Exploring Lifestyle Factors for Type 2 Diabetes Risk

This report presents a proposal for a qualitative health research project focusing on the social construction of Type 2 diabetes mellitus and its implications, particularly within the context of Australia. The study aims to explore the lifestyle and dietary factors contributing to the increasing prevalence of Type 2 diabetes among young adults (aged 20-34). The research design employs a focus group study to gather data on participants' knowledge, perceptions, daily routines, levels of physical activity, stress, and barriers to maintaining a healthy lifestyle. The cultural setting of South Australia is highlighted due to its high prevalence of Type 2 diabetes, with considerations for the diverse population, including migrants and indigenous communities. Ethical considerations, including informed consent and confidentiality, are emphasized. The research objectives include assessing awareness of the disease, exploring daily habits, and identifying barriers to a healthy lifestyle. The study will involve recruiting 30 participants, categorized into three homogenous groups based on socio-economic status, Aboriginality, and refugee status, with a median age of 25, excluding those already diagnosed with Type 2 diabetes. The focus group interviews will be conducted in three stages: planning, conduction, and analysis of data, with thematic analysis used for reporting. The research seeks to provide insights that could inform the development of interventions to prevent and manage Type 2 diabetes in young adults.

The mission of WHO is the attainment by all peoples of the highest possible level of health.
PROPOSAL TENDER
GRANT TITLE: WHO - EXPLORATORY STUDIES IN THE SOCIAL
CONSTRUCTION OF CHRONIC DISEASES AND THEIR IMPLICATIONS FOR
PRACTICE, POLICY, HEALTH PROMOTION AND/OR LIVING WITH THESE
CONDITIONS.
PROJECT TITLE:
NAME OF APPLICANT:
STUDY LOCATION: DURATION OF STUDY:
DEADLINE FOR PROPOSALS: OPEN ROLLLING DEADLINES
APPLICATION (ESSAY) LENGTH: 2,500 words
The ostensible goal of this assignment is to simulate (in an admittedly artificial way) the
practical and processual dimensions of designing a qualitative, health research project. You
are to devise a project that will effectively explore perceptions of type two diabetes mellitus
and draw extensively on the research you have done (ie. focus group) and the central theme
or themes that emerged from your analysis of this preliminary study. It is essential that you
read more widely and reference this material in your report—you will be penalised if you
have limited your sources to those provided. The journals Social Science & Medicine, Critical
Public Health, Health Sociology Review, Medical Anthropology Quarterly, Health Policy and
Third World Quarterly (most of the issues are available online) have many articles on a wide
range of issues pertaining to diabetes and are an excellent place to start searching

INTRODUCTION
Title
The title of proposal is “Study of lifestyle factors to risk for type 2 diabetes”
Introduction
In Australia, type 2 diabetes is very common and it is largely associated with
lifestyle factors. According to National Health Survey, around 1.2 million people are
diagnosed with diabetes and in 2014-15; about 85% cases were reported of type 2
diabetes (Haynes et al. 2015). It is increasing at an alarming rate among the young
adults due to various dietary and lifestyle factors. Poor diet, insufficient physical
activity and inability to maintain normal body weight are some of the common risk
factors for the progression of type 2 diabetes. However, surprisingly, type 2
diabetes is becoming an epidemic among the young adults aged 18-35 years of
age. Various factors play a role in the pathogenesis of type 2 diabetes among
young adults. Lifestyle factors are related to dietary intake like low intake of fibres,
glycemic carbohydrates and high amount of intake of saturated fatty acids
increases the risk for diabetes. According to Lee et al. (2013), overweight people
tend to lead a sedentary lifestyle that results in lack of physical exercise and high
fat dietary intake. Another study by Grantham et al. (2013) showed that high BMI
and fat distribution can result in inactive lifestyle increasing the risk for type 2
diabetes. These disturbances result in insulin resistance and glucose metabolism
that make an individual susceptible to type 2 diabetes along with risk for
cardiovascular diseases.
Although, many studies are conducted regarding the study of dietary and
lifestyle factors and increased risk for type 2 diabetes, there are few studies
conducted to study the reasons behind the increased prevalence of type 2 diabetes
among young adults in Australia. Moreover, at present, few papers studied the
lifestyle factors that contributed to the risk for type 2 diabetes in young adults.
Therefore, research is required that help to know the lifestyle factors that contribute
to risk for type 2 diabetes among young adults so that proper interventions can be
developed for the prevention. By knowing these factors, it would be helpful to
reduce the incidence and prevalence of type 2 diabetes among young adults in
Australia.
Study aim
The aim of the research is to study the lifestyle and associated dietary
factors among young adults in Australia that increase the risk for type 2 diabetes.
The barriers would also be explored that would be helpful in developing
interventions and recommendations aiding in prevention of type 2 diabetes among
young adults.
The contribution of this research study is that it would be helpful in
developing interventions based on identified barriers in Australian setting that would
reduce the high incidence and prevalence of type 2 diabetes.
Study objective
 To assess the knowledge and perceptions of young adults about type 2
diabetes
 To explore their daily lifestyle and meal intake
 To explore the level of physical exercise in their daily routine
 To explore the level of stress they experience in their daily life
 To identify the barriers that prevent them from maintaining a healthy lifestyle

Research question
What are the main lifestyle factors among the young adults that contribute to risk for
type 2 diabetes in Australia and identification of barriers that prevent young adults
to maintain healthy lifestyle.
Research design and rationale
The study design for the research would be focused-group study where
group sessions would help to determine the lifestyle factors that increase the risk
for type 2 diabetes. When focus-grouped study is conducted, it is helpful in
collecting large volume of data in a short time. The data that would be collected
through the interview would be helpful in targeting the research topic. The focus
group study would be helpful for this research as it help to provide access to
diversity of experiences and data on the research question and topic.
CULTURAL CONTEXT OR SETTING
Cultural setting
The cultural setting of this topic is in South Australia as statistics shows that
this region has highest type 2 diabetes prevalence being a silent pandemic disease.
Cultural or social factors also play an important role in the prevalence of diabetes
among the population. Apart from exercise and diet, for the prevention and
management of type 2 diabetes, cultural and social background study is also
important that predispose people to a particular risk (Wilson and Renzaho 2015).
According to Harding et al. (2014), people have no prior diabetes knowledge until
they are diagnosed with the disease with high health illiteracy. For the better
prevention of diabetes among young adults, it is important to make people aware of
this disease condition and associated risk factors contributing to diabetes.
There is mixed population in Australia with migrants and indigenous people
so there are different culinary and way of cooking is also different. For example, oil
is considered a luxury item among Burmese living in Australia and they consume
mainly deep-fried food that increases the risk for overweight leading to risk for type
2 diabetes. Moreover, in Australia, diabetes is considered a stigma and so many
people do not want to recognize themselves as diseased with the condition.
Language also acts as barrier that prevents them to seek treatment or help form
general practitioners, as they do not speak English language (Slocum and
Saldanha 2016).
Australia is having slightly high obesity population and consumes high
calorie foods. Australians consume high amount of junk food and processed snacks
that increases average energy uptake up to 35%. Among this calorie intake,
children and young adults consume 41% of this total energy that is contributing to
poor nutrition. The eating habits in Australia is poor as people intake less than 7%
of vegetable intake as compared to 54% recommended intake of fruits and
vegetables. Meat is preferred over plants that also contribute to obese conditions.
The above statistics shows that current Australian eating habits is not proper and
that is contributing to obese and overweight conditions results in increased risk for
type 2 diabetes (Rose et al. 2017).
Ethical approval
Ethical considerations are important for the conduction of any research and it

is important for the researchers to maintain the ethical standards before the
conduction of research. It is important to maintain the confidentiality and privacy of
the participants and interviews that would be taken so that there is no breaching of
the gathered data. Briefing should be done for the participants explaining them the
purpose and objectives of the study. The Human Research Ethics Committee
(HREC) will provide consent for the research proposal after reviewing the proposal
guidelines. Prior informed consent will taken from the participants in written and
signed to avoid any sort of legal obligations. During the interview, participants
should not be forced to answer any objectionable question that can make the
participants uncomfortable (Stepanov et al. 2015).
DESCRIPTION OF THE PROJECT
The research question is to study the lifestyle and associated factors that increase
the risk and predispose people to type 2 diabetes among young adults in an
Australian setting. For the fulfilling of this aim, certain research objectives need to
be studied; the assessment of diabetes knowledge is important to evaluate their
level of awareness about the disease condition. Another objective is to explore the
daily diet, meal portion, level of physical exercise that accounts for providing
information about the extent to which they lead a sedentary lifestyle. It is also
important to explore their daily routine, level of stress, as it is also a possible factor
for the risk to type 2 diabetes.
The study design for the research is focus-grouped study. Focus-grouped
study is an efficient way of data collection method in qualitative study. A semi-
structured group interview process is appropriate for the study as focused groups
would be helpful to collect large data on the specific research topic.
This focus-grouped interview requires appropriate recruitment of participants
of similar type and same age group. The second consideration would be
environment that should be comfortable for the conduction of the interview. The
third consideration is the moderator that comprises of skill in the group discussions
by using pre-determined questions that are relevant to the topic. The environment
should be permissive and calm for the participants. Finally, the analysis and
reporting that consists of thematic analysis with appropriate reporting and
systematic analysis of the data collected from the interview (Zwaanswijk and van
Dulmen 2014).
For this study, about 30 young adults of the age 20-34 years that comprises
of Australian inhabitants would be considered for the study. The baseline
characteristics of the participants would comprise of median age 25 years. The
participants who have a family history of diabetes or obese are included in the study
and those who are already diagnosed with type 2 diabetes are excluded from the
study.
For the sampling, participants are obese having BMI more than normal according to
their weight would be recruited. Dietary assessment and other lifestyle exposures
would be assessed in the focus-grouped interview. The participants will be called
for the group discussion by professional interviewers from Statistics Australia.
Focus-group interviews comprises of three main stages; planning, conduction and
analysis of data. Planning would comprise of chronological plan that comprises of

identification of participants, their characteristics, recruitment, conduction of
meetings and feedback on planning. Three groups comprising of 10 people each
from homogenous groups would be considered for the interview because single
groups is not enough for data analysis and require different segments of the
population. High socio-economic groups (HES), Aboriginals and refugee are the
three groups that will be comprising of 10 people each of the mean age of 25 years.
The participants will be divided into demographic factors like age, size, gender,
status ad geographical location. Each group will be assigned different sessions of
the interview. There should be minimal involvement of moderator in the discussion
as it may give rise to bias in the production of data.
The questionnaire comprising of open-ended questions would cover important
topics that are specific to research question and promote exploration of the
participants’ perceptions to some extent. The duration of interview would be two
hours containing same line of questions that provides same content providing
efficiency and elimination of differences.
A semi-structured questionnaire that includes pre-determined questions will be
given to the participants that comprise of 20 food, beverage and lifestyle related
items for the evaluation of lifestyle and dietary factors. Moreover, it also comprises
of questions that would assess their knowledge level regarding diabetes as it is
directly linked to the behavioural outcomes. The questionnaire assessed the usual
frequency of food consumption like servings, number of meals, and portion size and
average portion of meal that they consume on a daily basis. Food items like
chocolate, soft drinks and fast foods were categorized into tertiles. It also comprises
of their daily lifestyle like occupation that would help to determine the level of stress
that they encounter in their daily life.
For the conduction of interview, the chosen respondents would be asked
questions that are appropriately formulated comprising of meal, daily routine and
knowledge about diabetes. Groups would be homogeneous with same age and
cultural level. As the groups comprised of people from different cultural
backgrounds, professional interpreters will be present in the interview along with the
moderator.
Data analysis is a time-taking process that requires systematic and careful analysis
of the discussions and recorded interview. Systematic code of content analysis is
important for the data analysis. The sessions will be recorded, transcribed and
analysed by the researchers. This qualitative research method mostly depends on
main characteristics that comprises of groups that are homogenous, sequence of
sessions, focus on the specific topic and qualitative data collection. The analysis of
transcripts should be done at group level and not individual level.
The rigour of the study will be addressed in a way where the focus will be given to
organization of groups rather than analysis of issues that are discussed.
Subjectivity of the method will be maintained by providing enough exploration of
topic that is known less among the focused groups and for that, simple descriptive
narrative would be useful that can save time and efficiency. Trustworthiness of the
study can be addressed by collecting reliable and trustworthy information from the
participants through positive interactions with them (Stewart and Shamdasani
2014).
The rationale for choosing focus-group interview is that it would help to know about
the participants’ beliefs, attitudes, feelings and reactions that would not be feasible
by other methods like one-to-one interviewing, observation or questionnaire surveys
(Stewart and Shamdasani 2014). This would also help to obtain large volume of

detailed information about group and personal perceptions, feelings and opinions. It
also provides an opportunity for clarification and broader information range
(Krueger and Casey 2014). This would also help to identify the change in behaviour
and investigation of perceptions of different population groups in Australia about
type 2 diabetes.
OBJECTIVES OF THE PROJECT
The objectives of this focus-grouped study are to explore and study the lifestyle
factors that can increase the risk of type 2 diabetes among young adults. This study
will also explore the dietary factors, daily meal intake and portion size along with
level of stress that they encounter in their daily life. Most importantly, this study
would assess the level of knowledge among young adults regarding diabetes and
high prevalence among the South Australian population.
The young adults would benefit from this program as it would help to develop
interventions after the assessment of level of knowledge and barriers identified that
make them prone to type 2 diabetes. This would help to reduce the burden of
disease due to diabetes and associated risk factors that propel the vulnerable
population towards accumulation of this disease. By identifying barriers, it would be
helpful in preventing type 2 diabetes due to lifestyle factors and minimising the
impact of risk factors that contribute to type 2 diabetes progression.
REFERENCES AND SOURCES
Grantham, N.M., Magliano, D.J., Hodge, A., Jowett, J., Meikle, P. and Shaw, J.E.,
2013. The association between dairy food intake and the incidence of diabetes in
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health nutrition, 16(2), pp.339-345.
Harding, J.L., Shaw, J.E., Peeters, A., Guiver, T., Davidson, S. and Magliano, D.J.,
2014. Mortality trends among people with type 1 and type 2 diabetes in Australia:
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Haynes, A., Bulsara, M.K., Bower, C., Jones, T.W. and Davis, E.A., 2015. Cyclical
variation in the national incidence of childhood type 1 diabetes in Australia (2000-
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