Qualitative Analyses of the Reasons Why Patients Do Not Attend Scheduled Inpatient Appointments in a Hospital in Guangzhou, China

How health seeking behavior develops in patients with type 2 diabetes: a qualitative study based on health belief model in China

Background

Type 2 diabetes(T2DM) is a global health problem which is accompanied with multi-systemic complications, and associated with long-term health burden and economic burden. Effective health seeking behavior (HSB) refers to reasonably utilize health resources, effectively prevent and treat diseases, and maintain health. Effective health seeking behavior (HSB) is vital to mitigate the risk of T2DM complications. However, health seeking behavior for T2DM patients remains sub-optimal worldwide.

Objective

The study aimed to explore the internal logic of how health seeking behavior of T2DM patients develops and the influencing factors of health seeking behavior. With a view to provide a reference basis for improving the health seeking behavior situation of T2DM patients.

Methods

This study was conducted at an integrated tertiary hospital in China. People who were diagnosed with T2DM, capable of expressing clearly and had no mental illness, were approached based on a purposive sampling. The experience of T2DM and health seeking behavior were collected via in-depth interviews. A theory-driven thematic analysis based on Health Belief Model (HBM) was applied for data analysis. Inductive reasoning was used to identify emerging themes which were not included in HBM.

Results

26 patients with T2DM were included in the current study. Seven themes were identified, including: (1) T2DM diagnosis and severity; (2) T2DM treatment and management; (3) Perceived susceptibility of diabetes progression; (4) Perceived severity of diabetes progression; (5) Perceived benefits of health seeking behavior; (6) Perceived barriers of health seeking behavior; (7) Perception of behavioral cues. Generally, patients with T2DM lacked reliable sources of information, considered T2DM to be slow-progressing and without posing an immediate threat to life. Consequently, they did not fully grasp the long-term risks associated with T2DM or the protective effects of health seeking behavior.

Conclusion

This study highlighted the challenges in health seeking behavior for patients with T2DM. It suggested that future interventions and strategies should involve multi-faceted approaches, targeting healthcare providers (HCPs), patients with T2DM, and their support networks. This comprehensive strategy can help patients better understand their condition and the importance of effective health seeking behavior. Ultimately, enhancing their capacity for adopting appropriate health-seeking practices.

Factors and Reasons Associated With Appointment Non-attendance in Hospitals: A Narrative Review

Non-attendance at hospital appointments is an extremely prevalent issue impacting healthcare systems on a daily basis. This phenomenon adversely affects patient health and healthcare providers, leading to delays in diagnosis and treatment, inefficient resource utilization, and increased healthcare expenses. The detrimental impact of non-attendance is not limited to patients who miss appointments, the knock-on effects of extended waiting times and reduced appointment availability are felt throughout healthcare systems. The purpose of this narrative review is to explore the factors underlying appointment non-attendance in hospital settings, to improve healthcare delivery and patient adherence. An extensive review of the existing global literature was conducted. Quantitative studies that explored the relationship between appointment non-attendance and patient characteristics, such as age, gender, marital status, education level, distance from the hospital, and source of referral, were included. Younger patients, males, individuals with lower levels of education, and those living farther from hospitals were more likely to miss appointments. Marital status was significant, with married patients showing better attendance, as was referral source, with general practitioner referrals associated with higher non-attendance. Qualitative studies identifying both patient-centered and hospital-specific reasons, such as forgetfulness, appointment time, protracted waiting times, patient-physician relationship, and patients' knowledge and perception of their health condition, were also included in the review. Lack of appointment reminders, difficulties in managing appointments, and inadequate patient-physician communication were significant hospital-specific reasons given for non-attendance. Patients' lack of awareness regarding the importance of attending appointments and limited understanding of their health conditions were also identified as patient-centered contributors. Non-attendance at hospital appointments is a multifaceted issue influenced by a range of socioeconomic, personal, and systemic factors. Addressing these factors requires a holistic approach that includes patient education, improved communication, and tailored healthcare delivery strategies, especially for vulnerable populations in rural areas. Enhanced reminder systems and streamlined appointment management could serve as pivotal interventions to reduce non-attendance rates, ultimately improving healthcare outcomes and resource utilization.

A Qualitative Exploration of Self-Management Behaviors and Influencing Factors in Patients With Type 2 Diabetes

BACKGROUND AND AIMS

The self-management behavior of patients with diabetes involves a complex set of actions involving medication therapy, lifestyle changes, and management of complications in the daily routine. Our study aims to explore adherence to self-management behaviors by patients with type 2 diabetes and the potential factors influencing those behaviors.

METHODS

This qualitative study used semi-structured interviews conducted with patients who have type 2 diabetes and who were recruited from the department of endocrinology in a tertiary teaching hospital. Data were analyzed thematically using the interview framework.

RESULTS

Overall, 28 patients with type 2 diabetes were recruited and interviewed. Three types of medication noncompliance behaviors were coded. In particular, blindly optimistic attitudes toward the condition in younger patients who had a short duration of diabetes and fear of or pain from medication therapy were key influencing factors. Irregular monitoring and missed follow-up visits were the most frequently mentioned noncompliance behaviors. Poor understanding of blood glucose monitoring, selective ignorance due to pressure of uncontrolled blood glucose, and blindly optimistic attitudes were also identified as key influencing factors. Dietary behaviors were characterized by an overemphasis on the amount of food in the diet and the preference or declination for particular types of food; ignorance of the dietary structure was present. Misconceptions about dietary and exercise practices were the main types of lifestyles' noncompliance.

CONCLUSION

Our study showed the complex picture of noncompliance with self-management behaviors by patients with type 2 diabetes. Noncompliance covered disordered and arbitrary changes in medication therapy, blood glucose monitoring with poorest adherence, lifestyle modifications and complication management. The study findings identify clear challenges to self-management behavior and identify potential key influencing factors. Future interventions and strategies should aim to help patients translate healthcare provider's information and instructions into action that improve compliance.