Healthcare Professionals’ Perspectives of Patients’ Experiences of the Self-Management of Type 2 Diabetes in the Rural Areas of Pakistan: A Qualitative Analysis
Abstract
:1. Introduction
2. Methods
2.1. Qualitative Design
- What are the differences between physician and patient understandings of self-management of type 2 diabetes in the rural area of Pakistan?
- What factors affect diabetes self-management practices?
2.2. Sample and Recruitment
2.3. Consent to Participate
2.4. Data Collection
2.5. Qualitative Data Analysis
3. Results
3.1. Low Self-Efficacy
“I consider the non-compliance of patients to the advice given to them as a rude behaviour on their part”. “I came to this part of the country with great enthusiasm to help this under-served population and then feel frustrated when realize that I am talking to the walls and then the enthusiasm for putting the patient on the right track diminishes with the time.”(GP-1)
“I always asked them to follow the GP’s advice but patients lack of follow-up of GP’s advice all the time frustrated me”(Nurse-2)
“I have told patients, in case they have any problems in managing their diabetes or they face any problem or need any clarifications, just call me and I will help them out even after working hours.”(GP-5)
“I have received a call from the patient that he has a problem controlling his sugar level in the morning (fasting glucose level > 140 mg/dl). I advised him to have light meals in the night, take prescribed medicines, walk for 30 minutes and have at least 3 hours gap between the food and sleep and that worked very well for the patient.”(GP-8)
“After couple of days, the patient sent me a message on my mobile thanking me for the help and advice. I think that kind of communication may bridge the gap of misunderstanding between the patient and doctor.”(GP-8)
“I always discussed a lot with the patients about their self-management activities and encouraged them to continue or make more efforts – that way patients are encouraged and felt that they are taken care of the clinical staff.”(Nurse-3)
3.2. Influence on Diabetes Self-Management Activities
“Women in this rural area of Pakistan had a difficult time in managing their diabetes as compared to men. In this society, women cook the food according to the choices of the family–women don’t have much to say on the choice of the food, so they have no idea how to manage their diabetes in the environment they live and in relation to the healthy food choices.”(GP-6)
“In Pakistani culture, if unhealthy food is served in parties on a special occasion, it is considered rude not to eat that and bringing diabetes–appropriate food to such events would not be accepted.”(Nurse-4)
“Religious belief plays an important role in this population. Some patients considered that this disease came from “Allah” (God), so Allah will cure that as well so no need to make efforts on self-management activities.”(GP-10)
“One of the nurses mentioned that patients are reluctant to follow the strict diet and want to enjoy the food of their choices.”(Nurse-5)
“There is a need to promote self-monitoring behaviour and health education for the patients as these patients do not understand the complications of the disease and how to care for themselves.”(GP-9)
“I think that diabetes self-care education can play an important role for this population as there is a complete lack of knowledge about this disease among these patients.”(Nurse-6)
3.3. Patient-Doctor Relationship
“I have provided clear direction how to use the medicines and follow up the healthy diet and exercise to my patients but it was of no use as the patients did not follow my advice. In fact, patients complained that there was no control on blood sugar and indicated that their health further deteriorated.”(GP-10)
“The patients do not follow my suggestions, and hence, they decided not to adhere to dietary and behavioural recommendations.”(GP-10)
“…. Many patients in Pakistan are using traditional medicines and sometime their side effects make them more sick blaming the general practitioners for not looking after their health well.”(GP-7)
3.4. Non-Adherence to Diet and Exercise
“There is no diet and exercise consideration—patients with diabetes eat whatever is cooked at home for the family. Physical activity is non-existent as they don’t have proper facilities in this area where they can safely do the physical activities.”(GP-1)
3.5. Conflicts with Patients
“In Pakistani society, food is considered a very important factor which unites people and keeps them together. Many patients with type 2 diabetes in Pakistan eat whatever is presented to them in parties, so the doctor’s advice is not followed.”(GP-2)
“This type of behaviour always results in a conflict with the patients.”(GP-3)
3.6. Lack of Support
“Patients don’t get any support from the family members to manage their diabetes. It was hard for them to cook diabetes “health-food” which may be separate from the rest of the extended family members living together.”(Nurse-7)
“I feel like giving up my efforts as there is no way I can convince these patients about the complications of diabetes and make them understand the benefits of self-management of diabetes.”(GP-2)
4. Discussion
5. Conclusions
6. Practice Implication
- This study is the first of its kind to explore the healthcare professionals’ perspectives of type 2 diabetes mellitus patients in the middle-aged population of Pakistan.
- The article highlighted the ways type 2 diabetes is managed in Pakistan.
- This article will help to minimize the gap between patient–doctor relationships and to achieve optimal glycaemic control and medication adherence.
- Healthcare professionals to set achievable management and self-management goals.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
Appendix A
- Please tell me about the barriers to self-management in patients? Are there any issues related to?
- Human resources and the availability of trained staff
- Funding for clinical consultations, medicines and other public health services
- Cultural/religious barriers which might prevent people from seeking care
- To what extent do diabetic patients use existing services?
- What is your experience of under-usage?
- What is your experience of over-usage?
- What is the effect of the service usage patterns you have mentioned?[Prompt: relevant to self-management]
- To what extent does culture influence patients’ access to health care?
- What in particular influences the Pakistani communities?
- Can you give me an example specific to the Pakistani communities?
- Many people in Pakistan with chronic illness like diabetes often report seeking traditional medicines. What do you think about that? Are there any issues related to?
- Reported effect of these treatments
- Self-medication
- Side-effects reported from the treatment
- How do patients respond to the treatments you might prescribe? Are there any issues related to?
- Reported effect of the treatment
- Self-medication
- Non-compliance
- Side-effects reported from the treatment
- Thinking about the issues raised in the earlier discussions, what could be done to address or overcome these issues?
- What do you think would improve diabetes care of patients with type 2 diabetes?[Prompt: what impacts would more self-management have?]
- What could be done in your profession to improve things?
- What sort of things need to be done more broadly to improve service for people with diabetes?
- Are there any other issues that you want to raise that we have not discussed about management of diabetes?
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Demographic | GPs (n = 10) | Nurses (n = 10) | Total (n = 20) |
---|---|---|---|
Age (average, in years) | 48 | 50 | 49 |
Marital Status | |||
Single/never married | 0 | 1 | 1 |
Married | 10 | 9 | 19 |
Separated/divorced | 0 | 0 | 0 |
Education | |||
Completed college or university | 10 | 10 | 20 |
Professional degree (MBBS/MD) | 10 | 0 | 10 |
Specialization (MRCGP/MRCP) | 4 | 0 | 4 |
Employment | |||
Full/part-time | 10 | 10 | 20 |
Unemployed | 0 | 0 | 0 |
Years in Practice (mean) | 16 | 18 | 17 |
Family Background | |||
Languages spoken at home | Urdu/Punjabi Pushto | Urdu/Punjabi Pushto | - |
Cultural Background | Mohajir/Punjabi and Pathan | Mohajir/Punjabi and Pathan | - |
Themes | GP’s (Feelings) | Nurses (Feelings) |
---|---|---|
Low self-efficacy | Personally affected by conflicts with the patients | Lack of follow-up by patients frustrating |
Influence on diabetes self-management activities | Social and cultural barriers | Barriers from: joint family, religious |
Patient–doctor relationship | Conflict with the patients | More expectations from patients |
Non-adherence to diet and exercise | Patients do not follow instructions | Difficulties to follow-up instructions |
Conflicts with patients | Patients do not listen to advice | Patients poor attitude |
Lack of support | No support from the Healthcare providers No Social support | Less support from family |
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Ansari, R.M.; Harris, M.; Hosseinzadeh, H.; Zwar, N. Healthcare Professionals’ Perspectives of Patients’ Experiences of the Self-Management of Type 2 Diabetes in the Rural Areas of Pakistan: A Qualitative Analysis. Int. J. Environ. Res. Public Health 2021, 18, 9869. https://doi.org/10.3390/ijerph18189869
Ansari RM, Harris M, Hosseinzadeh H, Zwar N. Healthcare Professionals’ Perspectives of Patients’ Experiences of the Self-Management of Type 2 Diabetes in the Rural Areas of Pakistan: A Qualitative Analysis. International Journal of Environmental Research and Public Health. 2021; 18(18):9869. https://doi.org/10.3390/ijerph18189869
Chicago/Turabian StyleAnsari, Rashid M., Mark Harris, Hassan Hosseinzadeh, and Nicholas Zwar. 2021. "Healthcare Professionals’ Perspectives of Patients’ Experiences of the Self-Management of Type 2 Diabetes in the Rural Areas of Pakistan: A Qualitative Analysis" International Journal of Environmental Research and Public Health 18, no. 18: 9869. https://doi.org/10.3390/ijerph18189869