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Assessing Health Inequalities of Diabetes Care Through the Application of the Bio-ecology Theory

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Healthcare Policy, Innovation and Digitalization

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Abstract

The National Institute for Health and Care Excellence (NICE) guidelines for the management of diabetes state that structured diabetes education should be offered to every person and their carer(s) at or around the time of diagnosis, with annual reinforcement and review. In 2016, the UK’s Health and Social Care Information Centre’s National Diabetes Audit for England identified only 6% of newly diagnosed Type 2 diabetics attended a course. Diabetes UK has called for radical improvements to the provision. This study attempts to determine why the uptake has been so poor and then offer possible solutions. The study utilised Bronfenbrenner’s bio-ecology theory and was made up of four phases: phase one, a pilot study of health educators to identify why patients were not attending the courses. Phase two a qualitative review, using thematic analysis, of patients on their views of structured education. Phase three a census investigating the provision of structured education. It compared the 152 Primary Care Trusts (PCTs) with the new 194 Clinical Commissioning Groups (CCGs) in England. Phase four is a qualitative review using thematic analysis of healthcare professionals (HCPs) on their reasons for providing the care they did. NHS England has a decentralisation approach to managing diabetes structured education in England. There is a lack of awareness of these programmes amongst patients. This is driven by the proliferation of courses provided by NHS England and the budget restrictions to promote them. The quality of diabetes structured education and the ability of patients to attend varied by PCT/CCG, creating a non-inclusive service. In this example, it was established that centralising elements of the diabetes structured education programmes like branding, marketing, course development and programme management could alleviate many of the problems that NHS England currently faces and increase patient engagement. Such a move would also reduce costs and help bridge the current budget deficit. This chapter demonstrates how researchers can utilise Bronfenbrenner’s bio-ecology theory to investigate healthcare management processes. More specifically, it is an example of investigating patients, their careers, healthcare professional and policy all in one study. It also addresses a common debate amongst healthcare managers whether systems should be centralised or decentralised.

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Notes

  1. 1.

    A General Practitioner is a family doctor who is the main point of contact for general healthcare for NHS patients.

  2. 2.

    Bronfenbrenner referred to ontogenetic as the development that occurs as a function of experience rather than as a function of the genetic make-up of an individual (see Lambert and Johnson 2011).

  3. 3.

    Now Self-Management UK (see www.selfmanagementuk.org/).

  4. 4.

    Oates (1972) provided an insightful analysis of the trade-off between centralisation and decentralisation by contrasting efficient internalisation of inter-jurisdictional spillovers through centralisation and efficient matching of local policies to local tastes through decentralisation. This analysis culminated in the celebrated ‘Oates’ Decentralization Theorem’, delineating conditions under which centralized or decentralised provision of public goods is efficient. (Bloch and Zenginobuz 2012).

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Acknowledgements

The author would like to thank Diabetes UK with their support in this research. The author would also like to that Anna Heyman, the research assistant who diligently coordinated the results of this research.

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  1. Chair of the Retail Institute Special Interest Research Group and Health Research Lead for the Business School, Leeds Business School, Leeds Beckett University, Leeds, UK

    Alan Shaw

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  1. Alan Shaw
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Correspondence to Alan Shaw .

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Editors and Affiliations

  1. Department of Quantitative Methods, School of Business, Istanbul University, Istanbul, Türkiye

    Eyüp Çetin

  2. Department of Business Administration, Faculty of Business Administration and Economics, Trakya University, Edirne, Türkiye

    Hilal Özen

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Readers should note that the author is currently a trustee (volunteer) at X-PERT Health, one of the national providers of diabetes structured education.

Appendix

Appendix

See Tables 7.5 and 7.6.

Table 7.5 The range of type 1 structured education courses delivered in England
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Table 7.6 The range of type 2 structured education courses delivered in England
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Shaw, A. (2023). Assessing Health Inequalities of Diabetes Care Through the Application of the Bio-ecology Theory. In: Çetin, E., Özen, H. (eds) Healthcare Policy, Innovation and Digitalization. Accounting, Finance, Sustainability, Governance & Fraud: Theory and Application. Springer, Singapore. https://doi.org/10.1007/978-981-99-5964-8_7

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