How do people with Type 2 diabetes perceive and respond to cardiovascular risk?

Objectives To explore how people with Type 2 diabetes perceive cardiovascular risk, and how those perceptions might affect their motivation to make lifestyle changes. Methods The setting was a diabetes clinic in a UK teaching hospital. A qualitative study was conducted, using semistructured individual interviews and template analysis of content. The participants were 20 Type 2 diabetic patients, aged between 52 and 77 years, half with and half without cardiovascular disease (CVD). Results Whether they had CVD or not, most people were aware they were at risk of it, of its causative factors, and possible effects. However, they were more likely to attribute it to unchangeable factors like 'stress' and 'heredity', than medical risk factors like cholesterol and smoking. Patients with pre-existing CVD correctly regarded their risk as higher than those without. Few saw any direct link between being diabetic per se and cardiovascular risk. Lifestyle changes were precipitated by major life events and motivated by family support, fear of complications, and a belief that one should follow doctors' advice. A common reaction to CVD and diabetes was stoical acceptance, allowing patients to view their lives positively, whilst living with unpredictable potentially disabling diseases. Conclusions Patients were unaware how strongly diabetes influences cardiovascular risk. Their ideas about risk were very different from those of conventional medicine, and provided individual rationales for making choices about treatment and risk-influencing behaviour. Contextual factors, such as family milieu, also influenced their behaviour. Clinicians should not assume patients share the same mental model of risk as they, and must be prepared to explore peoples' individual constructs and health beliefs.