Transforming Practice: Co-Creating Practitioner Training to Challenge Stigma and Support Activity with Type 1 Diabetes

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Supervisory Team Director of Studies: Dr Emma Richardson, Senior Research Fellow Supervisors: Prof. Dez Kyte Prof. Győző Molnár

Research Group: Adapted Physical Activity Research Unit

The PhD Opportunity: People with Type 1 diabetes (T1D) consistently report a strong desire to participate in physical activity (PA), yet face persistent structural, educational, and interpersonal barriers throughout their lives. Evidence demonstrates that PA is highly beneficial for glycaemic management, psychological wellbeing, and long-term health (Riddell & Peters, 2023), but participation remains disproportionately low due to fears of hypoglycaemia, technological challenges, stigma, and the lack of informed support from teachers, coaches, and fitness professionals (Brazeau et al., 2018; Kennedy et al., 2018).

A national study exploring PA experiences across the life course in people with T1D (Richardson et al., in press) reinforces these issues at scale, showing that misunderstanding, stigma, and ill-informed comments from PA providers constitute a “golden thread” of exclusion from childhood through older adulthood. Participants described educators and coaches who were unsure how to support glucose monitoring, restricted participation unnecessarily, or inadvertently reinforced internalised ableism—often discouraging lifelong engagement in PA.

Currently, PA professionals receive little or no mandatory training on T1D, despite functioning as key gatekeepers of safe, inclusive, and empowering activity environments. This mismatch between the strong desire of people with T1D to be active and the limited knowledge, confidence, and preparedness of PA providers represents a significant gap in policy, practice, and public health guidance. Existing research demonstrates that targeted education for teachers and coaches can significantly improve safety, motivation, and PA participation (Kilbride et al., 2011; Brazeau et al., 2014), yet such training is rarely co-produced with those directly affected.

The nuanced and socially shaped realities of being active with T1D highlight that only resources developed with the T1D community can meaningfully reflect lived experience, challenge stigma, and generate lasting behaviour change among providers.

PhD Opportunity

Transforming Practice: Co-Creating Practitioner Training to Challenge Stigma and Support Activity with Type 1 Diabetes

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This PhD aims to co-produce, implement, and evaluate education and training resources that equip PA providers to support safe, inclusive, and empowering participation for people living with T1D.

The research will address the following questions:

1. What knowledge, attitudes, and current practices do physical activity providers (teachers, coaches, fitness instructors) hold in relation to supporting people with T1D? 2. What do people living with T1D identify as the essential components of effective provider education, and how can these be translated into accessible training resources? 3. What is the impact of co-produced training on provider confidence, knowledge, and practice, and on the participation experiences of people with T1D?

This research will adopt a Participatory Action Research (PAR) approach, ensuring that people living with T1D are not merely participants but active collaborators in shaping the research process and its outputs. PAR is particularly suited to this project given its emphasis on co-production, its capacity to challenge traditional researcher- participant hierarchies, and its orientation towards actionable, real-world change (Bergold & Thomas, 2012).

The study will proceed through iterative cycles of inquiry, action, and reflection, working alongside a co-researcher group of people with T1D to develop, pilot, and refine training resources in dialogue with PA providers. The research will be theoretically grounded in critical ableism studies. Ableism refers to the network of beliefs, practices, and structures that privilege certain bodies and minds as "normal" while devaluing and marginalising those deemed deficient or dependent (Campbell, 2009; Goodley, 2014).

In physical activity contexts, ableism operates through assumptions about who can and should be active, often positioning people with chronic conditions such as T1D as inherently limited, risky, or in need of protection.

This theoretical lens enables the research to move beyond individualistic explanations of low PA participation (e.g., lack of motivation or knowledge) and instead interrogate the systemic and attitudinal barriers embedded in PA provision. It also provides a critical framework for understanding how well-intentioned but ill- informed provider behaviours, such as unnecessary restrictions or over-cautious gatekeeping, can reinforce exclusion and internalised stigma. By foregrounding ableism, the study positions inclusive PA not as a matter of accommodation but as a question of rights and social justice.

This PhD will address this gap through a focused, co-produced programme of work that will create, test, refine, and evaluate education and training resources for teachers, fitness instructors, coaches and other PA providers. The project will ultimately assess changes in practice and their impact on participation, safety, and wellbeing for people living with T1D.

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References: • Bergold, J., & Thomas, S. (2012). Participatory research methods: A methodological approach in motion. Forum: Qualitative Social Research, 13(1), Art. 30. https://doi.org/10.17169/fqs-13.1.1801 • Brazeau, A.-S., Rabasa-Lhoret, R., Strychar, I., & Mircescu, H. (2018). Barriers to physical activity among patients with type 1 diabetes: A systematic review. Diabetes, Obesity and Metabolism, 20(3), 585–593. https://doi.org/10.1111/dom.13110 • Brazeau, A. S., Gingras, V., Leroux, C., Suppère, C., Mircescu, H., Desjardins, K., … Rabasa-Lhoret, R. (2014). A pilot program for physical activity promotion in adults with type 1 diabetes: The PEP-1 program. Applied Physiology, Nutrition, and Metabolism, 39(4), 465–471. https://doi.org/10.1139/apnm-2013-0287 • Kennedy, A., Narendran, P., Andrews, R. C., Daley, A., Greenfield, S. M., & Waheed, G. (2018). Attitudes and barriers to exercise in adults with type 1 diabetes: A qualitative study. Diabetic Medicine, 35(9), 1189–1195. https://doi.org/10.1111/dme.13657 • Kilbride, L., Charlton, J., Cox, A., Daley, A., & Campbell, F. (2011). Understanding the experiences of people with type 1 diabetes engaging in exercise: A qualitative study. Practical Diabetes International, 28(4), 163–167. https://doi.org/10.1002/pdi.1584 • Richardson, E. V., Bright, C., Farrow, D., & Nathan, H. (in press). Physical activity experiences of people with type 1 diabetes across the life course. Adapted Physical Activity Quarterly, • Riddell, M. C., & Peters, A. L. (2023). Exercise in adults with type 1 diabetes mellitus. Nature Reviews Endocrinology, 19(2), 98–111. https://doi.org/10.1038/s41574-022-00756-6

Application Process: To begin the application process please go to https://www.worc.ac.uk/research/research-degrees/applying-for-a-phd/.

The Interview: All successful applicants will be offered an interview with the proposed Supervisory Team. You will be contacted by a member of the Doctoral School Team to find a suitable date. Interviews can be conducted in person or over Microsoft Teams.

Funding your PhD: For information about Doctoral Loans please visit: https://www.worc.ac.uk/study/fees- and-finance/doctoral-loans.aspx

During your PhD you can access the Research Conference Support Scheme to support the costs of presenting your research at an external conference.

Research at the University of Worcester Research is central to the University’s mission to make a difference in everything that we do. We are committed to delivering excellent research which extends the boundaries of human knowledge but which also improves people’s lives by enabling better health outcomes, improving food security, developing environmentally

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sustainable solutions for crop production and socially sustainable solutions to our ageing population, enhancing public knowledge and understanding of the past and present.

The University hence focuses its research around five high-level challenges facing society, locally, nationally and globally:

• Human Health and Wellbeing • Sustainable Futures • Digital Innovation • Culture, Identity and Social Exclusion • Professional Education

The success of our research is reflected in our continuous improvement in external research assessment processes. In the most recent Research Excellence Framework, REF 2021, the University saw a near 50% increase in the scale of its research and 12% increase in quality, building on its performance in REF 2014 when it was the UK’s most improved university in terms of Research Power, a combination of scale and quality.

Research Degrees at Worcester Our research students are central to our overall mission for research. They are working at the cutting edge of their disciplines and driving forward the quality of our research whilst enriching our research culture. We are looking to increase our research student numbers as a strategic imperative.

Our commitment to our students is reflected in the results of the Postgraduate Research Experience Survey 2025 in which we ranked 3rd for overall research student satisfaction nationally. Key to our success in his area is the Doctoral School, a focal point for all our research students.

It provides:

• day-to-day support for our students, both administrative and practical, through our dedicated team • a Research Student Study Space with both PCs and laptop docking station • a comprehensive Researcher Development Programme for students and their

supervisors

• a programme of student-led conferences and seminars

Research Unit

Adapted Physical Activity Research Unit The Adapted Physical Activity Research Unit is committed to transforming the field of adapted physical activity through bold, interdisciplinary work that bridges theory and practice. Grounded in principles of inclusivity, collaboration, and innovation, we focus on physical activity as a human rights and social justice issue.

Our aim is to dismantle barriers to participation, amplify marginalised voices, and influence systemic change so that all individuals can move, play, and thrive on their

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own terms. Working alongside disabled communities, practitioners, and cross-sector partners, we co-create knowledge and solutions that are both rigorous and deeply meaningful to those most affected. From examining joy and identity through movement, to developing culturally competent practice, to ‘cripping’ research methodologies and reimagining participation beyond traditional norms, our work challenges inequities and reshapes what inclusive physical activity can be.

This PhD will contribute to that mission, joining a vibrant research environment dedicated to redefining access, equity, and possibility in physical activity.

Widening Participation As part of its mission statement the University is committed to widening participation for its higher degrees. Although most candidates will have an undergraduate and/or a Masters degree, the University is happy to accept applications from candidates with relevant professional qualifications and work-related experience.

For further information or an informal discussion on this project, please contact Dr Emma Richardson; e.richardson@worc.ac.uk

Research areas