Authors: Dr Nilani Sammuarachchi
Abstract: Type 2 Diabetes Mellitus (T2DM) constitutes a major and escalating global and national public health challenge, characterised by rising prevalence, substantial complication burden, and profound impacts on physical, psychological, and social wellbeing. Despite the availability of effective pharmacological treatments, evidence-based clinical guidelines, and structured diabetes education programmes, a significant proportion of individuals continue to experience suboptimal glycaemic control and diminished quality of life. These persistent gaps highlight the need for integrative approaches that extend beyond biomedical management to address behavioural, emotional, and contextual influences on diabetes self-management. This doctoral research applied the TAP-IT mixed-methods framework to examine the interrelationships between clinical indicators, self-care behaviours, emotional experiences, and lived realities of adults managing T2DM. A convergent mixed-methods design was employed, involving 150 adults diagnosed with T2DM who participated in quantitative surveys, clinical assessments, and in-depth qualitative interviews. Quantitative analyses demonstrated high levels of medication adherence (80%), moderate dietary adherence (65%), and comparatively low engagement in physical activity and psychological support behaviours. Significant associations were identified between self-care behaviours and key clinical indicators, including glycated haemoglobin (HbA1c), body mass index (BMI), and blood pressure, underscoring the central role of lifestyle and behavioural factors in glycaemic control and cardiometabolic risk. Qualitative thematic analysis revealed diabetes-related distress, cultural expectations, family and caregiving responsibilities, limited motivation, and time constraints as major barriers to sustained self-management, while strong family support, culturally responsive healthcare, and positive clinician–patient relationships emerged as critical facilitators. Triangulation of quantitative, qualitative, and clinical data generated a comprehensive and integrated understanding of how emotional burden and contextual constraints shape behavioural patterns and metabolic outcomes in T2DM. The TAP-IT framework proved effective in identifying misalignments between clinical recommendations and the lived experiences of individuals managing diabetes in everyday contexts. The findings emphasise the necessity of person-centred and culturally responsive care models that integrate emotional support, tailored health education, and community-based interventions alongside clinical management. This study contributes novel evidence demonstrating that effective T2DM management requires coordinated, multidimensional strategies addressing biological, behavioural, psychological, and sociocultural determinants simultaneously, with particular relevance for Māori, Pasifika, and South Asian populations in Aotearoa New Zealand.
DOI: http://doi.org/10.5281/zenodo.20560629
