Attitudes towards, facilitators and barriers to the provision of diabetes self-care support: A qualitative study among healthcare providers in Ghana

Digital technology and its effects on knowledge improvement for diabetes management: An integrative review

AIM

To evaluate the effectiveness of educational digital technology in improving patients' and health professionals' knowledge about diabetes management.

BACKGROUND

The use of digital technologies has been expanding in recent years in several areas of healthcare and education.

DESIGN

Integrative literature review.

DATA SOURCES

The following databases were searched: PubMed, Lilacs, BDENF, Web of Science and SciELO (1 January 2016 and 31 December 2020).

REVIEW METHODS

Titles and abstracts were screened and selected by independent reviewers based on eligibility criteria. A consensus was drawn on which articles should be included. Data were extracted using an instrument created by the authors, and the synthesis of knowledge was made by compiling the results in a table and identifying thematic axes.

RESULTS

Seventy-one articles were retrieved, and after the final analysis, a total of 11 were included. Most studies have pointed out benefits from the use of digital technologies in diabetes education, with two thematic categories emerging: 'Digital technologies in the education of patients with diabetes' and 'Digital technologies in continuing professional education in diabetes'.

CONCLUSION

The use of digital technologies is beneficial and effective both for continuing professional education and educating patients about diabetes management.

Challenges in Access to Support Resources for Diabetic Patients: A Qualitative Study in Deprived Areas of Iran

OBJECTIVES

This study aimed to identify the perceptions of challenges in access to diabetes-related support resources among patients with type 2 diabetes and their family caregivers.

METHODS

This qualitative study was conducted with 18 patients with type 2 diabetes and nine of their family caregivers, using the conventional content analysis method, in 2020 in Lorestan Province, Iran. The participants were selected through purposive sampling and the process continued until the data was saturated. Thirty semi-structured interviews, carried out from February to April 2020, were used to collect the data; they were analyzed using Graneheim and Lundman's content analysis (2004).

RESULTS

The study showed two main categories of structural challenges (subcategories: shortage of skilled professionals and defects in executive processes) and destructive inefficiencies (subcategories: service bottlenecks, uncertain support, and irresponsibility of medical team), indicating the dimensions of the participants' perceptions of barriers to support.

DISCUSSION

The findings of the study showed that barriers relating to the structure and function of healthcare organizations were among the most important challenges perceived by patients with diabetes when pursuing their care. However, there may be other barriers that have not been addressed due to the lack of support resources in deprived areas and the lack of awareness of patients.

Main Aspects of Preparing Diabetic Patients in Poland for Self-Care

Diabetes is a lifestyle disease which can cause many complications and organ-related disorders. The aim of the study was to analyze selected aspects of preparing patients with diabetes for self-care. The study group consisted of 190 people diagnosed with type 1 and type 2 diabetes, including 101 women and 89 men. The mean age of the respondents was 42.2 ± 13.4 years. The study was conducted using an anonymous self-designed questionnaire containing 50 questions. Among the respondents, 23.2% did not control their glucose levels at home. The respondents most often measured glucose once a day (33.6%) or three times a day (26.7%). A total of 64.7% of the respondents declared that they kept a self-monitoring diary. The knowledge of the symptoms of hypoglycemia and the ability to properly manage it was declared by 64.8% of the respondents. A total of 52.1% of the patients did not undertake any activity lasting more than 30 min at least 3 times a week, and 75.2% described their condition as very good and good. Independent participation in therapy, i.e., taking hypoglycemic drugs or insulin, was declared by 63.7% of the respondents. Despite undergoing therapeutic education, the study population diagnosed with diabetes still shows deficiencies in terms of awareness of proper health behaviors. Objective results showed that the patients had insufficient knowledge and skills in terms of self-care and self-observation, blood glucose and blood pressure measurements, physical activity, diet therapy as well as adherence to pharmacotherapy recommendations. Despite the good general preparation for self-care as declared by the respondents, these patients require further systematic, individual educational activities. The results of the present study have implications for nursing practice, patient therapeutic education, and the functioning of the public health and healthcare systems. The number of diabetic patients is constantly increasing. Patients require coordinated care and individualized therapeutic education in order to be prepared for self-care and self-management, thus reducing the risk of complications. Delaying the occurrence of potential complications provides patients with a chance to live an active private and professional life, and protects the health care system from carrying the cost burden of expensive highly specialized services.

Understanding the information culture for self-management support of people living with diabetes in Ghana

Purpose

The purpose of this study is to explore the information culture of people living with Diabetes Mellitus (DM) and how that impacts their self-management practices in Ghana. The study focuses on the information experiences and information cultural patterns and creates awareness of the need for people to be aware of effective information management for sustainable self-management support.

Design/methodology/approach

An interpretive qualitative approach was used. A total of 12 interviewees involving 10 diabetes patients and 2 health professionals provided data for the study. Allowing the participants to freely talk about their attitude and behaviour, defining their experiences around information for their self-management was the best approach to achieve an in-depth understanding this study seeks.

Findings

The specific elements defining the information of people living with DM in Ghana can be identified. People living with the condition are willing to share information about their condition not only with those within their diabetic community but also with anyone interested. They prefer to use information from sources they find reliable and trust, and they have good information-related competencies that are consistent with diabetic patients in other countries’ contexts to help them identify, access, use and share relevant information. Only a few of the interviewees have difficulty in evaluating the accuracy and currency of some of the information. But they receive a lot of support from experienced people from their community. People also prefer to have information about the condition in their ethnic language. It is important for people living with the condition in Ghana to get involved in the diabetic groups, clubs and community, as members appear to receive the most benefit and support from the community to self-manage the condition alone.

Research limitations/implications

The study is limited by the number of participants and the distances between the researchers and the research context. Also, even though two groups of participants were interviewed (diabetic patients and health professionals), the analysis did not separate the responses of the different groups of study participants. This paper provides a useful insight and understanding of the culture of people living with diabetes in Ghana in terms of how they access, use and share the information they need to support their self-management. It will create awareness of the importance of being mindful of information culture patterns in people in other groups in Ghana and beyond. The research processes and procedures described in the paper can be replicated by other researchers in other contexts.

Originality/value

Although there have been a lot of studies about diabetes and people living with the condition in Ghana, to the best of the authors’ knowledge, this is the first study looking at how people define their need for information, how they identify the source of the information and how they access and use the information, including their general behavioural patterns that influence these information experiences.

Barriers to Diabetes Patients' Self-Care Practices in Eastern Ethiopia: A Qualitative Study from the Health Care Providers Perspective

BACKGROUND

All types of diabetes can damage the heart, blood vessels, eyes, kidneys, nerves and increase the overall risk of disability and premature death. Diabetes mellitus requires a range of self-care practices, scientifically recommended to control the glycemic level and maintain the patient's health. However, perceived barriers that hinder patients from fully implementing these diabetes self-care practices and obstacles have not been thoroughly explored. Therefore, this study aimed to explore the barriers to diabetes patients' self-care practices from the perspective of health care providers in two public hospitals in Harar City, Eastern Ethiopia.

METHODS

Researchers conducted an exploratory qualitative study among 26 health care providers working in two public hospitals from March to June 2021. The study participants were recruited from different disciplines working on diabetes care. Interviews were conducted in the Amharic language until the saturation point was reached. The interviews were tape-recorded, transcribed, and translated to English. Each transcript was read, re-read, and then exported to ATLAS.ti 7 software for coding. Field notes were used to supplement verbatim transcriptions. Initial codes were generated. The consistency between the two coders and their alignment with research questions were checked and applied to all subsequent transcripts after reached on consensus. The thematic analysis was employed in line with the primary set research question.

RESULTS

Researchers identified barriers to diabetes patients' self-care practices such as system, health care providers, and patient-level. These barriers were categorized under three main themes: lack of organized diabetes care services, limited collaborative care practices, and perceived lack of knowledge on self-care practices. In addition, the lack of multidisciplinary team care, lack of training for health care providers on diabetes self-care practices, and availability of laboratory tests and diabetes medication were prominent barriers.

CONCLUSION

Multi-level barriers to diabetes patients' self-care practices such as system, health care providers, and patients were identified. Therefore, interventions targeting proper service integration, building providers' and patients' capacity on diabetes self-care practices, and ensuring the sustainability of laboratory tests and medication supplies are essential. These interventions need to be accomplished through multi-level stakeholders' engagement and one-to-one or group interventions covering the multi-level challenges.

Managing diabetes mellitus with comorbidities in primary healthcare facilities in urban settings: a qualitative study among physicians in Odisha, India

Aim

To explore the perceived barriers and facilitators in the management of the patients having diabetes with comorbidities by primary care physicians.

Methods

A qualitative In-Depth Interview study was conducted among the primary care physicians at seventeen urban primary health care centres at Bhubaneswar city of Odisha, India. The digitally recorded interviews were transcribed verbatim and translated into English. The data were analysed using thematic analysis.

Results

Barriers related to physicians, patients and health system were identified. Physicians felt lack of necessary knowledge and skills, communication skills and overburdening due to multiple responsibilities to be major barriers to quality care. Patients’ attitude and beliefs along with socio-economic status played an important role in treatment adherence and in the management of their disease conditions. Poor infrastructure, irregular medicine supply, and shortage of skilled allied health professionals were also found to be barriers to optimal care delivery, as was the lack of electronic medical records and personal treatment records.

Conclusion

Comprehensive guidelines with on the job training for capacity building of the physicians and creation of multidisciplinary teams at primary care level for a more holistic approach towards management of diabetes with comorbidities could be the way forward to optimal delivery of care.

Statins-related peripheral neuropathy among diabetic patients

BACKGROUND

Peripheral neuropathy (PN) is a complaint with often unidentified reasons. Some medicines, including statins therapy, are anticipated to be amongst the reasons for PN.

AIMS

This study intended to assess the association of peripheral neuropathy with statins therapy amongst Type 2 diabetic patients.

METHODS

At Penang General Hospital, 757 cases were categorized into two groups (564 with statins therapy and 193 without statins therapy). The diagnosis of PN was investigated retrospectively for a period of 10 years (2006-2016). Confounding risk factors as age, diabetes period, hypertension, glycemic control, other co-morbidity, and prescriptions were matched.

RESULTS

About 129 (22.9%) cases from 564 statins users had PN. Only 30 (15.5%) subjects had PN from 193 statins non-users. Chi-square test showed a significant variance among statins treatment cohort and statin-free cohort in the occurrence of PN (P-value: 0.001). Spearman's investigation presented a positive correlation (r: 0.078, p-value: 0.031) among statins use and PN prevalence. Binary logistic regression was statistically significant for statins therapy as a predictor of peripheral neuropathy incidence (r²: 0.006, p-value: 0.027) amid diabetic patients. The relative risk of peripheral neuropathy connected with statins therapy is (RR: 1.47, 95% CI: 1.02-2.11). The excess relative risk is 47.1%. While the absolute risk (AR) is 7.3% and the number needed to harm (NNH) is 14.

CONCLUSIONS

The study indicated a positive association between peripheral neuropathy and statins utilization. Peripheral neuropathy was higher amongst statins users than the statins-free group.

Perceived interpersonal and institutional challenges to patient advocacy in clinical nursing practice: a qualitative study from Ghana / Interpersonelle und institutionelle Herausforderungen für die Rolle als Patientenfürsprecher/-in aus Sicht der Pflege: eine qualitative Studie aus Ghana

Background

Nurses often speak on patients’ behalf and safeguard their safety through their advocacy role. However, some challenges like the negative attitude of team members and lack of institutional support often hamper this role. These challenges have not been well studied in the Ghanaian context.

Aim

This study explores the perceived environmental challenges to patient advocacy among nurses in Ghana.

Setting

The study was conducted at a regional hospital in Ghana.

Participants

Participants were nurses or midwives working in the hospital.

Methods

A qualitative exploratory descriptive design was employed in the study of 15 purposively sampled participants. Participants were interviewed individually and data were analysed using content analysis.

Findings

The study revealed interpersonal challenges and institutional challenges to patient advocacy, such as hierarchical nurse–doctor relationships and ineffective multidisciplinary team, time constraints and lack of institutional support. Nurses often failed to advocate because they did not want to risk conflict with doctors. Limited interprofessional interaction, suspicion and resentment in the multidisciplinary team negatively affected nurses’ role as patient advocates. Inadequate curricular support for patient advocacy and lack of support for training programmes or to undertake further studies were the additional challenges.

Conclusion

Patient advocacy could be a stressful role for nurses; thus, efforts to strengthen teamwork and increase nurse involvement in hospital decision-making are required.

Implications for nursing and health policy

The findings could influence hospital management policies to enhance stronger interprofessional collaboration, increase opportunities for professional advancement for nurses and nurses’ inclusion in decision-making.

Pilot Implementation of Adapted-Family Diabetes Self-Management Education Into a Clinical Setting

Objectives: Marshallese are a Pacific Islander community that experience a disproportionate rate of type 2 diabetes. The purpose of this study is to evaluate the preliminary effectiveness and feasibility of an Adapted-Family Diabetes Self-Management Education (DSME) intervention among Marshallese adults diagnosed with type 2 diabetes and their family members when delivered in a clinical setting. Methods: Marshallese patients (primary participants) with type 2 diabetes (n = 10) and their family members (n = 10) enrolled in a pilot study deigned to evaluate an Adapted-Family DSME curriculum conducted by community health workers and a certified diabetes educator in a clinical setting. Primary and family participants' health information and biometric data (HbA1c, blood pressure, cholesterol, and body mass index) were collected at preintervention and 12 weeks postintervention. Results: All 10 primary participants and 8 of the family members received all 10 hours of the education intervention. Nine of the 10 primary participants and 8 of the 10 family members completed the pre- and postintervention data collection events. Primary participants demonstrated a mean decrease in HbA1c of 0.7%, from pre- to postintervention, as well as improved blood pressure and cholesterol. Family members demonstrated minor improvements in HbA1c and blood pressure. Conclusions: Results suggest preliminary effectiveness and feasibility of the Adapted-Family DSME in a clinic setting and will inform implementation of a fully powered study.