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Fredericks KJ, Naidoo M. Quality of care of patients with type 2 diabetes mellitus at a public sector district hospital. S Afr Fam Pract (2004) 2023; 65:e1-e9. [PMID: 37427776 DOI: 10.4102/safp.v65i1.5713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Globally, diabetes mellitus (DM) remains one of the leading causes of mortality, with approximately 2 million deaths in 2019, the condition also contributes significantly to adverse health conditions and costs. The study aimed to describe the quality of care (QOC) rendered to patients with type 2 DM (T2DM) seeking care at Wentworth Hospital (WWH), a district hospital in KwaZulu-Natal province, South Africa. METHODS A descriptive cross-sectional design was used, and all patients living with T2DM on treatment who had accessed care for at least 1 year were included. Data were collected through structured exit interviews, and their clinical data were extracted from their medical records. Their knowledge, attitudes and practices were assessed using a 5-point Likert scale. RESULTS The mean age (standard deviation [s.d.]) was 59 (13.0) years and most (65.3%) were female, of African (30.0%) and Indian (38.6%) descent, with two-thirds (69.4%) obtaining a secondary school education. Their mean glycated haemoglobin (HbA1c) (s.d.) was 8.6 (2.4%). Over 82% had one or more comorbidity, while 30% had at least one DM-related complication. Generally, participants were pleased with the care received, but their knowledge and practices related to their T2DM was suboptimal. CONCLUSION This study indicates that the QOC was suboptimal due to poor efficacy indicators, poor knowledge and lack of adequate lifestyle measures, despite the frequency of medical practitioner reviews.Contributions: This study identified gaps in QOC and will aid South African public sector policy-makers in devising quality improvement initiatives.
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Affiliation(s)
- Kelly J Fredericks
- Department of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban.
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Ngassa Piotie P, Muchiri JW, Webb EM, Rheeder P. Assessing barriers to insulin therapy among people with type 2 diabetes in South Africa using the Insulin Treatment Appraisal Scale: A cross-sectional survey. Prim Care Diabetes 2022; 16:509-514. [PMID: 35690550 DOI: 10.1016/j.pcd.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/20/2021] [Accepted: 05/27/2022] [Indexed: 11/23/2022]
Abstract
AIMS To assess barriers to insulin therapy among people with type 2 diabetes after adapting the Insulin Treatment Appraisal Scale (ITAS) to the South African context. METHODS A panel of experts reviewed the original ITAS for clarity and relevance to the South African context. The ITAS was administered to 253 adults with type 2 diabetes attending diabetes outpatient clinics in the Tshwane Metropolitan Municipality. Internal consistency (Cronbach's alpha) was tested and construct validity was examined using exploratory factor analysis (EFA). PIR was appraised in insulin users and non-users. RESULTS The EFA revealed that the adapted ITAS had a two-factor structure, similar to the original scale, with acceptable internal consistency (α = 0.85). Insulin-using participants had significantly less negative attitudes to insulin therapy than non-users (40.7 ± 7.1 vs. 51.5 ± 11.2, p < 0.001). Compared to participants who used insulin, participants who did not use insulin were afraid of injecting themselves with a needle (71% vs. 11%, p < 0.001) and saw insulin treatment as a sign of worsening diabetes (63% vs. 29%, p < 0.001). CONCLUSIONS Consistent with previous studies, participants who were not using insulin had more negative beliefs and attitudes towards insulin treatment than those who were already using insulin. South African clinicians should use the ITAS to assess positive and negative perceptions regarding insulin therapy in both insulin-naïve and insulin-treated people, to evaluate interventions to reduce PIR and improve treatment outcomes.
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Affiliation(s)
- Patrick Ngassa Piotie
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, 0007 City of Tshwane, South Africa.
| | - Jane W Muchiri
- Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, 0007 City of Tshwane, South Africa.
| | - Elizabeth M Webb
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, 0007 City of Tshwane, South Africa.
| | - Paul Rheeder
- Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag X323, Arcadia, 0007 City of Tshwane, South Africa.
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Duncanson E, Le Leu RK, Shanahan L, Macauley L, Bennett PN, Weichula R, McDonald S, Burke ALJ, Collins KL, Chur-Hansen A, Jesudason S. The prevalence and evidence-based management of needle fear in adults with chronic disease: A scoping review. PLoS One 2021; 16:e0253048. [PMID: 34111207 PMCID: PMC8192004 DOI: 10.1371/journal.pone.0253048] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/27/2021] [Indexed: 11/27/2022] Open
Abstract
Background Little is known about the prevalence and best management of needle fear in adults with chronic disease, who may experience frequent and long-term exposure to needles for lifesaving therapies such as renal dialysis and cancer treatment. Identifying interventions that assist in management of needle fear and associated distress is essential to support these patients with repeated needle and cannula exposure. Method We followed the PRISMA methodology for scoping reviews and systematically searched PsychINFO, PubMed (MEDLINE), ProQuest, Embase and grey literature and reference lists between 1989 and October 2020 for articles related to needle discomfort, distress, anxiety, fear or phobia. The following chronic diseases were included: arthritis, asthma, chronic back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, and mental illness, or kidney failure. Literature concerning dentistry, vaccination, intravenous drug users and paediatric populations were excluded. Results We identified 32 papers reporting prevalence (n = 24), management (n = 5) or both (n = 3). Needle fear prevalence varied in disease cohorts: 17–52% (cancer), 25–47% (chronic kidney disease) and 0.2–80% (diabetes). Assessment methods varied across studies. Management strategies had poor evidence-base, but included needle-specific education, decorated devices, cognitive-behavioural stress management techniques, distraction, and changing the therapy environment or modality. Conclusion Although needle fear is common there is a paucity of evidence regarding interventions to address it among adults living with chronic disease. This scoping review has highlighted the need for improved identification of needle fear in adults and development of interventions are required for these cohorts.
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Affiliation(s)
- Emily Duncanson
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
| | - Richard K. Le Leu
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Lisa Shanahan
- Paramount Health Service, Adelaide, South Australia, Australia
| | - Luke Macauley
- Patient Partner for Central and Northern Adelaide Renal and Transplantation Service Clinical Research Group, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Paul N. Bennett
- Clinical and Health Services, University of South Australia, Adelaide, Australia
| | - Rick Weichula
- Centre for Evidence-based Practices, South Australia, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
| | - Stephen McDonald
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Anne L. J. Burke
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
- Psychology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kathryn L. Collins
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
- Psychology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Anna Chur-Hansen
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- * E-mail:
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Ngassa Piotie P, Wood P, Webb EM, Hugo JF, Rheeder P. Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings. Ther Adv Endocrinol Metab 2021; 12:20420188211054688. [PMID: 34733467 PMCID: PMC8558786 DOI: 10.1177/20420188211054688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In South Africa, initiating insulin for people with type 2 diabetes and subsequent titration is a major challenge for the resource-constrained healthcare system. Inadequate support systems in primary care, including not being able to access blood glucose monitors and test strips for self-monitoring of blood glucose, results in patients with type 2 diabetes being referred to higher levels of care. In primary care, initiation of insulin may be delayed due to a shortage of healthcare workers. The delayed initiation of insulin is also exacerbated by the reported resistance of both healthcare providers and people with type 2 diabetes to start insulin. In South Africa, telehealth provides an opportunity to overcome these challenges and manage insulin therapy in primary care. METHODS We describe the development of a digital health intervention including the framework used, the theoretical approach and subsequent implementation strategies. RESULTS This intervention is an innovative, nurse-driven and app-enabled intervention called 'the Tshwane Insulin Project intervention'. The Tshwane Insulin Project intervention was designed and evaluated using the framework recommended by the Medical Research Council for complex interventions. The Tshwane Insulin Project intervention was developed in four sequential phases: planning, design, implementation and evaluation. The Tshwane Insulin Project intervention followed the Integrated Chronic Disease Management framework to facilitate implementation and acceptability. The Tshwane Insulin Project comprises a facility-level intervention, where nurses evaluate patients and initiate insulin, an individual-level intervention where community healthcare workers visit patients at their homes to follow-up and provide educational information, while using telehealth to enable physician-directed insulin titration if needed, and a community-level intervention aimed at empowering community healthcare workers to support people living with diabetes and raise awareness of diabetes. CONCLUSION The technological advancements in digital health and telemedicine present an opportunity to improve diabetes care in resource-limited countries. This work can inform those intending to develop and implement complex interventions in primary healthcare in developing countries.
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Affiliation(s)
| | - Paola Wood
- Division of Biokinetics, Department of Physiology, Faculty of Health Sciences, University of Pretoria, Hatfield, South Africa
| | - Elizabeth M. Webb
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Johannes F.M. Hugo
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa; UP COPC Research Unit, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Paul Rheeder
- Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
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Ngassa Piotie P, Wood P, Webb EM, Marcus TS, Rheeder P. Willingness of people with Type 2 diabetes to start insulin therapy: Evidence from the South African Tshwane Insulin Project (TIP). Diabetes Res Clin Pract 2020; 168:108366. [PMID: 32791159 DOI: 10.1016/j.diabres.2020.108366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/22/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022]
Abstract
AIMS To determine factors associated with 'hypothetical willingness' to start insulin among people with Type 2 diabetes (T2DM). METHODS A quantitative cross-sectional study with insulin-naïve T2DM patients at 23 primary care facilities in the Tshwane Metropolitan Municipality. Data collected included demographic and clinical data, willingness to start insulin, attitudes and barriers to insulin therapy. Factors associated with unwillingness to start insulin therapy were explored using a multivariable logistic regression model. RESULTS Of 468 T2DM study patients (mean age 57.2, SD = 11.3 years), more than half (51.9%) expressed unwillingness to starting insulin therapy. Unwillingness was associated with negative attitudes (OR = 1.32, 95% CI = 1.12-1.55, p = 0.001) and reluctance (OR = 1.41, 95% CI = 1.27-1.57, p < 0.001) rather than age, sex, education or diabetes duration. The strongest reasons for patient unwillingness were injection anxieties, fear of needles, insufficient knowledge of insulin, feeling unable to cope with insulin and concerns about out-of-pocket costs. CONCLUSIONS The prospect of insulin therapy disturbs patients' sense of self and their psychological wellbeing. The high prevalence of psychological insulin resistance among these T2DM patients needs to be addressed for effective diabetes management.
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Affiliation(s)
- Patrick Ngassa Piotie
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa.
| | - Paola Wood
- Division of Biokinetics, Department of Physiology, Faculty of Health Sciences, University of Pretoria, P/Bag 14760, Hatfield 0001, City of Tshwane, South Africa.
| | - Elizabeth M Webb
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa.
| | - Tessa S Marcus
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa.
| | - Paul Rheeder
- Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa.
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Taylor CG, Taylor G, Atherley A, Hambleton I, Unwin N, Adams OP. The Barbados Insulin Matters (BIM) study: Barriers to insulin therapy among a population-based sample of people with type 2 diabetes in the Caribbean island of Barbados. J Clin Transl Endocrinol 2017; 8:49-53. [PMID: 29067259 PMCID: PMC5651331 DOI: 10.1016/j.jcte.2017.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/11/2017] [Accepted: 04/14/2017] [Indexed: 12/27/2022] Open
Abstract
AIM The purpose of this study was to document in people with type 2 diabetes (T2DM) in Barbados, attitudes and beliefs that may result in psychological insulin resistance. METHODS A representative, population-based, sample of 175 eligible people with T2DM 25 years of age and over was surveyed by telephone. The 20-item insulin treatment appraisal scale (ITAS) was administered (score range 20 to 100 for positive to negative perceptions). RESULTS 117 people participated (67% response rate, 32% male, mean age 66 years, 90% Black, 22% on insulin). Of non-responders, 52 were not contactable and 6 were difficult to communicate with. Negative perceptions about insulin use included - meant a worsening of diabetes (68%), would worry family (63%), feared self-injection (58%), meant a failure in self-management (57%), injections were painful (54%), would be seen as being sicker (46%), increased hypoglycaemia risk (38%), required effort (34%), causes weight gain (27%), causes a deterioration in health (14%), and would have to give up enjoyable activities (10%). Positive perceptions were - helps good glycaemic control (78%), would prevent complications (61%) and improves health (58%). Mean total ITAS score (61.6, SD = 7.7) was lower for those on insulin compared to those not on insulin (53.7 vs. 63.8, p < 0.0001). Sex, age and diabetes diagnosis duration were not significant predictors of ITAS score. CONCLUSIONS Multiple factors related to patient beliefs and attitudes need to be considered and addressed when initiating insulin in order to minimise psychological insulin resistance and delay. Patients using insulin had less negative perceptions than those not on insulin.
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Affiliation(s)
- Charles G. Taylor
- Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St. Michael, Barbados
| | - Gordon Taylor
- 1 West 5.115, Department for Health, University of Bath, Claverton Down, BA2 7AY, United Kingdom
| | - Anique Atherley
- Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St. Michael, Barbados
| | - Ian Hambleton
- Chronic Disease Research Centre, University of the West Indies, Cave Hill, Barbados
| | - Nigel Unwin
- Chronic Disease Research Centre, University of the West Indies, Cave Hill, Barbados
| | - O. Peter Adams
- Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St. Michael, Barbados
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Taylor CG, Bynoe K, Worme A, Hambleton I, Atherley A, Husbands A, Unwin N. A checklist that enhances the provision of education during insulin initiation simulation: a randomized controlled trial. Diabet Med 2016; 33:1204-10. [PMID: 26337285 DOI: 10.1111/dme.12956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 02/06/2023]
Abstract
AIM The study tested the hypothesis that doctors using an insulin information checklist during simulated insulin initiation would impart more information regarding insulin use. METHODS A total of 128 simulations were conducted. Doctors (n = 64) were recruited from practitioners recently completing internship (n = 19) and those established in primary care (n = 45). Both groups of doctors were strata randomized to control (n = 32) and intervention groups (n = 32), so that each group contained equal numbers. Doctors in each group experienced two identical simulations of insulin initiation with an intervening period of 10 min. Doctors in the intervention arm were introduced to an insulin initiation checklist, which they reviewed independently and utilized in the second simulation. Trained assessors captured the provision of education in 21 predefined educational areas. Differences in the change of the total education provided between the first and second simulations were assessed using linear regression. RESULTS The difference in the mean change of education provided between the first and second simulations within the 21 educational areas for the control and treatment groups was 9.7 [95% confidence interval (CI): 8.8-11.1, P < 0.001] - an increase of 46.2%. The difference for the 15 areas relevant to pen use was 7.3 (95% CI: 6.2-8.4, P < 0.001) - an increase of 51.6%. CONCLUSIONS The checklist resulted in doctors providing significantly more education applicable to syringe and insulin pen routes of insulin administration during simulations. Further research is needed on the checklist's impact on healthcare professionals and patient outcomes in the clinical context. (Clinical Trials Registry No: NCT02266303).
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Affiliation(s)
- C G Taylor
- Faculty of Medical Sciences, University of the West Indies, Cave Hill, Barbados
| | - K Bynoe
- Faculty of Medical Sciences, University of the West Indies, Cave Hill, Barbados
| | - A Worme
- Faculty of Medical Sciences, University of the West Indies, Cave Hill, Barbados
| | - I Hambleton
- Chronic Disease Research Center, University of the West Indies, Cave Hill, Barbados
| | - A Atherley
- Faculty of Medical Sciences, University of the West Indies, Cave Hill, Barbados
| | - A Husbands
- School of Medicine, University of Dundee, Dundee, UK
| | - N Unwin
- Chronic Disease Research Center, University of the West Indies, Cave Hill, Barbados
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Ng CJ, Lai PSM, Lee YK, Azmi SA, Teo CH. Barriers and facilitators to starting insulin in patients with type 2 diabetes: a systematic review. Int J Clin Pract 2015; 69:1050-70. [PMID: 26147376 DOI: 10.1111/ijcp.12691] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIM To identify the barriers and facilitators to start insulin in patients with type 2 diabetes. METHOD This was a systematic review. We conducted a systematic search using PubMed, EMBASE, CINAHL and Web of Science (up to 5 June 2014) for original English articles using the terms 'type 2 diabetes', 'insulin', and free texts: 'barrier' or 'facilitate' and 'initiate'. Two pairs of reviewers independently assessed and extracted the data. Study quality was assessed with Qualsyst. RESULTS A total of 9740 references were identified: 41 full-text articles were assessed for eligibility. Twenty-five articles (15 qualitative, 10 quantitative) were included in the review. Good inter-rater reliability was observed for the Qualsyst score (weighted kappa 0.7). Three main themes identified were as follows: patient-related, healthcare professional and system factors. The main patient-related barriers were fear of pain and injection (n = 18), concerns about side effects of insulin (n = 12), perception that insulin indicated end stage of diabetes (n = 11), inconvenience (n = 10), difficulty in insulin administration (n = 7), punishment (n = 7) and stigma and discrimination (n = 7). Healthcare professionals' barriers were as follows: poor knowledge and skills (n = 9), physician inertia (n = 5) and language barriers (n = 4). System barriers included lack of time (n = 5). The most common facilitators were understanding the benefits of insulin (n = 7), not being afraid of injections (n = 5), and patient education and information (n = 5). CONCLUSION Major barriers to insulin initiation persist despite availability of newer and safer insulin. Healthcare professionals should explore and address these barriers. Targeted interventions should be developed to overcome these barriers.
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Affiliation(s)
- C J Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - P S M Lai
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Y K Lee
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - S A Azmi
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - C H Teo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Ogunbanjo GA. Editor's focus. S Afr Fam Pract (2004) 2012. [DOI: 10.1080/20786204.2012.10874254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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