Background: The life expectancy of people with SMI is 10-25 years shorter than the general population, with leading causes including T2DM and cardiovascular diseases. To better understand health management needs of clients with SMI, the purpose of this study was to explore the subjective experience of T2DM self-management among people with SMI. The research question was, what facilitating factors and barriers were encountered by people with SMI while managing their T2DM?

Population: This qualitative photovoice study recruited 10 participants from an integrated care clinic using these criteria: age 18 to 65 years, a SMI diagnosis, a hemoglobin A1C level of 5.7% or higher, and capability to complete all study tasks. Method: Based on principles of community-based participatory research (CBPR), we provided cameras to participants to take photos about issues in the community. Participants completed three rounds of photo assignments and group meetings. We used the SHOWED discussion guide to facilitate group discussions. All meetings were recorded and transcribed. Data were analyzed using grounded theory methods, including open coding, axial coding, and selective coding. A computer program, NVivo 14, was used to assist in data analysis. Results: Facilitating factors of T2DM management for people with SMI included maintaining mental wellness, self-efficacy, community resources, and peer education. Barriers included stress, mental illness symptoms, homelessness, and a lack of agency. Cultural upbringing was both a facilitating factor and a barrier. A quadrant model was created to delineate the findings.

Conclusion: For people with SMI, it is critical to manage symptoms of mental illness to keep their T2DM in check. This study provides valuable information to inform the development of T2DM lifestyle interventions that incorporates the voice of people with comorbid SMI and T2DM.