Background Type 1 diabetes presents unique self-management challenges in workplace settings, yet research specifically focusing on type 1 diabetes in employment contexts remains limited. Despite legislative protections like the Equality Act (2010), people with diabetes continue to face difficulties integrating their condition with work responsibilities. Methods This research aimed: to explore the lived experiences and support needs of working adults with type 1 diabetes and generate practical evidence informed statements based on participant experiences and stakeholder perspectives. In-depth interviews with 21 workers living with type 1 diabetes were conducted to gather rich experiential data and compile a ‘wishlist’ of desired workplace accommodations. The lived experience data was analysed using Interpretative Phenomenological Analysis, while the workplace feasibility of each ‘wishlist’ item was assessed through a practical programme evaluation with 10 stakeholders. All findings were synthesised under the Psychosocial Flags Framework -- a biopsychosocial tool that can help understand and address psychosocial obstacles to recovery and return to work -- to develop a set of evidence-informed statements. Findings Self-management is complex, often involving negative attitudes, non-adherence, diabetes distress, and mental health issues. Strict self-management requirements often create psychological complications, which can extend to work life. Work emerged as critical areas needing intervention, due to failed accommodations, outdated policies, poor understanding, and disclosure difficulties. The interpretive phenomenological analysis showed type 1 diabetes to be highly individualised. Participants described a ‘balancing act’ between health and work, often leading to prioritising one over the other. While participants with more positive workplace environments reported better reconciliation experiences, these were rare. The perceived need to manage alone reinforced challenges, creating apprehension around visibility. Participants tended to hide illness, frequently avoiding self-management and disclosure. This reflected low confidence in voicing needs, highlighting requirement for safer, more inclusive workplace cultures. The practical programme evaluation bridged the needs of workers with type 1 diabetes with real-world stakeholder perspectives. Outputs fell into three categories: practical accommodations, psychological wellbeing, and awareness - with awareness interventions seen as most feasible. Reasons for unfeasibility typically revolved around responsibility, resources, or similar interventions already existing. Increasing knowledge was seen as crucial in improving available interventions and enhancing workplace culture and attitudes towards type 1 diabetes. Collectively, the findings led to evidence informed statements targeting systemic and individual change: shifting from reactive to proactive approaches, developing business cases for accommodations, improving policies, increasing psychological safety through awareness and education, facilitating disclosure practices, and developing more relevant guidance. Conclusions Ultimately, these findings could help workers with type 1 diabetes stay employed, avoiding the more difficult challenge of returning to work after job loss. But success requires partnership between workers and employers, where both can thrive. Several key players can contribute to supporting self-management at work: workers with type 1 diabetes, employers, healthcare professionals, and colleagues. Key elements include comprehensive education for employers and colleagues, fostering safety, providing disclosure guidance, creating inclusive culture, ensuring supportive physical spaces, and establishing open communication channels for individualised accommodations. Workplaces must strike a balance between support and autonomy, as many people with diabetes express a strong desire for independence yet require additional accommodations. Thus, support must facilitate self-management rather than co-management. These findings align with current UK Government concepts e.g., ‘Pathways to Work’, contributing to shifting workplace disability discourse from simply employing people with long-term conditions toward creating environments and providing support to spread opportunity and improve health.
| Date of Award | 6 Oct 2025 |
|---|
| Original language | English |
|---|
| Supervisor | Rajeeb Kumar Sah (Main Supervisor) & Stephen Hemingway (Co-Supervisor) |
|---|