| The incidence of type II diabetes continues to increase worldwide. Individuals diagnosed with diabetes must engage in diabetes self-management (DSM), which involves developing health promoting behaviors. At issue is that scholars do not yet fully understand the key dynamics that lead to long term engagement in such behaviors. The purpose of this qualitative research study was to explore the process by which low income women with type II diabetes integrate DSM into daily life, the conditions through which integration occurs, and the role of habit and occupation in the process. The Transactional Perspective was the theoretical framework that guided the study. A multi-methods approach, using semi-structured interviews, photography, Time Geographic Diaries, and a standardized assessment, was used to collect data on ten low income women, ages 45-64, with type II diabetes. A Grounded Theory approach to data analysis facilitated the development of the Transactional Model of Diabetes Self-Management Integration, which depicts the theorized process of DSM integration. Based on the data, the following primary phases of DSM integration emerged: Potential Uptake, Inquiry, Practice, Contingent Integration, and Reconfiguration. These five phases describe the process whereby individuals accept aspects of diabetes education and training as congruent with their circumstances, act on them, and practice with them until they become a more integrated part of their daily lives. Individuals then continue to modify their habits, change their situations, and develop strategies to further facilitate DSM integration. Once habituated, these components may remain an integrated part of daily life until destabilizing life events necessitate reconfiguration. The integration process is a temporally contiguous process that unfolds through time, and is influenced by individuals' past life experiences, habits, and situations. Key findings demonstrate that individuals develop the skills and abilities to modify their habits and the corresponding aspects of their situation that support those habits through inquiry and practice, and this leads to integration. The study findings also suggest the importance of occupation in DSM integration because inquiry and practice are situated within occupational engagement. The implications of this work for both occupational therapy and occupational science are discussed. |
