Developing preventative approaches that address the social determinants of type 2 diabetes in high risk populations
Type 2 diabetes risk and prevalence is highest amongst
certain ethnic groups and those of lower socioeconomic status. For diabetes prevention strategies to be effective at population level and in the most high risk groups, it is likely that they will need to address these social determinants in addition to focusing purely on individual-level behavioural approaches. Social Prescribing is an innovations being widely adopted within the NHS policy (including the recent ‘NHS long term plan’) as a way of addressing these social risk factors. It generally involves linking patients in primary care with community services offering employment, housing or financial advice, as well as a range of ‘healthy lifestyle’ activities, such us cooking classes, weight management or exercise programmes. Despite widespread national support, evidence for the effectiveness of social prescribing is currently sparse, its implementation is heterogeneous and complex, and it incorporates little robust evaluation across health domains.
My PhD aims to investigate whether social prescribing can contribute to comprehensive type 2 diabetes prevention by influencing its social determinants in populations at high risk. I will draw on realism to investigate the complex interpersonal, organizational, social and policy context in which social prescribing is implemented, and illuminate key domains and tensions at these different and interconnected levels. I will undertake a realist review to synthesize the current evidence base for social prescribing and its potential impact in diabetes prevention. The findings of the review will guide my empirical research, which will investigate how social prescribing relevant to people at high risk of diabetes ‘works’ in a multi-ethnic, socio-economically diverse community using qualitative, quantitative and realist methods. Building on the previous phases, I will develop a ‘transferable framework’ that will potentially guide implementation and evaluation of social prescribing relevant to type 2 diabetes prevention at scale.
3 – Health, Biopolitics & Social Inequality