Diabetes mellitus is more common among individuals with schizophrenia compared to the general population, yet little is known about their diabetic self-care. This grounded theory study was conducted to identify the process by which individuals with schizophrenia and diabetes develop an understanding of the diagnosis of diabetes, identify the factors that influence the development of their diabetic self-care skills, and generate a theory that describes the antecedents and outcomes of their diabetic self-care. Twenty-six interviews were conducted among eleven respondents who were diagnosed with schizophrenia and diabetes. Four health care providers were also interviewed. Data were analyzed using the constant comparison method. Methods included open, axial, and selective coding, and the use of field notes and theoretical memos. Trustworthiness of the findings was enhanced through prolonged engagement, participant observation, member checks, and an audit trail. The core category that describes diabetic self-care among respondents is "Evolving Self-Care." This is the process by which study respondents overcame the barriers that psychiatric symptoms presented as they engaged in diabetic self-care. The first major category is Mastering Schizophrenia, a stage in which respondents acknowledged their vulnerability to schizophrenia based on their experiences with psychosis and effectiveness of mental health treatment. Health beliefs developed during this stage focused on illness acceptance, understanding the serious negative consequences of psychosis, and understanding the need to adhere to mental health treatment. The second category, Accommodating Diabetes, occurred when respondents personalized their observations about diabetes and developed an understanding of diabetes based on their own experiences. This stage of self-care also involved acceptance of the diagnosis of diabetes, and application of acquired knowledge about schizophrenia to the care of diabetes. The third category of Evolving Self-Care is Striving for Health, in which respondents recognized their responsibility to care for both schizophrenia and diabetes to the best of their abilities, despite the challenges that both illnesses presented. Providers are encouraged to take a holistic approach towards the education and treatment of their patients with schizophrenia and diabetes.
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