Care home staff experiences of delivering diabetes care: a grounded theory study

Diabetes is highly prevalent among care home residents and is associated with increased clinical complexity due to multimorbidity, frailty, and cognitive impairment. Care home staff play a central role in diabetes management; however, there is limited theoretical understanding of how diabetes care is organised and delivered in long-term care settings. This study aimed to explore care home staff experiences of supporting residents living with diabetes and to develop an empirically grounded explanation of the processes shaping diabetes care in care homes.

A qualitative study informed by Glaserian grounded theory was conducted. Semi-structured interviews were undertaken with 20 care home staff across 17 care homes in Northern Ireland, including registered nurses, care assistants, home managers, and catering staff. Data collection and analysis proceeded concurrently using constant comparative methods and theoretical sampling. Analysis focused on identifying key processes influencing how diabetes care was prioritised, enacted, and sustained in everyday practice.

Three interrelated categories were identified: Prioritisation, Risk, and Labour. Diabetes education was inconsistently prioritised relative to mandatory training and was unevenly distributed across staff roles. Diabetes-related risk was primarily conceptualised in terms of avoiding acute events, particularly hypoglycaemia, with less attention to longer-term complications or interactions with multimorbidity. Substantial informal and relational labour was undertaken by staff to support residents' quality of life, negotiate dietary practices, and coordinate care. These categories were integrated through a core category of Misalignment, describing the disconnect between the complexity of diabetes care needs and the organisation of education, roles, and support within care home systems.

Diabetes care in care homes is sustained through adaptation, informal labour, and pragmatic risk management within systems that are not fully aligned to the demands of long-term diabetes care. Addressing this misalignment is essential to strengthening staff capability and informing the development of contextually appropriate educational and service-level interventions for care home settings.

Not applicable.