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Support needs for diabetes self-management : exploring the views of Maltese individuals with type 2 diabetes using a grounded theory approach

Buttigieg, Norma Josephine


Norma Josephine Buttigieg


Fiona Cowdell

Steven Ersser


Diabetes is a long-term condition which causes significant public health concern in view of its increasing prevalence and associated morbidity. Notwithstanding this, effective management has been shown to prevent or delay the onset of diabetes complications, thereby improving prognosis. Diabetes has a high self-management demand. This involves behaviour modification together with psycho-social adjustments required to overcome challenges with integrating diabetes management in one’s life. Such challenges often originate from the socio-cultural context and it is recognised that support for diabetes self-management should target these challenges. The purpose of this study was therefore to explore how Maltese individuals with Type 2 diabetes believe they can be supported to manage their condition, as well as to examine whether, and if so how such views may be shaped by the Maltese socio-cultural environment.

The study used a qualitative design guided by a Grounded Theory approach. Data were collected by in-depth focus group and one-to-one interviews, carried out amongst 52 adults with Type 2 diabetes recruited from an outpatient hospital clinic and community-based diabetes clinics in Malta. A total of six focus groups and twelve one-to-one interviews were conducted. Theoretical sampling was used and data analysis involved constant comparison of data, together with conceptualising and organising the data into categories. Generated categories were linked by exploring relationships between them, in the process of developing a substantive theory.

The emergent theory describes how participants viewed diabetes self-management as involving the implementation of skills in thought and behavioural management. These skills were found to be key to coping and consisted of flexibility, proactive management, stress management and developing a positive mind-set towards diabetes. Furthermore, the theory outlines how aspects of Maltese culture, including those related to stigma, family, food and health services were seen to influence diabetes self-management directly, or through their impact on the development of such skills. A basic social process emerged representing individuals’ movement across the coping continuum, characterising transition to a higher/lower level of coping, during particular episodes in life. This process reinforced the identified relationship between the socio-cultural context and patient’s agency, demonstrating how such movement coincided with negative/positive experiences of socio-cultural influence.

These findings have contributed new knowledge about the relationship between culture and diabetes-related coping. They suggest that patients may be supported in managing their diabetes by addressing cultural factors which influence the development of specific self-management skills. In Malta, this may involve new ways of delivering culturally sensitive care and education.


Buttigieg, N. J. (2016). Support needs for diabetes self-management : exploring the views of Maltese individuals with type 2 diabetes using a grounded theory approach. (Thesis). University of Hull. Retrieved from

Thesis Type Thesis
Deposit Date Aug 25, 2017
Publicly Available Date Feb 23, 2023
Keywords Health technology
Public URL
Additional Information Department of Health Technology and Perioperative Practice, The University of Hull
Award Date Jul 1, 2016


Thesis (4.5 Mb)

Copyright Statement
© 2016 Buttigieg, Norma Josephine. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

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