 4.3. Research approaches..................................................................................................... 96 4.3.1. Quantitative ........................................................................................................ 96 4.3.2. Qualitative .......................................................................................................... 96 4.3.3. Mixed Methods .................................................................................................. 96 4.4. Research design ............................................................................................................ 98 4.5. Research Procedures ................................................................................................... 105 4.5.1. Ethical Considerations...................................................................................... 105 4.5.2. Data Collection ................................................................................................. 107 4.6. Conclusion .................................................................................................................. 124 CHAPTER FIVE: FINDINGS ....................................................................................... 125 5.1. Introduction ................................................................................................................ 125 5.2. Profile of Participants ................................................................................................. 126 5.3. Findings ...................................................................................................................... 127 5.4. Similarities and differences in the results ................................................................... 181 5.5. Conclusion .................................................................................................................
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