Diabetes care and mental illness: constraining elements to physical activity and social participation in a residential care facility.
OBJECTIVE
To explore barriers and constraints to physical activity, as an integral component of diabetes care, in those with serious mental illness who reside in a for-profit group home.


METHODS
Institutional ethnography was the approach used to explore diabetes-related care practices among 26 women in a rural residential care facility in southern Ontario. Semi-structured, in-depth interviews were conducted with residents who had diabetes as well as with care providers, field workers and health professionals. Observations and document analysis were further methods used to reveal the disjuncture between diabetes care guidelines and the actualities of living within imposed constraints of group home care.


RESULTS
The residents in this government-regulated group home were sedentary, obtaining approximately 10 minutes per day of low-intensity exercise. The overarching government interest in cost containment created a context of rationing that resulted in a lack of opportunities to exercise and fully participate in social life. Furthermore, group home policies regulated systems of safety, reporting and financial accountability, but did not promote health.


CONCLUSIONS
The findings indicate an urgent need for government financial support for quality of life initiatives and amendments to group home policies that give primacy to health promotion, illness prevention and medical management of prevalent comorbid conditions such as diabetes.
University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada. Electronic address: ruth.lowndes@utoronto.ca.
Ruth
R
Lowndes
University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada.
Jan
J
Angus
University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada.
Elizabeth
E
Peter
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D015444:Exercise / Q000502:physiology*; D005260:Female; D016352:Group Homes / Q000379:methods* / Q000592:standards; D006699:Home Care Services; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009864:Ontario / Q000453:epidemiology; D012424:Rural Population; D058992:Social Participation; D055815:Young Adult
activité physique; diabetes; diabète; ethnographie institutionnelle; group home care; institutional ethnography; maladie mentale sérieuse; physical activity; serious mental illness; soins offerts en foyer de groupe