The experiences of Chinese general practitioners in communicating with people with type 2 diabetes-a focus group study

Tele-nursing awareness, needs, and related influences in T2DM patients: qualitative descriptive study

BACKGROUND

Tele-nursing, which utilizes digital health tools, has the potential to enhance the management of Type 2 Diabetes (T2DM). However, patients' awareness, needs, and barriers to using these services are not well understood. This study employed qualitative interviews to explore the perceptions of patients with T2DM towards tele-nursing and to identify factors influencing their adoption, with the aim of providing tailored strategies for effective service implementation.

METHODS

A descriptive qualitative research design was used. From June to August 2023, a purposive sampling method was used to select 20 T2DM patients from a hospital, following the principle of maximum variation. Semi-structured interviews were conducted, and the data were analyzed using thematic analysis.

RESULTS

Four main themes were identified: insufficient awareness and willingness to use tele-nursing, the need for tele-nursing services, facilitators of tele-nursing, and barriers to tele-nursing.

CONCLUSION

The awareness of tele-nursing among T2DM patients needs significant improvement. Patients expressed clear demands for tele-nursing services, including health education, dietary guidance, blood sugar monitoring, and medication reminders. However, the adoption of tele-nursing is influenced by factors such as service accessibility, scope, technological challenges, and associated costs. Tele-nursing should address the specialized nursing needs of T2DM patients by leveraging remote technology to provide personalized and flexible care options that align with their evolving requirements.

Primary Care Physicians' Responses to Treatment Burden in People With Type 2 Diabetes: A Qualitative Video Analysis in China

PURPOSE

This study aimed to examine the approaches general practitioners (GPs) use to respond to the treatment burden faced by people with type 2 diabetes.

METHODS

We retrospectively analyzed 29 videos of GP-patient consultations in an academic general practice clinic in China. Thematic analysis and a framework matrix approach were used to identify patterns in GPs' responses to the identified issues.

RESULTS

The median length of the 29 video-recorded consultations was 23 minutes 54 seconds. We identified 77 segments focusing on discussions about treatment burden. In 37.7% of these segments, the GP elicited and responded to discussions about treatment burden, whereas in 23.4%, the patient initiated the discussion and the GP responded to it, leaving 39.0% in which the patient initiated the discussion but the GP did not respond. In thematic analysis, medication was the component of treatment burden most frequently identified by both patients and GPs, followed by personal resources, medical information, and administrative burden. General practitioners used 12 response approaches to address patients' treatment burden. The most frequently used included active listening and nonverbal skills, shared decision making, and confidence and self-efficacy support, which were broadly applied across various issues. In contrast, GPs typically reserved health record management, motivational interviewing, and awareness of the patient's background for specific issues.

CONCLUSIONS

In clinical encounters, GPs used a wide variety of approaches to respond to different aspects of the treatment burden of type 2 diabetes. Our findings emphasize the need to improve GPs' response strategies through increased responsiveness and more rapid surfacing of issues during visits.

A multisectoral and multidisciplinary endeavor: a review of diabetes self-management apps in China

BACKGROUND

While the use of self-management apps has considerable promise to efficiently reduce the diabetes burden that disproportionally affects low- and middle-income countries (LMICs), and the multisectoral and multidisciplinary approaches have been encouraged to be used in diabetes management, little is known about the status of the integration of these approaches in the existing diabetes self-management apps. This review examines the diabetes apps in China as an indication of the current status of integrating multisectoral and multidisciplinary approaches in diabetes mHealth care in LMICs.

METHODS

Eligible diabetes apps were searched on major Chinese app stores up to December 23, 2022. The app comprehensiveness index (ranging 0-80) regarding the app functions and diabetes management domains was created. The multisectoral and multidisciplinary features were summarized using indices derived from current guidance.

RESULTS

Sixty-six apps were reviewed, all developed by private companies. The average comprehensiveness score was 16, with many major self-management domains and functions not represented among the reviewed apps. Forty apps (61%) involved multiple sectoral entities, with public/private and private/private collaborations being the most common collaborative combinations. Thirty-seven apps (56%) involved multiple disciplines, among which endocrinology/metabolism, nutrition, and cardiovascular medicine were the top three most common disciplines. Compared to non-multidisciplinary apps, multidisciplinary apps tended to provide more comprehensive services in apps (6.14 vs. 5.18, p = 0.0345). Different sectors and disciplines tended to work independently, without robust interactions, in providing diabetes management services in the reviewed apps.

CONCLUSION

Multisectoral and multidisciplinary features has presented in the current diabetes self-management apps in China; however, it is still in its infancy and significant limitations existed. More engagement of civil society organizations and community groups and innovative collaborations between sectors and disciplines are needed to provide comprehensive, continuous, and patient-centered mHealth care for patients with diabetes in LMICs like China. Clear guidance for integrating and evaluating the multisectoral and multidisciplinary efforts in self-management apps is necessary to ensure the effective use of mHealth solutions for diabetes management in LMICs.

Study on the determinants of health professionals' performance on diabetes management care in China

BACKGROUND

As the direct providers of diabetes management care in primary health care facilities (PHFs) in China, health professionals' performance on management care of diabetes determines the quality of services and patients' outcomes. This study aims to analyze the key determinants of health professionals' performance on diabetes management care in PHFs in China.

METHODS

We conducted a cross-sectional study in 72 PHFs in 6 cities that piloted the contracted family doctor service (CFDS). Self-developed questionnaire was used to measure three kinds of factors (capacity, motivation and opportunity) potentially influencing the performance of health professionals. The performance of diabetes management care in the study was measured as whether health professionals delivered 7 service items required by the National Basic Public Health Service Guideline with a total of 7 points and was divided into three grades of good, medium and bad. The questionnaire is self-administered by all the health professionals involved in the study with the number of 434. The Chi-square tests were used to compare differences of performance on diabetes management care among health professionals with different characteristics. The ordinal logistic regression was used to analyze the determinants on the performance of diabetes management care.

RESULTS

Health professionals who got higher score on diabetes knowledge test had odds of better performance on diabetes management care (OR = 1.529, P < 0.001). health professionals with higher degree of self-reported satisfaction on training (OR = 1.224, P < 0.05) and perception of decreasing workload (OR = 3.336, P < 0.01) had odds of better performance on diabetes management care. While health professionals with negative feeling on information system support had odds of worse performance on diabetes management care (OR = 0.664, P < 0.01).

CONCLUSIONS

Attention should be paid to the training of health professionals' knowledge on diabetes management capacity. Furthermore, measures to improve training for health professionals could satisfying their needs for self-growth and improve the motivation of health professionals. The information system supporting management care should be improved continuously to improve the health professionals' working opportunities and decrease the workload.

A multicentre, prospective, non-interventional study evaluating the safety of dapagliflozin in patients with type 2 diabetes in routine clinical practice in China (DONATE)

BACKGROUND

There are few large-scale studies evaluating the safety of the sodium-glucose cotransporter-2 inhibitor, dapagliflozin, in Chinese patients with type 2 diabetes. DONATE, a multicentre, single-arm, prospective, non-interventional study, is the first real-world study evaluating the safety of dapagliflozin in Chinese patients with type 2 diabetes in routine clinical practice.

METHODS

Between August 2017 and July 2020, patients with type 2 diabetes who had initiated dapagliflozin therapy and received ≥1 dose were prospectively recruited from 88 hospitals in China. Patients were subsequently followed up for 24 weeks; if patients discontinued dapagliflozin they were followed up for an additional 7 days after treatment discontinuation. The primary outcome was the proportion of patients with adverse events and serious adverse events, particularly key adverse events of special interest (AESI) including urinary tract infection, genital tract infection (typical symptoms with or without microbiological diagnosis) and hypoglycaemia (typical symptoms with or without blood glucose ≤3.9 mmol/L, or blood glucose ≤3.9 mmol/L without symptoms). Exploratory outcomes included the absolute change in metabolic parameters and the proportion of patients with other AESI including volume depletion, abnormal blood electrolytes, polyuria, renal impairment, diabetic ketoacidosis, hepatic impairment and haematuria.

RESULTS

A total of 3000 patients were enrolled, of whom 2990 (99.7%) were included in the safety analysis set. Mean (SD) age was 52.6 (12.0) years, and 65.8% of patients were male. Mean (SD) duration of type 2 diabetes at enrolment was 8.4 (7.1) years. Mean (SD) treatment duration of dapagliflozin was 209.1 (157.6) days. Adverse events were reported in 35.4% (n = 1059) of patients during the 24-week follow-up period. Overall, 9.0% (n = 268) were related to treatment and 6.2% (n = 186) were serious. Urinary tract infection, genital tract infection and hypoglycaemia were reported in 2.3% (n = 70), 1.3% (n = 39) and 1.1% (n = 32) of patients, respectively. The proportion of patients with other AESI was also low: polyuria (0.7%; n = 21), volume depletion (0.3%; n = 9), renal impairment (0.3%; n = 8), hepatic impairment (0.2%; n = 7), haematuria (0.2%; n = 6) and diabetic ketoacidosis (0.1%; n = 2).

CONCLUSIONS

This study demonstrated that once-daily dapagliflozin was well tolerated in Chinese patients with type 2 diabetes and the overall safety profile of dapagliflozin in clinical practice in China was consistent with that reported in clinical trials.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03156985. Registered on 16 May, 2017.

Using a mixed method to identify communication skills training priorities for Chinese general practitioners in diabetes care

BACKGROUND

In China diabetes care is gradually shifting from secondary to primary care with great infrastructure investment and GP training. However, most GPs in China lack communication skills training, which is a huge obstacle in communication with their patients in primary care. In this study we seek to identify training priorities that is evidence-based, appropriate for the context of primary care in China, and that meet the real needs of both GPs and people with diabetes.

METHODS

A mixed method approach was used. A conceptual framework was designed based on the MRC framework, action research and adult learning theories. Through a systematic review of the literature and qualitative research with GPs and patients with diabetes, a list of communication skills training components was developed by the research team. A modified nominal group technique (NGT) with GPs was used to evaluate these contents. Purposive sampling was used to recruit a variation of participants (age, work area, practice years and education background) from general practices in Guangzhou city, China. Eight structured nominal groups were facilitated to elicit the views of group members, and participants rated the 9-point Likert scale of importance and feasibility of the training items independently, before and after focus groups. The ranking of each item was calculated, based on the mean Likert score ratings from all participants. Video recordings of four NGT group discussions were thematically analysed using the Framework Method to explore reasons for any differences in rating items.

RESULTS

29 males and 29 female GPs from 28 general practices participated in NGT group discussions, with a mean age of 38.5 years and mean 12.3 years of practice experience. Based on the mean scores of importance and feasibility rating scores, the top 3 ranked priorities for communication training were 'health education' (importance 8.39, feasibility 7.67), 'discussing and explaining blood glucose monitoring' (8.31, 7.46), and 'diabetes complications and cardiovascular disease risk communication' (8.36, 7.12). Five main themes were identified from focus group discussions through qualitative analysis: 'impact on diabetes patients', 'GP attitudes towards communication skills', 'patient-related factors influencing the application of communication skills by GPs, 'local contextual factors', and 'training implementation'.

CONCLUSIONS

Priorities for communication skills training for Chinese GPs in diabetes care were identified. These are set in the context of GPs' current experience of communication with patients in China who have diabetes, which is often unsatisfactory. This study describes the baseline from which better primary care for diabetes in China needs to be developed. Based on suggestions from GPs themselves, it identifies an agenda for improvement in communication as a key component of diabetes care in China.

The Chinese version of the revised Diabetes Distress Scale for adults with type 2 diabetes: Translation and validation study

Objectives

This study aimed to translate the revised 17-item Diabetes Distress Scale (DDS17, 2017) into mandarin (simplified) Chinese and validate the Chinese version of DDS17 (C-DDS17, 2021) among adult patients with type 2 diabetes in China.

Methods

A scale translation and cross-sectional validation study was conducted. The DDS17 was translated into mandarin (simplified) Chinese through a five-step process: authorization, forward translation, synthesis, back translation, and amendment. During this session, 59 patients assessed the understandability and readability of the translated scale. From June 7 to September 4, 2021, a cross-sectional study that adhered to the COSMIN checklist was conducted with 400 individuals with type 2 diabetes from three Class A tertiary comprehensive hospitals in Beijing, China. The content, construct, convergent, discriminant validity, and reliability (Cronbach’s α coefficient and item-total correlation coefficients) of the C-DDS17 were evaluated. This study was a part of a project registered in the Chinese Clinical Trial Registry (no. ChiCTR2100047071).

Results

Among the participants, 33.3% (133/400) of them experienced moderate to high diabetes distress. The content validity indices of the C-DDS17 equaled 1.00. The scale yielded a four-factor structure. The average variances extracted were 0.42–0.57, which was lower than squared correlations. Cronbach’s α coefficient was 0.88 for the overall scale and ranged from 0.76 to 0.81 for sub-scales. Corrected item-total correlation coefficients ranged from 0.42 to 0.61. The eighth item (“Feeling that I am often failing with my diabetes routine”) was better fit to physician distress than regimen distress but had little influence on the validation results.

Conclusions

The C-DDS17 is a reliable and valid instrument for assessing diabetes distress in patients with type 2 diabetes. It is a promising instrument for early identification and management of diabetes distress in clinical practice and trials.

The experiences of people with type 2 diabetes in communicating with general practitioners in China - a primary care focus group study

BACKGROUND

With the implementation of health care reforms in China, primary care is on a journey to provide care for most patients with type 2 diabetes. While Chinese general practitioners (GPs) have described challenges in communication with diabetes patients in their daily practice, little is known about patients' experiences in communicating with their GPs.

METHODS

Five focus groups (of 4-5 participants each) were used to explore views from patients with type 2 diabetes. Purposive sampling was used to recruit a spread of participants from general practices in Guangzhou city, China. Focus groups were audio-recorded, transcribed, and thematically analyzed using the Framework Method.

RESULTS

Ten males and 12 female patients from five general practices participated in focus group discussions, with a mean age of 57.3 years and 7.3 years of diabetes duration. Five main themes emerged: patients' understanding about diabetes, diabetes medication, communication with GPs, physician-patient relationships, and healthcare systems and context. Patients generally searched for information on the internet, but they weren't always sure if it was trustworthy. Several communication needs were described by diabetes patients, such as explanation of blood glucose monitoring, medication information support, communication in the risk of diabetes complications and cardiovascular disease, and language barriers. Communication was frequently brief and not tailored to their concerns, and some described being scolded or panicked by GPs. Participants acknowledged the pressures within the health system, such as short consultation times, an incoherent GP-hospital interface and high demand.

CONCLUSIONS

Key issues from the patients' perspective for the development of primary care based management of diabetes in China were identified. People with type 2 diabetes require more access to trustworthy diabetes information and wish for better channels of communication with their GPs. Strategies may be required to improve GPs' communication skills with their patients that also consider the context of the wider health system environment in China.