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J Adv Nurs. 2001 May;34(4):501-10.

Forced externalization of control in people with diabetes: a qualitative exploratory study.

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Faculty of Health, Department of Primary and Community Nursing, Greenbank Building, University of Central Lancashire, Preston PR1 2HE, UK.



The purpose of this study was to explore and describe the patients' perceptions of the Diabetic Disease State and its complications using an ethnographic method.


Diabetes mellitus is an extensively researched and studied disease, however, relatively little attention has been given to the lived experience of chronic illness.


A purposive sample of 18 people with diabetes was derived from a diabetes register database. Data were collected by semistructured interviews, which were tape-recorded and transcribed. The transcripts were analysed together with the researchers' observational notes, using open coding procedures to identify main categories. Discussion of the results is made in the theoretical context of the locus of control (LOC) framework.


Three main categories emerged from the data: information-knowledge of illness; the psychological burden of diabetes; rationalizing. A further subcategory, reality avoidance, was identified. The findings showed that these people with diabetes experience and describe complex psychological effects and coping mechanisms in having a chronic illness.


The findings also suggested that participants in this study might have felt that the control of their chronic condition had been externalized to the health care professionals responsible for their care.

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