Patient and Provider Dilemmas of Type 2 Diabetes Self-Management: A Qualitative Study in Socioeconomically Disadvantaged Communities in Stockholm
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting
2.2. Study Design and Approach
2.3. Participant Selection
2.4. Data Collection
2.5. Data Analysis
2.6. Ethical Approval and Participation Consent
3. Results
3.1. Diabetes as Part of Aging and Family History
“… no, diabetes is sugar and a little sugar in the body is ok. Dad also had it, it is common to have diabetes.”(Male with T2D)
“… They do not know they are sick. They say that they have a little diabetes, a little sugar that the body gets used to …”(Health provider)
3.2. Glucose Control through Numbers
“Today I took the blood sugar test. I had about 7.6 that is ok. I panic when I get more than about 8 or 9.”(Female with T2D)
“… If you tell the patient that their blood sugar is high, you see no reaction, but if you give the numbers, you get a different reaction. And if you say then that it has improved, and then justify it with the numbers, then they get motivated.”(Health provider)
3.3. Tailoring of Information and Advice to Fit Daily Life
“I am on medication for heart disease and high blood pressure. Diabetes is just one of the conditions that I am being treated for. At the health center they tell me what to eat and that I should walk at least one hour but I don´t like it. I am always tired and I have back pain so I cannot do much.”(Female with T2D)
“… they told me, you must reduce your food, and exercise a lot … They just say you have to do that and that and that, but don’t tell you how. I need a plan with information on what to eat.”(Male with T2D)
“It is the patient’s responsibility, but a difficult one too. I often tell new patients that it is your responsibility but as a physician, you cannot just leave the responsibility to the patient. You cannot just say that it is his responsibility, you have to help them.”(Healthcare provider)
“… what I have discovered is, I have patients that have different food habits. So first I have to learn the culture and what they eat, and then I have to be able to give advice. There are Somalis, so you have to be able to learn their food. For example, I did not know that they eat a banana every meal.”(Healthcare provider)
3.4. Frustrations Associated with Sustaining Change
“… It is frustrating when you are out at barbecues with friends. Then they eat more while you eat just a little. No, I want to eat normally. I want to eat like them …”(Male with T2D)
“… No, I no longer test my sugar at home, I used to get stressed and worried every time I tested my sugar. So I decided I will only do that when I go to the health center.”(Male with T2D)
“… sometimes we call and call and do not reach the patient. Maybe they have moved or are abroad for about 10 months. I don’t know what they do in their home countries. Some come back but with high glucose values. Others don’t come, so we also give up.”(Healthcare manager)
“What is problematic then is that, the perception of food, treatment and physical activity is perhaps different from what we are used to.”(Healthcare manger)
3.5. Differing Views of Self-Management Support
“They try to help me with everything. My wife is trying to help me with the cooking and such. My wife watches what I eat. She makes a lot of salad, fish, chicken and little rice and no sugar.”(Male with T2D)
“… they are not with you every day to choose for you what you should or should not eat or what you should or should not do. You are alone with your diabetes … no one can help you except yourself …”(Male with T2D)
“… A separate group is better because women have this thing, if it is a walk, men go fast but women are not as fast as men and during walking we can discuss and talk about some things … When women are alone, I do not know, but it’s better that way.”(Female with T2D).
4. Discussion
4.1. Diabetes Perceptions
4.2. Glycemic Control for T2D
4.3. From New Routines to Sustainable Change
4.4. Self-Management Support
4.5. Methodological Considerations
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
References
- Hjelm, K.; Bard, K.; Apelqvist, J. Gestational diabetes: Prospective interview-study of the developing beliefs about health, illness and health care in migrant women. J. Clin. Nurs. 2012, 21, 3244–3256. [Google Scholar] [CrossRef] [PubMed]
- Lorig, K.R.; Sobel, D.S.; Ritter, P.L.; Laurent, D.; Hobbs, M. Effect of a self-management program on patients with chronic disease. Effic. Clin. Pract. 2001, 4, 256–262. [Google Scholar]
- Moser, A.; van der Bruggen, H.; Widdershoven, G.; Spreeuwenberg, C. Self-management of type 2 diabetes mellitus: A qualitative investigation from the perspective of participants in a nurse-led, shared-care programme in the Netherlands. BMC Public Health 2008, 8, 91. [Google Scholar] [CrossRef] [PubMed]
- Norris, S.L.; Engelgau, M.M.; Venkat Narayan, K.M. Effectiveness of self-management training in type 2 diabetes: A systematic review of randomized controlled trials. Diabetes Care 2001, 24, 561–587. [Google Scholar] [CrossRef] [PubMed]
- Anderson, R.M.; Funnell, M.M. Patient empowerment: Reflections on the challenge of fostering the adoption of a new paradigm. Patient Educ. Couns. 2005, 57, 153–157. [Google Scholar] [CrossRef] [PubMed]
- Anderson, R.M.; Funnell, M.M. Patient empowerment: Myths and misconceptions. Patient Educ. Couns. 2010, 79, 277–282. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kennedy, A.; Rogers, A.; Vassilev, I.; Todorova, E.; Roukova, P.; Foss, C.; Knutsen, I.; Portillo, M.C.; Mujika, A.; Serrano-Gil, M.; et al. Dynamics and nature of support in the personal networks of people with type 2 diabetes living in Europe: Qualitative analysis of network properties. Health Expect. 2014, 18, 3172–3185. [Google Scholar] [CrossRef] [PubMed]
- Vassilev, I.; Rogers, A.; Kennedy, A.; Koetsenruijter, J. The influence of social networks on self-management support: A metasynthesis. BMC Public Health 2014, 14, 719. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bertero, C.; Hjelm, K. Social support as described by foreign-born persons diagnosed with type 2 diabetes mellitus and living in Sweden. Nurs. Health Sci. 2010, 12, 507–514. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Stuckler, D.; Siegel, K. Sick Societies: Responding to the Global Challenge of Chronic Disease. Occup. Med. 2012, 62, 388–389. [Google Scholar] [CrossRef]
- Bhopal, R.S.; Douglas, A.; Wallia, S.; Forbes, J.F.; Lean, M.E.; Gill, J.M.; McKnight, J.A.; Sattar, N.; Sheikh, A.; Wild, S.H.; et al. Effect of a lifestyle intervention on weight change in south Asian individuals in the UK at high risk of type 2 diabetes: A family-cluster randomised controlled trial. Lancet Diabetes Endocrinol. 2014, 2, 218–227. [Google Scholar] [CrossRef]
- Inzucchi, S.E.; Bergenstal, R.M.; Buse, J.B.; Diamant, M.; Ferrannini, E.; Nauck, M.; Peters, A.L.; Tsapas, A.; Wender, R.; Matthews, D.R. Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach. Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2012, 35, 1364–1379. [Google Scholar]
- Booth, A.O.; Lowis, C.; Dean, M.; Hunter, S.J.; McKinley, M.C. Diet and physical activity in the self-management of type 2 diabetes: Barriers and facilitators identified by patients and health professionals. Prim. Health Care Res. Dev. 2013, 14, 293–306. [Google Scholar] [CrossRef] [PubMed]
- Ryan, R.M.; Deci, E.L. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am. Psychol. 2000, 55, 68–78. [Google Scholar] [CrossRef] [PubMed]
- Newton, P.; Asimakopoulou, K.; Scambler, S. A Qualitative Exploration of Motivation to Self-Manage and Styles of Self-Management amongst People Living with Type 2 Diabetes. J. Diabetes Res. 2015, 2015, 638205. [Google Scholar] [CrossRef] [PubMed]
- Grady, P.A.; Gough, L.L. Self-Management: A Comprehensive Approach to Management of Chronic Conditions. Am. J. Public Health 2014, 104, e25–e31. [Google Scholar] [CrossRef] [PubMed]
- Kelly, M.P.; Barker, M. Why is changing health-related behaviour so difficult? Public Health 2016, 136, 109–116. [Google Scholar] [CrossRef] [PubMed]
- Ahlin, K.; Billhult, A. Lifestyle changes—A continuous, inner struggle for women with type 2 diabetes: A qualitative study. Scand. J. Prim. Health Care 2012, 30, 41–47. [Google Scholar] [CrossRef] [PubMed]
- Mosnier-Pudar, H.; Hochberg, G.; Eschwege, E.; Halimi, S.; Virally, M.L.; Guillausseau, P.J.; Touboul, C.; Dejager, S. How patients’ attitudes and opinions influence self-care behaviours in type 2 diabetes. Insights from the French DIABASIS Survey. Diabetes Metab. 2010, 36, 476–483. [Google Scholar] [CrossRef] [PubMed]
- Wallin, A.M.; Lofvander, M.; Ahlstrom, G. Diabetes: A cross-cultural interview study of immigrants from Somalia. J. Clin. Nurs. 2007, 16, 305–314. [Google Scholar] [CrossRef] [PubMed]
- Mosnier-Pudar, H.; Hochberg, G.; Eschwege, E.; Virally, M.L.; Halimi, S.; Guillausseau, P.J.; Peixoto, O.; Touboul, C.; Dubois, C.; Dejager, S. How do patients with type 2 diabetes perceive their disease? Insights from the French DIABASIS survey. Diabetes Metab. 2009, 35, 220–227. [Google Scholar] [CrossRef] [PubMed]
- Nagelkerk, J.; Reick, K.; Meengs, L. Perceived barriers and effective strategies to diabetes self-management. J. Adv. Nurs. 2006, 54, 151–158. [Google Scholar] [CrossRef] [PubMed]
- Flores, G. Culture and the patient-physician relationship: Achieving cultural competency in health care. J. Pediatr. 2000, 136, 14–23. [Google Scholar] [CrossRef]
- Wachtler, C.; Brorsson, A.; Troein, M. Meeting and treating cultural difference in primary care: A qualitative interview study. Fam. Pract. 2006, 23, 111–115. [Google Scholar] [CrossRef] [PubMed]
- Ferguson, W.J.; Candib, L.M. Culture, language, and the doctor-patient relationship. Fam. Med. 2002, 34, 353–361. [Google Scholar] [PubMed]
- Agardh, E.E.; Ahlbom, A.; Andersson, T.; Efendic, S.; Grill, V.; Hallqvist, J.; Ostenson, C.G. Explanations of socioeconomic differences in excess risk of type 2 diabetes in Swedish men and women. Diabetes Care 2004, 27, 716–721. [Google Scholar] [CrossRef] [PubMed]
- Wandell, P.E.; Gafvels, C. High prevalence of diabetes among immigrants from non-European countries in Sweden. Prim. Care Diabetes 2007, 1, 13–16. [Google Scholar] [CrossRef] [PubMed]
- Wandell, P.E.; Wajngot, A.; de Faire, U.; Hellenius, M.L. Increased prevalence of diabetes among immigrants from non-European countries in 60-year-old men and women in Sweden. Diabetes Metab. 2007, 33, 30–36. [Google Scholar] [CrossRef] [PubMed]
- Stringhini, S.; Sabia, S.; Shipley, M.; Brunner, E.; Nabi, H.; Kivimaki, M.; Singh-Manoux, A. Association of socioeconomic position with health behaviors and mortality. JAMA 2010, 303, 1159–1166. [Google Scholar] [CrossRef] [PubMed]
- Agerholm, J.; Bruce, D.; Ponce de Leon, A.; Burstrom, B. Socioeconomic differences in healthcare utilization, with and without adjustment for need: An example from Stockholm, Sweden. Scand. J. Public Health 2013, 41, 318–325. [Google Scholar] [CrossRef] [PubMed]
- Immigration and Emigration by Sex and Country of Birth 1970–2017 and Projection 2018–2070. Available online: http://www.scb.se/en/finding-statistics/statistics-by-subject-area/population/population-projections/population-projections/pong/tables-and-graphs/immigration-and-emigration-by-sex-and-country-of-birth-19702017-and-projection-20182070/ (accessed on 5 April 2018).
- Wandell, P.E.; Carlsson, A.; Steiner, K.H. Prevalence of diabetes among immigrants in the Nordic countries. Curr. Diabetes Rev. 2010, 6, 126–133. [Google Scholar] [CrossRef] [PubMed]
- Carlsson, A.C.; Wandell, P.E.; Hedlund, E.; Walldius, G.; Nordqvist, T.; Jungner, I.; Hammar, N. Country of birth-specific and gender differences in prevalence of diabetes in Sweden. Diabetes Res. Clin. Pract. 2013, 100, 404–408. [Google Scholar] [CrossRef] [PubMed]
- Andersson, T.; Ahlbom, A.; Carlsson, S. Diabetes Prevalence in Sweden at Present and Projections for Year 2050. PLoS ONE 2015, 10, e0143084. [Google Scholar] [CrossRef] [PubMed]
- Glans, F.; Elgzyri, T.; Shaat, N.; Lindholm, E.; Apelqvist, J.; Groop, L. Immigrants from the Middle-East have a different form of Type 2 diabetes compared with Swedish patients. Diabet. Med. 2008, 25, 303–307. [Google Scholar] [CrossRef] [PubMed]
- Hjelm, K.; Bard, K.; Nyberg, P.; Apelqvist, J. Religious and cultural distance in beliefs about health and illness in women with diabetes mellitus of different origin living in Sweden. Int. J. Nurs. Stud. 2003, 40, 627–643. [Google Scholar] [CrossRef]
- Taloyan, M.; Wajngot, A.; Johansson, S.E.; Tovi, J.; Sundquist, K. Sexual dysfunction in Assyrian/Syrian immigrants and Swedish-born persons with type 2 diabetes. BMC Res. Notes 2012, 5, 522. [Google Scholar] [CrossRef] [PubMed]
- Franklin, M.; Lewis, S.; Willis, K.; Bourke-Taylor, H.; Smith, L. Patients’ and healthcare professionals’ perceptions of self-management support interactions: Systematic review and qualitative synthesis. Chronic Illn. 2018, 14, 79–103. [Google Scholar] [CrossRef] [PubMed]
- Peyrot, M.; Rubin, R.R.; Lauritzen, T.; Skovlund, S.E.; Snoek, F.J.; Matthews, D.R.; Landgraf, R. Patient and provider perceptions of care for diabetes: results of the cross-national DAWN Study. Diabetologia 2006, 49, 279–288. [Google Scholar] [PubMed]
- Fitzgerald, J.T.; Stansfield, R.B.; Tang, T.; Oh, M.; Frohna, A.; Armbruster, B.; Gruppen, L.; Anderson, R. Patient and Provider Perceptions of Diabetes: Measuring and evaluating differences. Patient Educ. Couns. 2008, 70, 118–125. [Google Scholar] [CrossRef] [PubMed]
- Tang, T.S.; Stansfield, R.B.; Oh, M.; Anderson, R.M.; Fitzgerald, J.T. Patient-provider perceptions of diabetes and its impact on self-management: A comparison of African-American and White patients. Diabet. Med. 2008, 25, 341–348. [Google Scholar] [CrossRef] [PubMed]
- Guwatudde, D.; Absetz, P.; Delobelle, P.; Östenson, C.-G.; Olmen Van, J.; Alvesson, H.M.; Mayega, R.W.; Ekirapa Kiracho, E.; Kiguli, J.; Sundberg, C.J.; et al. Study protocol for the SMART2D adaptive implementation trial: A cluster randomised trial comparing facility-only care with integrated facility and community care to improve type 2 diabetes outcomes in Uganda, South Africa and Sweden. BMJ Open 2018, 8, e019981. [Google Scholar] [CrossRef] [PubMed]
- Statistik Årsbok för Stockholm 2018. Available online: http://statistik.stockholm.se/attachments/article/38/Statistisk%20%C3%83%C2%A5rsbok%20f%C3%83%C2%B6r%20Stockholm%202018.pdf (accessed on 16 June 2018).
- Sundquist, K.; Malmstrom, M.; Johansson, S.E.; Sundquist, J. Care Need Index, a useful tool for the distribution of primary health care resources. J. Epidemiol. Community Health 2003, 57, 347–352. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wenzel, H.; Jansson, S.; Landin-Olsson, M. Integrated Diabetes Care: A Multidisciplinary Approach, 1st ed.; Springer International Publishing: Berlin, Germany, 2017; pp. 201–214. ISBN 978-3-319-13389-8. [Google Scholar]
- Stockholm County Council. Diabetes Inom Primärvården 2013. Available online: https://www.vardgivarguiden.se/globalassets/utbildning-och-utveckling/vardutveckling/fokusrapporter/diabetes-inom-primarvarden-2013.pdf (accessed on 5 April 2018).
- The National Board of Health and Welfare. National guidelines for Diabetes Care: Support for Governance and Management. Available online: https://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/19803/2015-4-12.pdf (accessed on 15 June 2018).
- Zapata-Barrero, R. Interculturalism in the post-multicultural debate: A defence. Comp. Migr. Stud. 2017, 5, 14. [Google Scholar] [CrossRef] [PubMed]
- Taylor, C. Interculturalism or multiculturalism? P&SC 2012, 38, 413–423. [Google Scholar]
- Hellgren, M.I.; Petzold, M.; Bjorkelund, C.; Wedel, H.; Jansson, P.A.; Lindblad, U. Feasibility of the FINDRISC questionnaire to identify individuals with impaired glucose tolerance in Swedish primary care. A cross-sectional population-based study. Diabet. Med. 2012, 29, 1501–1505. [Google Scholar] [CrossRef] [PubMed]
- Green, J.; Thorogood, N. Qualitative Methods for Health Research, 1st ed.; Sage: Thousand Oaks, CA, USA, 2018. [Google Scholar]
- Vaismoradi, M.; Turunen, H.; Bondas, T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs. Health Sci. 2013, 15, 398–405. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Braun, V.; Clarke, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef] [Green Version]
- Wallin, A.M.; Ahlstrom, G. From diagnosis to health: A cross-cultural interview study with immigrants from Somalia. Scand. J. Caring Sci. 2010, 24, 357–365. [Google Scholar] [CrossRef] [PubMed]
- Adriaanse, M.; Snoek, F.; Dekker, J.; van der Ploeg, H.; Heine, R. Screening for Type 2 diabetes: An exploration of subjects’ perceptions regarding diagnosis and procedure. Diabet. Med. 2002, 19, 406–411. [Google Scholar] [PubMed]
- Koch, T.; Jenkin, P.; Kralik, D. Chronic illness self-management: Locating the “self”. J. Adv. Nurs. 2004, 484–492. [Google Scholar] [CrossRef] [PubMed]
- Jayne, R.L.; Rankin, S.H. Application of Leventhal’s self-regulation model to Chinese immigrants with type 2 diabetes. J. Nurs. Scholarsh. 2001, 33, 53–59. [Google Scholar] [CrossRef] [PubMed]
- Bramberg, E.B.; Dahlborg-Lyckhage, E.; Maatta, S. Lack of individualized perspective: A qualitative study of diabetes care for immigrants in Sweden. Nurs. Health Sci. 2012, 14, 244–249. [Google Scholar] [CrossRef] [PubMed]
- Andersen, J.H.; Whyte, S.R. Measuring risk, managing values: Health technology and subjectivity in Denmark. Anthropol. Med. 2014, 21, 265–276. [Google Scholar] [CrossRef] [PubMed]
- Rothman, R.L.; Montori, V.M.; Cherrington, A.; Pignone, M.P. Perspective: The Role of Numeracy in Health Care. J. Health Commun. 2008, 13, 583–595. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Huizinga, M.M.; Elasy, T.A.; Wallston, K.A.; Cavanaugh, K.; Davis, D.; Gregory, R.P.; Fuchs, L.S.; Malone, R.; Cherrington, A.; DeWalt, D.A.; et al. Development and validation of the Diabetes Numeracy Test (DNT). BMC Health Serv. Res. 2008, 8, 96. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Osborn, C.Y.; Cavanaugh, K.; Wallston, K.A.; White, R.O.; Rothman, R.L. Diabetes Numeracy: An overlooked factor in understanding racial disparities in glycemic control. Diabetes Care 2009, 32, 1614–1619. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Zaugg, S.D.; Dogbey, G.; Collins, K.; Reynolds, S.; Batista, C.; Brannan, G.; Shubrook, J.H. Diabetes Numeracy and Blood Glucose Control: Association With Type of Diabetes and Source of Care. Clin. Diabetes 2014, 32, 152–157. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cavanaugh, K.; Wallston, K.A.; Gebretsadik, T.; Shintani, A.; Huizinga, M.M.; Davis, D.; Gregory, R.P.; Malone, R.; Pignone, M.; DeWalt, D.; et al. Addressing Literacy and Numeracy to Improve Diabetes Care. Two randomized controlled trials. Diabetes Care 2009, 32, 2149–2155. [Google Scholar] [CrossRef] [PubMed]
- Evans, J.M.; Mackison, D.; Swanson, V.; Donnan, P.T.; Emslie-Smith, A.; Lawton, J. Self-monitoring of blood glucose in type 2 diabetes: Patients’ perceptions of ‘high’ readings. Diabetes Res. Clin. Pract. 2013, 102, 5–7. [Google Scholar] [CrossRef] [PubMed]
- Hye Seung, J. Clinical Implications of Glucose Variability: Chronic Complications of Diabetes. J. Clin. Endocrinol. Metab. 2015, 30, 167–174. [Google Scholar]
- Cavero-Redondo, I.; Peleteiro, B.; Álvarez-Bueno, C.; Garrido-Miguel, M.; Artero, E.G.; Martinez-Vizcaino, V. The effects of physical activity interventions on glycated haemoglobin A1c in non-diabetic populations: A protocol for a systematic review and meta-analysis. BMJ Open 2017, 7, e015801. [Google Scholar] [CrossRef] [PubMed]
- Fritschi, C.; Quinn, L. Fatigue in patients with diabetes: A review. J. Psychosom. Res. 2010, 69, 33–41. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Jallinoja, P.; Absetz, P.; Kuronen, R.; Nissinen, A.; Talja, M.; Uutela, A.; Patja, K. The dilemma of patient responsibility for lifestyle change: Perceptions among primary care physicians and nurses. Scand. J. Prim. Health Care 2007, 25, 244–249. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Isaksson, U.; Hajdarevic, S.; Abramsson, M.; Stenvall, J.; Hornsten, A. Diabetes empowerment and needs for self-management support among people with type 2 diabetes in a rural inland community in northern Sweden. Scand. J. Caring Sci. 2015, 29, 521–527. [Google Scholar] [CrossRef] [PubMed]
- Akiyama, H.; Antonucci, T. An Examination of Sex Differences in Social Support Among Older Men and Women. Sex Roles 1987, 17, 737–749. [Google Scholar]
- Boonsatean, W.; Dychawy, R.I.; Carlsson, A.; Östman, M. The Influences of Income and Education on the Illness Perception and Self-Management of Thai Adults with Type 2 Diabetes. J. Diabetes Metab. Disord. 2016, 3, 017. [Google Scholar] [CrossRef]
- Al-Murani, F.; Aweko, J.; Nordin, I.; Delobelle, P.; Kasujja, F.X.; Östenson, C.-G.; Peterson, S.S.; Daivadanam, M.; Alvesson, M.H. Community and stakeholder engagement in the prevention and management of type 2 diabetes: A qualitative study in socioeconomically disadvantaged suburbs in Stockholm. Glob. Health Act. 2018. under review. [Google Scholar]
- Malterud, K.; Siersma, V.D.; Guassora, A.D. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual. Health Res. 2015, 26, 1753–1760. [Google Scholar] [CrossRef] [PubMed]
Characteristics | Women | Men |
---|---|---|
Number of participants | 6 | 6 |
Duration of diabetes | ||
<5 | 3 | 2 |
≥5 | 3 | 4 |
Length of stay in Sweden (in years) | ||
5–15 | 3 | 1 |
>15 | 3 | 5 |
Employment status | ||
Employed | 3 | 3 |
Unemployed | 3 | 3 |
Education level | ||
Primary school | 2 | 2 |
High school | 2 | 2 |
University | 2 | 2 |
Age group | ||
35–59 | 2 | 4 |
>60 | 4 | 2 |
Characteristics | Women | Men |
---|---|---|
Number of participants | 8 | 2 |
Profession | ||
Doctors | 1 | 1 |
Nurses | 5 | - |
Healthcare managers | 3 | 1 |
Years of experience | ||
<5 | 1 | - |
6–10 | 2 | 1 |
>10 | 5 | 1 |
Themes: Dilemmas | Sub-Themes | Categories |
---|---|---|
Patient dilemma: Adopting and maintaining new routines through practical and appropriate lifestyle choices | Diabetes as part of aging and family history | Not as serious as conditions like hypertension and cancer (patient) Patients do not perceive diabetes as serious (provider) |
Glucose control through numbers | Interpreting diabetes control through numbers (patient) Easy to communicate numbers (provider) | |
Provider dilemma: Balancing expectations and pre-conceptions of self-management | Tailoring of information and advice to fit daily life | Insufficient information (patient) Adopting selective recommendations (patient) Ignoring impossible recommendations (patient) Cultural differences as a barrier to interaction (provider) Balancing opposing roles of self-management responsibility (provider) |
Frustrations associated with sustaining change | Realizing chronicity (patient) Stress and anxiety of monitoring glucose levels (patient) Belief in education to promote behavior change (provider) Coping with “difficult” patients (provider) | |
Differing views of self-management support | Expecting support from family (patient) Low expectation of support from friends and peers Balancing between family support and patient privacy (provider) |
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Aweko, J.; De Man, J.; Absetz, P.; Östenson, C.-G.; Swartling Peterson, S.; Mölsted Alvesson, H.; Daivadanam, M. Patient and Provider Dilemmas of Type 2 Diabetes Self-Management: A Qualitative Study in Socioeconomically Disadvantaged Communities in Stockholm. Int. J. Environ. Res. Public Health 2018, 15, 1810. https://doi.org/10.3390/ijerph15091810
Aweko J, De Man J, Absetz P, Östenson C-G, Swartling Peterson S, Mölsted Alvesson H, Daivadanam M. Patient and Provider Dilemmas of Type 2 Diabetes Self-Management: A Qualitative Study in Socioeconomically Disadvantaged Communities in Stockholm. International Journal of Environmental Research and Public Health. 2018; 15(9):1810. https://doi.org/10.3390/ijerph15091810
Chicago/Turabian StyleAweko, Juliet, Jeroen De Man, Pilvikki Absetz, Claes-Göran Östenson, Stefan Swartling Peterson, Helle Mölsted Alvesson, and Meena Daivadanam. 2018. "Patient and Provider Dilemmas of Type 2 Diabetes Self-Management: A Qualitative Study in Socioeconomically Disadvantaged Communities in Stockholm" International Journal of Environmental Research and Public Health 15, no. 9: 1810. https://doi.org/10.3390/ijerph15091810