Social representations of diabetes in Ghana : reconstructing self, society and culture
Diabetes is a significant cause of adult disability and death in Ghana. Current research leaves significant questions unanswered about the integrated ways in which psychological and socio-cultural factors mediate chronic illness experiences and practices. This thesis develops a social psychological approach to address conceptual gaps in the field and outline practical possibilities for improving diabetes care. It draws on and expands the conceptual framework of social representations theory by incorporating socio-cultural theories of emotions, phenomenological perspectives on chronic illness experience, and the social psychology of participation. Rural and urban accounts of health, illness and diabetes (experiences) were elicited through semi-structured individual and group interviews with 68 people with diabetes, 62 lay healthy individuals and 23 health professionals working in the biomedical, ethnomedical and faith healing spheres. Further, six-month ethnographies were carried out in the life-worlds of 3 people with diabetes and 11 significant others. Using Atlas-ti, a systematic analysis identified the nature and inter-relationship between (1) cognitive-emotional polyphasia - shared/contested thinking, feeling and embodied action on health, illness and diabetes; (2) biographical disruption - life changes caused by diabetes and inter-subjective meanings evoked; and (3) illness action - coping strategies and styles in response to biographical disruption. Three sets of social representations of diabetes were identified: (1) the social representation of diabetes as a life-changing or life-threatening disease which emerged at the level of self; (2) the social representation of diabetes as a 'sugar disease' which circulated in the public sphere and (3) the social representation of diabetes as a spiritual disease which drew on cultural thought and practice. Each had positive and negative consequences for illness action. Informed by the social psychology of participation, the thesis outlines possibilities for transforming negative dimensions of social representations as a basis for improving diabetes care.