Diabetes care: Opinions, needs and proposed solutions of Swiss patients and healthcare professionals: a qualitative study

Priorities to improve woman-centred gestational diabetes mellitus care: A qualitative study to compare views between clinical and consumer end-users

BACKGROUND

Immigrants worldwide have a two-fold higher risk of gestational diabetes mellitus (GDM) than women of the host country. Providing culturally appropriate woman-centred GDM care to attenuate adverse maternal and neonatal health outcomes is a persistent challenge for health services. Underpinned by the Knowledge to Action Framework, understanding and comparing the views of patients from different ethnic backgrounds and healthcare professionals (HCPs) about current and optimal GDM care can highlight priority areas to improve woman-centred care. This qualitative study aimed to compare the views of ethnic Chinese and Australian-born Caucasian women and their HCPs, including endocrinologists, obstetricians, midwives, diabetes nurse educators and dietitians, about what constitutes optimal GDM care and how to improve woman-centred GDM care.

METHODS

Purposive sampling was used to recruit 42 Chinese and 30 Caucasian women with GDM and 17 HCPs from two large Australian hospital maternity services to complete in-depth, semi-structured interviews. Patients' and HCPs' views were thematically analysed and compared.

RESULTS

Four out of nine themes showed misalignments between patients' and HCPs' views on GDM care, reflecting priority areas to improve woman-centred care by (i) reaching agreement on the attitudes towards different treatment targets between HCPs; (ii) enhancing inter-professional communication; (iii) improving GDM care transition to postpartum care; and (iv) providing detailed dietary advice tailored to Chinese patients' cultural diet.

CONCLUSIONS

Further research on reaching consensus on treatment targets, enhancing inter-professional communication, developing a perinatal care transition model from pregnancy to postpartum, and developing Chinese patient-oriented educational resources is required to improve woman-centred care.

"Self-care of the feet in people with type 2 diabetes. A qualitative study"

OBJECTIVE

To understand the experiences of adults over 65 years of age with type 2 diabetes mellitus, regarding foot self-care.

METHOD

Qualitative phenomenological study with a descriptive approach. It is carried out in the facilities of the Primary Care Center of Les Planes de Sant Joan Despí, Barcelona, belonging to the Catalan Institute of Health. For the data collection, a semi-structured and individual interview was used, with a script of basic aspects to be explored, not closed and focused on the objectives of the research. The interviews were carried out between June 2019 and December 2020. A thematic analysis was carried out concomitantly with the collection of these.

RESULTS

A final sample of 13 persons (4 men and 9 women) participated in the study. Adherence to diabetic foot self-care recommendations is irregular. Participants explain risky behaviours despite knowing that they can cause injury to feet previously considered high risk. The evaluation of the podiatrist supposes an economic cost that some people cannot afford.

CONCLUSIONS

The nurse has to do an exhaustive follow-up of how persons with diabetes take care of her feet, insisting on preventive recommendations not only in the annual review but every time the person attends the diabetes follow-up consultation. Effective nurse-podiatrist communication is needed to improve prevention and follow-up of people at risk of diabetic foot disease.

Experiences of self-management support in patients with diabetes and multimorbidity: a qualitative study in Norwegian general practice

Aim:

The purpose of this study was to explore how patients with diabetes and multimorbidity experience self-management support by general practitioners (GPs), nurses and medical secretaries in Norwegian general practice.

Background:

Self-management support is recognised as an important strategy to improve the autonomy and well-being of patients with long-term conditions. Collaborating healthcare professionals (cHCPs), such as nurses and medical secretaries, may have an important role in the provision of self-management support. No previous study has explored how patients with diabetes and multimorbidity experience self-management support provided by cHCPs in general practice in Norway.

Methods:

Semi-structured interviews with 11 patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) with one or more additional long-term condition were performed during February–May 2017.

Findings:

Patients experienced cHCPs as particularly attentive towards the psychological and emotional aspects of living with diabetes. Compared to GPs, whose appointments were experienced as stressful, patients found cHCPs more approachable and more likely to address patients’ questions and worries. In this sense, cHCPs complemented GP-led diabetes care. However, neither cHCPs nor GPs were perceived to involve patients’ in clinical decisions or goal setting during consultations.

Diabetes care: Comparison of patients' and healthcare professionals' assessment using the PACIC instrument

RATIONALE, AIMS AND OBJECTIVE

Whereas the Patient Assessment of Chronic Illness Care (PACIC) instrument measures the extent to which care received by patients is congruent with the Chronic Care Model, the 5As model emphasizes self-management and community resources, 2 key components of the Chronic Care Model. We aimed at comparing evaluation of diabetes care, as reported by patients with diabetes and healthcare professionals (HCPs), using these instruments.

METHODS

Two independent samples, patients with diabetes (n = 395) and HCPs (including primary and secondary care physicians and nurses; n = 287), responded to the 20-item PACIC and the six 5As model questions. The PACIC-5A (questions scored on a 5-point scale, 1 = never to 5 = always) was adapted for HCPs (modified-PACIC-5A). In both samples, means and standard deviations for each question as well as proportions of responses to each response modality were computed, and an overall score was calculated for the 20-item PACIC.

RESULTS

Patients' and HCPs' overall scores were 2.6 (SD 0.9) and 3.6 (SD 0.5), respectively, with HCPs reporting higher scores for all questions except 1. Patients' education and self-management, referral/follow-up and participation in community programs were rated as low by patients and HCPs.

CONCLUSION

Healthcare professionals, particularly diabetes specialists, tended to report better PACIC scores than patients, suggesting that care was not reported similarly when received or provided. Evaluation differences might be reduced by a closer collaboration between patients and HCPs, as well as the implementation of community-based interventions considering more patients' perspectives such as patients' education and self-management.

Negotiating Diet in Networks: A Cross-European Study of the Experiences of Managing Type 2 Diabetes

Food and diet are central aspects of diabetes self-management but the relevance of social networks for the way people are supported in their management of type 2 diabetes is often under-acknowledged. In this article, we aimed to explore the coalescences between these two phenomena among people with type 2 diabetes to increase knowledge of interactions within social network related to daily diet. The article is based on 125 qualitative interviews with individuals with type 2 diabetes from five European countries. Based on assumptions that people with chronic illnesses reshape relationships through negotiation, we analyzed negotiations of food at different levels of network. The respondents' reflections indicate that there are complex negotiations that influence self-management and food, including support, knowledge, and relationships within families; attention and openness in social situations; and the premises and norms of society.

Connectivity, contest and the ties of self-management support for type 2 diabetes: a meta-synthesis of qualitative literature

This paper presents a meta-synthesis of the literature on community-based self-management to support experiences of people diagnosed with type 2 diabetes. The aim was to synthesise findings on both formal and informal self-management support with particular reference to the relevance and influence of the social context operating at different levels. The review forms part of EU-WISE, a project financed through EU's 7th Framework Programme. The review was performed by systematically searching MEDLINE, PubMed, EMBASE, CINAHL, PsycINFO and Web of Science for English language publications between 2005 and 2014 presenting research conducted in Europe on the experiences and perspectives of self-management concerns of patients diagnosed with type 2 diabetes. The search yielded 587 abstracts, which were reduced through search strategy refinement and eligibility and quality criteria to 29 papers that were included in the review. This review highlights the relevance of contextual factors operating at micro- and macro-levels. The synthesis yielded six second-order thematic constructs relating to self-management: sense of agency and identity, the significance and meaning of social networks, minimal disruption of everyday life, economic hardship, the problem of assigning patients' responsibility and structural influences of primary care. Using a line of argument synthesis, these themes were revisited, and a third-order construct, connectivity emerged which refers to how links in daily life are interwoven with peoples' social networks, local communities, economic and ideological conditions in society in a way which support self-management activities. This meta-synthesis indicates a need to heed the notion of connectivity as a means of mobilising and supporting the self-management strategies of people with type 2 diabetes in everyday life.

Primary and tertiary health professionals' views on the health-care of patients with co-morbid diabetes and chronic kidney disease - a qualitative study

BACKGROUND

Health-care for co-morbid diabetes and chronic kidney disease (CKD) is often sub-optimal. To improve health-care, we explored the perspectives of general practitioners (GPs) and tertiary health-care professionals concerning key factors influencing health-care of diabetes and CKD.

METHODS

A total of 65 health professionals were purposively sampled from Australia's 2 largest cities to participate in focus groups and semi-structured interviews. Four focus groups were conducted with GPs who referred to 4 tertiary health services in Australia's 2 largest cities, with 6 focus groups conducted with tertiary health-care professionals from the 4 tertiary health services. An additional 8 semi-structured interviews were performed with specialist physicians who were heads of diabetes and renal units. All discussions were facilitated by the same researcher, with discussions digitally recorded and transcribed verbatim. All qualitative data was thematically analysed independently by 2 researchers.

RESULTS

Both GPs and tertiary health-care professionals emphasised the importance of primary care and that optimal health-care was an inter-play between patient self-management and primary health-care, with specialist tertiary health-care support. Patient self-management, access to specialty care, coordination of care and a preventive approach were identified as key factors that influence healthcare and require improvement. Both groups suggested that an integrated specialist diabetes-kidney service could improve care. Unit heads emphasised the importance of quality improvement activities.

CONCLUSIONS

GPs and tertiary health-care professionals emphasised the importance of patient self-management and primary care involvement in the health-care of diabetes and CKD. Supporting GPs with an accessible, multidisciplinary diabetes-renal health service underpinned by strong communication pathways, a preventive approach and quality improvement activities, may improve health-care and patient outcomes in co-morbid diabetes and CKD.

Adult-Onset Type 1 Diabetes: A Qualitative Study of Decision-Making Needs

INTRODUCTION

Type 1 diabetes is an autoimmune disease resulting from insulin deficiency and must be carefully managed to prevent serious health complications. Diabetes education and management strategies usually focus on meeting the decision-making needs of children and their families, but little is known about the decisional needs of people with adult-onset type 1 diabetes.

OBJECTIVE

The aim of this study was to explore the diabetes-related decision-making needs of people diagnosed with adult-onset type 1 diabetes.

METHODS

An interpretive descriptive qualitative study was conducted. Participants who self-identified as having adult-onset type 1 diabetes were interviewed using a semistructured interview guide. Transcripts were coded to identify needs, supports and barriers using thematic analysis.

RESULTS

Participating in the study were 8 adults (2 men, 6 women), ages 33 to 57, with type 1 diabetes for durations of 1 to 20 or more years. Their decision-making needs are summarized in 6 broad themes: 1) people diagnosed with type 1 diabetes are launched into a process of decision-making; 2) being diagnosed with type 1 diabetes means you will always have to make decisions; 3) knowledge is crucial; 4) personal preferences matter; 5) support is critical for decisions about self-care in type 1 diabetes; 6) living with type 1 diabetes means making very individualized decisions about daily life.

CONCLUSIONS

The findings describe the sudden and ubiquitous nature of type 1 diabetes decision-making and the need to tailor approaches for making care decisions in type 1 diabetes. People diagnosed with adult-onset type 1 diabetes require access to reliable information, support and opportunities for participation in decision-making.

How social inequalities impact the course of treatment and care for patients with type 2 diabetes mellitus: study protocol for a qualitative cross-sectional study from the patient's perspective

INTRODUCTION

Studies from various scientific disciplines have demonstrated that socioeconomic inequalities in type 2 diabetes mellitus negatively affect groups with a low socioeconomic status. Furthermore, socioeconomic inequalities also exist in terms of access to, and utilisation and perceived quality of, diabetological care. The aim of this qualitative study, which focuses on the patient's perspective, is to provide insights into the ways socioeconomic inequalities impact the course of treatment and care of patients with type 2 diabetes mellitus. The study aims to develop an understanding of how socioeconomic inequalities in care arise.

METHODS AND ANALYSIS

A cross-sectional qualitative study will be conducted using a sample of about 20 patients with type 2 diabetes mellitus aged 18 and older. Patients will be recruited successively from the University Hospital in Halle/Saale, Germany, a general practitioner's office, and in a specialised diabetological practice. The patients will be interviewed personally once, using semistructured qualitative interviews. All interviews will be recorded, transcribed, and analysed based on Grounded Theory.

ETHICS AND DISSEMINATION

All interviewees will receive comprehensive written information about the study and sign a declaration of consent prior to the interview. The study will comply rigorously with data protection legislation. The research team has obtained the approval of the Ethical Review Committee at the MLU Halle-Wittenberg, Germany. The results of the study will be published in high-quality, peer-reviewed international journals, presented at several congresses and used for developing follow-up research projects.

TRIAL REGISTRATION NUMBER

This study has been registered with the German Clinical Trials Register and assigned DRKS00007847.

Adopting the sensemaking perspective for chronic disease self-management

BACKGROUND

Self-monitoring is an integral component of many chronic diseases; however few theoretical frameworks address how individuals understand self-monitoring data and use it to guide self-management.

PURPOSE

To articulate a theoretical framework of sensemaking in diabetes self-management that integrates existing scholarship with empirical data.

METHODS

The proposed framework is grounded in theories of sensemaking adopted from organizational behavior, education, and human-computer interaction. To empirically validate the framework the researchers reviewed and analyzed reports on qualitative studies of diabetes self-management practices published in peer-reviewed journals from 2000 to 2015.

RESULTS

The proposed framework distinguishes between sensemaking and habitual modes of self-management and identifies three essential sensemaking activities: perception of new information related to health and wellness, development of inferences that inform selection of actions, and carrying out daily activities in response to new information. The analysis of qualitative findings from 50 published reports provided ample empirical evidence for the proposed framework; however, it also identified a number of barriers to engaging in sensemaking in diabetes self-management.

CONCLUSIONS

The proposed framework suggests new directions for research in diabetes self-management and for design of new informatics interventions for data-driven self-management.

Convergences and divergences of diabetic patients' and healthcare professionals' opinions of care: a qualitative study

OBJECTIVES

To investigate opinions' convergences and divergences of diabetic patients and health-care professionals on diabetes care and the development of a regional diabetes programme.

BACKGROUND

Development and implementation of a regional diabetes programme.

RESEARCH DESIGN

Qualitative study using focus groups to elicit diabetic patients' and health-care professionals' opinions, followed by content analysis.

SETTING AND PARTICIPANTS

Eight focus groups: four focus groups with diabetic patients (n = 39) and four focus groups with various health-care professionals (n = 34) residing or practicing in the canton of Vaud, Switzerland, respectively.

RESULTS

Perceived quality of diabetes care varied between individuals and types of participants. To improve quality, patients favoured a comprehensive follow-up while professionals suggested considering existing structures and trained professionals. All participants mentioned communication difficulties between professionals and were favouring teamwork. In addition, they described the role that patients should have in care and self-management. Financial difficulties were also mentioned by both groups of participants. Finally, they were in favour of the development of a regional diabetes programme adapted to actors' needs. For patients indeed, such a programme would represent an opportunity to improve information and to have access to comprehensive care. For professionals, it would help the development of local networks and the reinforcement of existing tools and structures.

DISCUSSION AND CONCLUSIONS

Acknowledging convergences and divergences of opinions of both diabetic patients and health-care professionals should help the further development of a programme adapted to users' needs, taking all stakeholders interests and priorities into consideration.

Characteristics of a self-management support programme applicable in primary health care: a qualitative study of users' and health professionals' perceptions

Background

Development of more self-management support programmes in primary health care has been one option used to enhance positive outcomes in chronic disease management. At present, research results provide no consensus on what would be the best way to develop support programmes into new settings. The aim of the present study was therefore to explore users’ and health professionals’ perceptions of what would be the vital elements in a self - management support programme applicable in primary health care, how to account for them, and why.

Methods

Four qualitative, semi-structured focus group interviews were conducted in Central Norway. The informants possessed experience in development, provision, or participation in a self-management support programme. Data was analysed by the Systematic Text Condensation method.

Results

The results showed an overall positive expectation to the potential benefits of development of a self-management support programme in primary health care. Despite somewhat different arguments and perspectives, the users and the health professionals had a joint agreement on core characteristics; a self-management support programme in primary health care should therefore be generic, not disease specific, and delivered in a group- based format. A special focus should be on the everyday- life of the participants. The most challenging aspect was a present lack of competence and experience among health professionals to moderate self-management support programmes.

Conclusions

The development and design of a relevant and applicable self-management support programme in primary health care should balance the interests of the users with the possibilities and constraints within each municipality. It would be vital to benefit from the closeness of the patients’ every-day life situations. The user informants’ perception of a self-management support programme as a supplement to regular medical treatment represented an expanded understanding of the self-management support concept. An exploring approach should be applied in the development of the health professionals’ competence in practice. The effect of a self-management support programme based on the core characteristics found in this study needs to be evaluated.

Diabetes self-management arrangements in Europe: a realist review to facilitate a project implemented in six countries

Background

Self-management of long term conditions can promote quality of life whilst delivering benefits to the financing of health care systems. However, rarely are the meso-level influences, likely to be of direct relevance to these desired outcomes, systematically explored. No specific international guidelines exist suggesting the features of the most appropriate structure and organisation of health care systems within which to situate self-management approaches and practices. This review aimed to identify the quantitative literature with regard to diabetes self-management arrangements currently in place within the health care systems of six countries (The United Kingdom, The Netherlands, Norway, Spain, Bulgaria, and Greece) and explore how these are integrated into the broader health care and welfare systems in each country.

Methods

The methodology for a realist review was followed. Publications of interest dating from 2000 to 2013 were identified through appropriate MeSH terms by a systematic search in six bibliographic databases. A search diary was maintained and the studies were assessed for their quality and risk of bias.

Results

Following the multi-step search strategy, 56 studies were included in the final review (the majority from the UK) reporting design methods and findings on 21 interventions and programmes for diabetes and chronic disease self-management. Most (11/21, 52%) of the interventions were designed to fit within the context of primary care. The majority (11/21, 52%) highlighted behavioural change as an important goal. Finally, some (5/21, 24%) referred explicitly to Internet-based tools.

Conclusions

This review is based on results which are derived from a total of at least 5,500 individuals residing in the six participating countries. It indicates a policy shift towards patient-centred self-management of diabetes in a primary care context. The professional role of diabetes specialist nurses, the need for multidisciplinary approaches and a focus on patient education emerge as fundamental principles in the design of relevant programmes. Socio-economic circumstances are relevant to the capacity to self-manage and suggest that any gains and progress will be hard to maintain during economic austerity. This realist review should be interpreted within the wider context of a whole systems approach regarding self-care support and chronic illness management.

Electronic supplementary material

The online version of this article (doi:10.1186/1472-6963-14-453) contains supplementary material, which is available to authorized users.