Abstract
OBJECTIVE: To explore the social organization of food provision and dietary intake in seriously mentally ill people with diabetes who reside in a forprofit group home.
METHODS: Institutional ethnography was 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 with diabetes, care providers, field workers, and health professionals. Observations and document analysis were also used to understand the lack of congruence between diabetes guidelines and the possibilities for diabetes management within the confines of group home care.
RESULTS: Although it was mandated in group home guidelines that “Health Canada’s Eating Well with Canada’s Food Guide” (2007) be followed, menus were planned within the context of a limited food budget of approximately $1.91 per day per resident. Group home policies regulated systems of safety, reporting, and financial accountability, but not health promotion. Inspections carried out by the Public Health Department focused primarily on food safety during handling, preparation, and storage, and compliance to regulations regarding environmental cleanliness and infection control.
CONCLUSION: Resource rationing found in group home care exacerbates illness in an already marginalized group. Financial support is required to enable provision of healthy food choices, including dairy products, fresh fruits, and vegetables. Additional support is required for care of co-morbid conditions such as diabetes for associated food costs and education to improve outcomes. Group home policies must take into consideration health threats to this population and give primacy to health promotion and illness prevention.
Key Words: Diabetes, dietary intake, serious mental illness, group home care, institutional ethnography
Résumé
OBJECTIF: Explorer l’organisation sociale de l’approvisionnement en aliments et les apports alimentaires de personnes diabétiques gravement atteintes de maladies mentales vivant dans un foyer de groupe à but lucratif.
MÉTHODE: Nous avons utilisé l’ethnographie institutionnelle pour explorer les pratiques de soins du diabète chez 26 femmes vivant dans un établissement de soins résidentiels en milieu rural dans le sud de l’Ontario. Nous avons mené des entretiens semi-directifs approfondis avec des résidentes diabétiques, des fournisseurs de soins, du personnel de terrain et des professionnels de la santé. Nous avons aussi eu recours à l’observation et à l’analyse documentaire pour comprendre le manque de concordance entre les lignes directrices sur le diabète et les possibilités de prise en charge de cette maladie dans le cadre des soins en foyer de groupe.
RÉSULTATS: Malgré les lignes directrices des foyers de groupe, qui doivent suivre les directives de l’ouvrage Bien manger avec le Guide alimentaire canadien de Santé Canada (2007), les menus étaient planifiés dans le contexte d’un budget alimentaire limité (environ 1,91 $ par jour par résidente). Les politiques du foyer abordaient les systèmes de sécurité, de production de rapports et de responsabilité financière, mais pas la promotion de la santé. Les inspections menées par le Service de santé publique étaient axées principalement sur la salubrité des aliments durant leur manipulation, leur préparation et leur entreposage et sur la conformité aux règlements de propreté de l’environnement et de contrôle des infections.
CONCLUSIONS: Le rationnement des ressources observé dans les soins en foyer de groupe exacerbe les maladies au sein d’un groupe déjà marginalisé. Une aide financière est nécessaire à un approvisionnement en aliments sains, notamment en produits laitiers et en fruits et légumes frais. Un soutien supplémentaire est également nécessaire pour le soin des comorbidités comme le diabète, afin de couvrir les coûts des aliments et de la sensibilisation connexes afin d’améliorer les résultats. Les politiques des foyers de groupe doivent prendre en considération les menaces pour la santé dans cette population et accorder la priorité à la promotion de la santé et à la prévention de la maladie.
Mots Clés: diabète, apport alimentaire, maladie mentale grave, soins en foyer de groupe, ethnographie institutionnelle
Footnotes
Financial Support: Ruth Lowndes was financially supported during doctoral studies by the Canadian Diabetes Association, the Registered Nurses’ Foundation of Ontario, Southlake Regional Health Centre, and the University of Toronto.
Acknowledgements: Ruth Lowndes thanks Drs. Eric Mykhalovskiy and Timothy Diamond for their invaluable support and profound insights throughout the doctoral thesis development, from which this publication stems.
Conflict of Interest: None to declare.
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