The authors acknowledge the contribution of Phillipa Rispin, who provided medical writing services under contract to AXDEV Group.  |  Background: Methods 2.1. Diabetes Metab Syndr. They further reported using insulin punitively when patients did not adhere to treatment regimens. The University of Tennessee, Knoxville's institutional review board approved the study before data collection began. Semi-structured interviews were conducted among 23 people living with type 2 diabetes and 14 HCPs recruited from the diabetes clinics of three hospitals in Tamale, Ghana. This qualitative study aimed to describe older adults' values and preferences for type 2 diabetes care. The number of people with diabetes increases by ~ 1 million yearly,1 and diabetes was the primary diagnosis in 23.8 million visits to office-based physicians in 2006, most commonly to general practitioners, family physicians, and internists.2 Managing diabetes requires practitioners to be competent in complexities of disease management as well as in patient communication, counseling, and education—understanding how multiple psychosocial factors affect patient care and outcomes. One example was laboratory test value cutoff points, which they reported differing among guidelines, leading to confusion. “Some of the drugs that are new, we're still not using them. USA.gov. Both positive and negative aspects of lived experience were reported, although the former was less common. Practitioners also noted that patients are reluctant to be screened because of the stigma that insurers attach to the diagnosis. Aims and objectives: Generalists were found to be more likely to consider patient-centered variables such as patients' adherence behaviors, preference for lifestyle modifications and oral medications, and fear of injections in initiating insulin therapy, whereas specialists did not recognize these as major factors or barriers.11 Specialists, compared to generalists, also placed less emphasis on guidelines and significantly greater emphasis on quantitative measures such as A1C, age, and weight. Int J Environ Res Public Health. HHS Practices were located predominantly in urban settings with populations > 100,000. Both PCPs and AHPs identified gaps in their knowledge of how to manage patients' expectations (Table 3) and provide appropriate psychosocial support (PCP 1.55, AHP 1.16) to patients trying to self-manage their condition. Design: Qualitative study that followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. The findings of this study highlight important needs within our health care system that must be addressed if we are to enhance the well-being of patients with diabetes. An in-depth qualitative study of behavioral and performance gaps, barriers, and educational needs of PCPs providing care to people with type 2 diabetes was therefore undertaken. doi: 10.1136/bmjopen-2015-008687. 2019 Oct 12;16(20):3857. doi: 10.3390/ijerph16203857. Relevance to clinical practice: Even when the disease is detected early, practitioners who are confused by the presence of multiple practice guidelines, unclear about diagnostic cut-off points, or having trouble staying current regarding available pharmacological treatments will be less likely to prescribe either oral medications or insulin effectively according to guidelines. Epub 2008 Apr 25. Methods. 2015 Nov 23;15:516. doi: 10.1186/s12913-015-1174-8. It employed a qualitative research design, including both qualitative and quantitative data collection techniques to provide robust and trustworthy findings.12,13 Qualitative research facilitated in-depth examination of knowledge and skills as well as perceived and unperceived attitudes, confidence, and contextual issues. Enter multiple addresses on separate lines or separate them with commas. Parry O, Peel E, Douglas M and Lawton J. The nature of a needs assessment is to concentrate on gaps rather than on excellence, which can seem to provide a negative and pessimistic view of care. Furthermore, PCPs and AHPs require guidance in the management of adherence and behavior change through effective patient communication and education strategies. Qualitative studies may be conducted as part of a larger study, to initially explore an issue where little research exits, and/or in partnership with a quantitative study. As one AHP stated, People with diabetes play a central role in determining their quality of life. Alzubaidi H, Mc Namara K, Browning C, Marriott J. BMJ Open. Interviews were completed by 15 participants and lasted between 45 min and 1 h.10 We developed the topic guide based on relevant qualitative research within the European Diabetes Prevention Study.19, 20 As in our previous work, we allowed flexibility within the topic guide for participants to follow their own train of thought, employed active listening to prompt a revisit of areas … This study aimed to determine self-monitoring practices, awareness to dietary modifications and barriers to medication adherence among physically disabled type 2 diabetes mellitus patients. Barriers relating to subjective norms were inadequate family support, social stigma (usually by spouses and other members of the community) and cultural beliefs. Themes were validated among coders, and discrepancies were resolved through discussions until concordance was achieved for all cases. Brundisini F, Vanstone M, Hulan D, DeJean D, Giacomini M. BMC Health Serv Res. Keywords: diabetes, meaning of the disease, coping, qualitative study. The health care providers identified gaps in treatment competencies as well, particularly in knowledge and confidence in prescribing insulin and in managing comorbidities. 12,13 Qualitative research facilitated in-depth examination of knowledge and skills as well as perceived and … They reported awareness of the risk factors for type 2 diabetes and confidence in their abilities to screen and test for it; however, they did not consistently do so in a systematic way. 2nd edn. We do not capture any email address. Methods. However, both groups of practitioners reported that they did not systematically screen patients for diabetes as would be appropriate, reporting that testing is expensive, impractical, difficult to use in all patients, and time-consuming. Using qualitative methods, this study explores barriers and facilitators for diabetes self-management in underserved adults with type 2 diabetes in three small urban and one rural mid-western FQHC and contrasts those in good and poor glycemic control. We employed convenience sampling using a maximum variation technique in order to sample a wide range of respondents. These assessments were reciprocally supported by the patients' experiences. “That denial is big, and we may be a little bit at fault ourselves trying to ease the news with the patients. The rate of qualitative research on the lived experience of diabetes has increased over the last 25 years. It employed a qualitative research design, including both qualitative and quantitative data collection techniques to provide robust and trustworthy findings. PCPs in particular seldom involved patients' family and friends in diabetes education and discussion of management strategies. However, little is known about barriers to diabetic self-care (diet, exercise, medication taking, self-monitoring of blood glucose and foot care) in sub-Saharan Africa. Qualitative study that followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. The constant comparative method of data analysis was used and identified themes classified according to constructs of the theory of planned behaviour (TPB): attitudes/behavioural beliefs, subjective norms and perceived behavioural control. However, vascular changes caused by diabetes may already be accumulating, with duration of glycemic burden being a strong predictor of adverse outcomes. The confusion engendered by the multiplicity of guidelines extends into treatment, with both PCPs and AHPs reporting substantive gaps in their knowledge of pharmacological treatment (Table 3). Patients with diabetes were well represented in PCPs' practices; 66% of practices (23/35) were composed of 11-50% of patients with diabetes and 89% of practices (28/35) saw more than 26 patients with diabetes per month. was used to carry out this analysis. This study was funded by the ADA with the support of an unrestricted educational grant from Pfizer, Inc. Dr. Garvey recognizes support from the National Institutes of Health (RO1 DK038765), the Department of Veteran Affairs and the VA Merit Review, and the University of Alabama at Birmingham Diabetes Research and Training Center (P60 DK079626). Caro-Bautista J, Martín-Santos FJ, Villa-Estrada F, Morilla-Herrera JC, Cuevas-Fernández-Gallego M, Morales-Asencio JM. We would also like to express our appreciation for the contributions of the health care professionals and patients who gave their time and experience to this research. Diabetic patients have reduced life expectancy, increased risk of microvascular and macrovascular complications, and diminished quality of life.18 Lack of timely intervention and suboptimal care result in an increased burden of illness for individuals and for society. The Feasibility and Preliminary Efficacy of an eHealth Lifestyle Program in Women with Recent Gestational Diabetes Mellitus: A Pilot Study. The sampling method used was purposive or selective sampling.15 To ensure ethical treatment of participants, institutional review board approval and participants' informed consent were obtained. Semi‐structured interviews were conducted among 23 people living with type 2 diabetes and 14 HCPs recruited from the diabetes clinics of three hospitals in Tamale, Ghana. Subjects' characteristics are described in Tables 1 and 2. Open coding of each text segment of the transcripts was initially performed, with detailed RESEARCH DESIGN AND METHODS. In this study, we aimed to obtain an in-depth understanding of users’ acceptability of a mobile app for diabetes self-management, and to explore their communication with health-care personnel concerning the app. 2015 Nov 17;5(11):e008687. PCPs in diabetes care reported filling many roles for which they were not formally trained, particularly the role of supporting necessary patient behavior change. All PCPs expressed lack of confidence in prescribing it, describing substantive gaps in their knowledge of its correct use (Table 3). Objective Diabetes mellitus is highly prevalent and can lead to serious complications and mortality. Results: © 2020 by the American Diabetes Association. The qualitative results from this study suggest need for more formalized exploration of effective means to meet the ongoing support needs of people with diabetes. An exploratory study of predictors of self-care behaviour in persons with type 2 diabetes. They also reported gaps related to their ability to treat patients with cases of concomitant metabolic syndrome. NIH NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Diabet Med 2013; 30: e17–24 pmid:22998426 Interview sessions were conducted at diabetes clinic—Penang general hospital. it outright, and practitioners, lacking conviction, did not urge them to change their minds. Our aim was to examine how diagnosis is perceived by a sample of newly diagnosed type 2 diabetes patients. Some patients refused All PCPs in the sample reported substantive gaps in their knowledge of contraindications to specific treatments. In addition, they identified gaps in their knowledge of diagnostic criteria and clarity regarding laboratory test value cutoff points and characterized guidelines as unhelpful in providing optimal clarity for clinical practice. A quantitative research on self-management of type 2 diabetes in middle-aged population of rural area of Pakistan . COVID-19 is an emerging, rapidly evolving situation. Self-management suffers when PCPs and AHPs lack skills to address patients' emotional reactions and to help them with psychosocial issues, when they lack adequate referral sources, and when they have difficulty communicating with their patients in an effective manner.3 Health care practitioners must also ensure that patients understand the value of the diabetes health care team, the roles of various stakeholders, and how to successfully navigate the health care system to take advantage of available support. Purpose of Study . We would also like to thank Genevieve Myhal, PhD, Performance Optimization Associate, AXDEV Group, who was instrumental in carrying out this research. As health care evolves, the roles of both providers and patients evolve with it. Objective. Qualitative data from each focus group were audio-recorded. Public health education has the potential to expand and support education and lifestyle changes for patients, their families, and their communities, providing a healthier social context. Such interventions should have both individualised and community-wide approaches. Diabetes Spectrum Print ISSN: 1040-9165, Online ISSN: 1944-7353. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. In this study, 56 outpatients with confirmed type I or II diabetes were administered the standardized quantitative components required to diagnose and stage diabetic neuropathy according to the San Antonio Consensus Statement (1) and the Mayo Clinic protocol (2). Barriers and enablers to healthcare access and use among Arabic-speaking and Caucasian English-speaking patients with type 2 diabetes mellitus: a qualitative comparative study. The aim of this research was to identify the ways in which self-management strategies are perceived by people with T2DM as being either supportive or Patients expressed frustration with practitioners' lack of understanding of their perspective, whereas health care practitioners expressed frustration with patients' inability to achieve objectives in health-behavior change and metabolic control.4,5 Although physicians acknowledged the importance of psychosocial issues and behavioral factors in diabetes management, their interaction and educational interventions with their patients centered primarily on disease, pathophysiology, and treatment regimens—an emphasis inconsistent with their patients' perceived needs.6 Comparison of patients' and providers' estimates of patient self-care activities revealed further discrepancies, with patients reporting higher levels of their own adherence to therapeutic regimens compared with reports of their providers.3, Programs targeting improvement in patient adherence are complex and can include multiple intensive components such as reminders, reinforcement, counseling, and family therapy.7 To further compound the disparity between needs of patients and actions of professionals, clinicians acknowledged that their patients had multiple physical and psychosocial obstacles to treatment adherence and self-care, yet in practice, they focused almost entirely on managing blood glucose levels.6 Clinicians reported lack of crucial resources—particularly skill, time, and adequate referral sources—to manage these problems.3 This was particularly true of generalists (both physicians and nurses), who were significantly less likely than diabetes specialists to utilize psychosocial strategies.8, Nurses overall perceived significantly higher severity and prevalence of psychosocial problems than did physicians, and nurses were significantly more active in using psychosocial strategies despite their perception of their skills being lower compared to physicians.8 Psychological treatment by PCPs or specialists was relatively rare; only 10% of patients reported receiving such help.3 Availability of services was an important variable; physicians and nurses who perceived greater availability of psychosocial and educational resources made more referrals to these resources.8, Physicians themselves do not adhere to treatment guidelines. Spencer JE, Cooper HC, Milton B. Moreover, triangulation of findings from multiple participant groups and data sources was used, further strengthening the evidence provided.14, Current best practices in the care of patients with type 2 diabetes were determined based on a comprehensive literature review. Self-management offers them a chance to take control of their medical condition and make informed choices for self-directed behavior change.19 It has become a cornerstone of diabetes care that patients engage in self-care with the support of multidisciplinary, integrated diabetes health care teams.20 However, the effectiveness of this model requires motivated, knowledgeable patients and health care teams. For example, the early stages of type 2 diabetes are asymptomatic. Coding of data was based on grounded theory.14 Coders were experienced qualitative researchers, including co-author SMH, who reviewed and discussed categories before analyzing transcripts to reach a consensus of understanding. Qualitative studies of type 1 diabetes report on the experiences of children/adolescents and their parents as well as patients who use diabetes technology. Gap analysis items were included in which subjects rated their current and desired levels of knowledge or skill, with the difference being the gap. Melbourne, Victoria: Oxford University Press, 2005. The study revealed that patients also do not understand the referral system; for example, they do not consistently realize that they must return to their PCP after seeing a consultant and can get lost in the system. — AHP Selective coding was then performed, whereby data were systematically coded with respect to core concepts.13 N-Vivo 7.0 software (QSR International, Cambridge, Mass.) Health care professionals are called on to provide a broader range of care, encompassing not only medical expertise but also competence in communicating and collaborating with patients, families, communities, and each other in interdisciplinary teams.21-23 The current findings indicate that these capabilities are lacking. In-depth qualitative data collection and analysis allowed the elicitation and identification of concepts and variables involved in complex processes such as adherence.13,14 The qualitative approach was based on previous findings but also allowed for discovery of unexpected results. They also demonstrated lack of cultural awareness (e.g., not understanding the specifics of a Mexican-American patient's diet). Epub 2019 Mar 29. Participants 18 patients with type 2 diabetes. Yet PCPs and AHPs reported gaps in their ability to support their patients in coping with the psychological and emotional impact of their diagnosis and in supporting the behavior changes necessary to ensure long-term management and health, engaging in cognitive-rational versus emotional-behavioral strategies. Not having been trained in therapeutic relationship skills, they reported struggling to help their patients make behavior changes, stay motivated to adhere to treatment regimens, and participate in long-term follow-up. diabetes. Yet many are challenged in doing so.3, Although diabetes requires patients to accept a large role in self-management of their illness, examination of patients' and physicians' viewpoints revealed disparate viewpoints and experiences in approaches to treatment and psychosocial implications of managing and coping with the disease.  |  Ghana; barriers; diabetic patients; qualitative; self-care; sub-Saharan Africa. “The glucose tolerance test is so expensive and time-consuming and yet it's, you know, it would be wonderful to do that.” This educational needs assessment assessed gaps and barriers in care provided to patients with type 2 diabetes by their PCPs and AHPs. Sign In to Email Alerts with your Email Address. Participants were recruited at two clinical sites in Appalachian counties in eastern Tennessee. Patients (Table 2) were largely between 45 and 74 years of age and described themselves as African American or Caucasian. Background: In Pakistan, the prevalence of Type 2 diabetes is high ranging from 7.6 % (5.2 million Poor adherence versus lack of treatment intensification, How doctors choose medications to treat type 2 diabetes: a national survey of specialists and academic generalists, Evidence on “what works”: an argument for extended-term mixed method (ETMM) evaluation designs, The SAGE Handbook of Qualitative Research, Basics of Qualitative Research: Grounded Theory Procedures and Techniques, Research Design: Qualitative, Quantitative, and Mixed Approaches, Standards of medical care in diabetes—2008, Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycemia: Report of a WHO/IDF Consultation, Diabetes self-management education: a review of published studies, Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada, MOC competencies and criteria [article online], Accreditation Council for Graduate Medical Education, Common program requirements: general competencies [article online], Royal College of Physicians and Surgeons of Canada, The CanMEDS 2005 Physician Competency Framework: Better Standards: Better Physicians: Better Care [article online], Smart Connected Insulin Pens, Caps, and Attachments: A Review of the Future of Diabetes Technology, Brief Literature Review: The Potential of Diabetes Technology to Improve Sleep in Youth With Type 1 Diabetes and Their Parents: An Unanticipated Benefit of Hybrid Closed-Loop Insulin Delivery Systems, Mental Health and Behavioral Screening in Pediatric Type 1 Diabetes, Development and Implementation of the Readiness Assessment of Emerging Adults With Type 1 Diabetes Diagnosed in Youth (READDY) Tool, Institutional Subscriptions and Site Licenses, Special Podcast Series: Therapeutic Inertia, Special Podcast Series: Influenza Podcasts, https://doi.org/10.2337/diaspect.22.4.248, http://www.abms.org/Maintenance_of_Certification/MOC_competencies.aspx, http://www.acgme.org/outcome/comp/GeneralCompetenciesStandards21307.pdf, http://rcpsc.medical.org/canmeds/CanMEDS2005/CanMEDS2005_e.pdf, American Diabetes Association(R) Inc., 2009.

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