Perception of Barriers to Self-care Management Among Diabetic Patients

2009 ◽  
Vol 35 (5) ◽  
pp. 778-788 ◽  
Author(s):  
Julie A. Gazmararian ◽  
David C. Ziemer ◽  
Catherine Barnes
Keyword(s):  
Focus Group ◽  
Low Income ◽  
Diabetes Management ◽  
Lifestyle Changes ◽  
School Level ◽  
Self Management ◽  
Diabetic Patients ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Patients With Diabetes

Purpose The purpose of this study was to explore individual, educational, and system barriers that limit low-income diabetes patients’ ability to achieve optimal diabetes self-management. Methods Economically disadvantaged patients with diabetes who used the Diabetes Clinic of Grady Health System in Atlanta, Georgia, participated in 3 focus group discussions. Results The discussions were held with mostly African Americans (n = 35) to explore barriers to achieving optimal diabetes self-management. Most participants were not married, approximately one-third had less than high school level reading skills, and 40% were not currently working. In terms of individual barriers, the emotional toll from the diagnosis of and lifestyle changes to treat diabetes was a recurrent theme, and included stress, frustration, social isolation, interpersonal conflicts, depression, and fear. Denial was often mentioned as the key factor that inhibited adherence to a healthy mode of living. The educational barriers were failure to recognize the risks and consequences of an asymptomatic condition. Many participants did not understand A1C. Finally, several system barriers were identified. The participants identified needed services, including follow-up and refresher courses, support group discussions, nutrition and medication education, availability of different education modalities, and expanded clinic hours. Conclusions The focus group discussions identified both barriers to diabetes management and opportunities for improving care for underserved patients with diabetes. The results are useful to improve the delivery of care and to develop quantitative studies to explore particular areas of interest. Based on these results, the current system needs to provide more support and education to patients with diabetes.

scholarly journals IMPLEMENTASI KEBIJAKAN PEMBANGUNAN PERUMAHAN BAGI MASYARAKAT BERPENGHASILAN RENDAH DI RUSUNAWA KELURAHAN DUSUN BESAR KECAMATAN SINGARAN PATI KOTA BENGKULU

2015 ◽  
Vol 1 (2) ◽  
Author(s):  
Anita Marianata
Keyword(s):  
Focus Group ◽  
Data Collection ◽  
Low Income ◽  
Development Policy ◽  
Policy Development ◽  
Housing Development ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
The Government ◽  
Depth Interviews

This study aims to determine the implementation of housing development policy for low income communities in Kelurahan Dusun Besar, Singaranpati Subdistrict, Bengkulu City. This study uses a qualitative desciptive method and the data collection was conducted through in-depth interviews, focus group discussions, and documentation method. The results shows that the implementation of Rusunawa (simple rented flats) policy development in Kelurahan Dusun Besar has not been appropriate with expectation. The physical condition of Rusunawa is not habitable, because the construction of Rusunawa has not finished or neglected until now. From the 96 residence in total, only 23 units were inhabited. The Rusunawa management also did not collect the rent, due the condition of facilities in Rusunawa was not adequate such as unavailable water supply. Besides, the Rusunawa management recognized that there was no authority resignation directly from the government of Bengkulu City to the management, so that the managers did not know exactly when these flats will be resolved or the rent expense will be charged. Moreover, there was no program to improve the economy of low-income communities, so the empowerment of low- income communities living in Rusunawa was impossible. Keywords: Implementation of Policy, Housing Policy, Socio-Economics, Low-Income Communities

scholarly journals Patient, caregiver, and health care provider perspectives on barriers and facilitators to heart failure care in Kerala, India: A qualitative study

2020 ◽  
Vol 5 ◽  
pp. 250
Author(s):  
Prinu Jose ◽  
Ranjana Ravindranath ◽  
Linju M. Joseph ◽  
Elizabeth C. Rhodes ◽  
Sanjay Ganapathi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Focus Group ◽  
Qualitative Study ◽  
Health Care Providers ◽  
Self Management ◽  
Care Providers ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
High Quality

Background: Deficits in quality of care for patients with heart failure (HF) contribute to high mortality in this population. This qualitative study aims to understand the barriers and facilitators to high-quality HF care in Kerala, India. Methods: Semi-structured, in-depth interviews were conducted with a purposive sample of health care providers (n=13), patients and caregivers (n=14). Additionally, focus group discussions (n=3) were conducted with patients and their caregivers. All interviews and focus group discussions were transcribed verbatim. Textual data were analysed using thematic analysis. Results: Patients’ motivation to change their lifestyle behaviours after HF diagnosis and active follow-up calls from health care providers to check on patients’ health status were important enablers of high-quality care. Health care providers’ advice on substance use often motivated patients to stop smoking and consuming alcohol. Although patients expected support from their family members, the level of caregiver support for patients varied, with some patients receiving strong support from caregivers and others receiving minimal support. Emotional stress and lack of structured care plans for patients hindered patients’ self-management of their condition. Further, high patient loads often limited the time health care providers had to provide advice on self-management options. Nevertheless, the availability of experienced nursing staff to support patients improved care within health care facilities. Finally, initiation of guideline-directed medical therapy was perceived as complex by health care providers due to multiple coexisting chronic conditions in HF patients. Conclusions: Structured plans for self-management of HF and more time for patients and health care providers to interact during clinical visits may enable better clinical handover with patients and family members, and thereby improve adherence to self-care options. Quality improvement interventions should also address the stress and emotional concerns of HF patients.

scholarly journals TRACK Implementation: a Bangladesh Scenario

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Abdul Kader Mohiuddin
Keyword(s):  
Low Income ◽  
Diabetes Management ◽  
Health Care Cost ◽  
Lifestyle Changes ◽  
Health Concern ◽  
Diabetic Patients ◽  
Middle Income ◽  
Middle Income Countries ◽  
Hospitalization Costs ◽  
The Cost

With the increasing burden of non-communicable diseases in low-income and middle-income countries (LMICs), biological risk factors, such as hyperglycemia, are a major public health concern in Bangladesh. Optimization of diabetes management by positive lifestyle changes is urgently required for prevention of comorbidities and complications, which in turn will reduce the cost. Diabetes had 2 times more days of inpatient treatment, 1.3 times more outpatient visits, and nearly 10 times more medications than non- diabetes patients, as reported by British Medical Journal. And surprisingly, 80% of people with this so called “Rich Man's Disease” live in low- and middle-income countries. According to a recent study of American Medical Association, China and India collectively are home of nearly 110 million diabetic patients. The prevalence of diabetes in this region is projected to increase by 71% by 2035. Bangladesh was ranked as the 8th highest diabetic populous country in the time period of 2010-2011. In Bangladesh, the estimated prevalence of diabetes among adults was 9.7% in 2011 and the number is projected to be 13.7 million by 2045. The cost of diabetes care is considerably high in Bangladesh, and it is primarily driven by the medicine and hospitalization costs. According to Bangladesh Bureau of Statistics, in 2017 the annual average cost per T2DM was $864.7, which is 52% of per capita GDP of Bangladesh and 9.8 times higher than the general health care cost. Medicine is the highest source of direct cost (around 85%) for patients without hospitalization. The private and public financing of diabetes treatment will be severely constrained in near future, representing a health threat for the Bangladeshi population.

Exploring vaginal ring acceptability for contraception and sexually transmissible infection protection in India: a qualitative research study

Sexual Health ◽  
2015 ◽  
Vol 12 (6) ◽  
pp. 532 ◽  
Author(s):  
Udita Das ◽  
Mamta Sharma ◽  
Maggie Kilbourne-Brook ◽  
Patricia S. Coffey
Keyword(s):  
Focus Group ◽  
Low Income ◽  
New Technologies ◽  
Relevant Literature ◽  
Male Partner ◽  
Vaginal Ring ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Sexually Transmissible Infections ◽  
Vaginal Rings

Background New vaginal rings are being developed as single and multipurpose prevention technologies to protect women from pregnancy and/or sexually transmissible infections, such as HIV. Data on ring acceptability in low-resource settings is critical for new technologies to meet user needs. Methods: Women from slum and lower-income areas around Delhi, India, participated in focus group discussions on vaginal ring product perceptions and preferences. Participants were recruited based on following eligibility categories: age, marital status, contraceptive use, and number of children. The translated transcriptions of the qualitative data were analysed using a coding scheme generated from the areas of inquiry and relevant literature. Results: A total of 103 women from lower-middle-class or slum areas in Delhi participated in 13 focus group discussions between December 2012 and January 2013. Participants shared perceptions of vaginal ring product attributes, including size, colour, intended use (single indication or dual purpose), duration of use, side effects, biodegradability, and various preferences regarding product use, including access, use during sex, wear patterns, cleaning, and disposal. Participants also reflected on willingness to pay and male partner acceptability. Conclusions: The results of this hypothetical acceptability study indicate that these low-income women in Delhi are: willing to try vaginal rings; unconcerned about wearing them during sex; very interested in protection from infections and unintended pregnancy; indifferent about colour of new rings; emphatic about being told that rings may change colour from menstrual blood staining; comfortable with thinner rings; willing to try thicker rings once familiar with thinner rings; in favour of starting with 1-month rings and then transitioning to longer-term rings; and in favour of first accessing rings at a facility and then managing resupply independently.

scholarly journals Experiences of using a digital type 2 diabetes prevention application designed to support women with previous gestational diabetes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Winifred Ekezie ◽  
Helen Dallosso ◽  
Ponnusamy Saravanan ◽  
Kamlesh Khunti ◽  
Michelle Hadjiconstantinou
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Focus Group ◽  
Gestational Diabetes ◽  
Technical Skills ◽  
Self Management ◽  
Focus Group Discussions ◽  
Group Discussions

Abstract Background Gestational diabetes mellitus (GDM) is diagnosed during pregnancy, and women with a history of GDM are at a higher risk of developing type 2 diabetes mellitus (T2DM). Prevention strategies focused on lifestyle modification help to reduce long-term complications. Self-management technology-based interventions can support behaviour change and diabetes control. The Baby Steps programme, a randomised controlled trial intervention offering group education and access to a mobile web application, was evaluated to explore user experience of the app and barriers and facilitators to app usability. Methods Ten semi-structured interviews and four focus group discussions were conducted with 23 trial participants between 2018 and 2019. Interviews and focus group discussions were audiotaped, transcribed and independently analysed. The analysis was informed by thematic analysis, with the use of the Nvivo 12 software. Results Themes identified were: (1) GDM and post-pregnancy support from healthcare services; (2) Impact of Baby Steps app on lifestyle changes; (3) Facilitators and barriers to the usability of the Baby Steps app. The Baby Steps app served as a motivator for increasing self-management activities and a tool for monitoring progress. Peer support and increased awareness of GDM and T2DM enhanced engagement with the app, while poor awareness of all the components of the app and low technical skills contributed to low usability. Conclusions This study documents experiences from existing GDM support, user experiences from using the Baby Steps app, and the barriers and facilitators to app usability. The app was both a motivational and a monitoring tool for GDM self-management and T2DM prevention. Peer support was a key trait for enhanced engagement, while barriers were low technical skills and poor awareness of the app components. A digital app, such as the Baby Steps app, could strengthen existing face-to-face support for the prevention of T2DM. The results also have wider implications for digital support technologies for all self-management interventions. Further research on the effect of specific components of apps will be required to better understand the long term impact of apps and digital interventions on self-management behaviours and outcomes. Trial registration ISRCTN, ISRCTN17299860. Registered on 5 April 2017.

scholarly journals Challenges and opportunities associated with cervical cancer screening programs in a low income, high HIV prevalence context

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Adebola Adedimeji ◽  
Rogers Ajeh ◽  
Amanda Pierz ◽  
Relindis Nkeng ◽  
Jackson Ndenkeh ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Focus Group ◽  
Cancer Prevention ◽  
Cervical Cancer Screening ◽  
Low Income ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Challenges And Opportunities ◽  
Depth Interviews

Abstract Background Cervical cancer is a leading cause of death among Cameroon women. The burden of cervical cancer is in part traceable to the inadequate understanding of socio-contextual determinants of access to screening and prevention opportunities. We explored multilevel individual, community and structural factors that facilitate or inhibit cervical cancer prevention in women at risk in a low-income, high HIV prevalence context. Methods We utilized an exploratory qualitative approach to obtain data through focus group discussions and in-depth interviews from May to August, 2018. A two-stage purposive sampling strategy was used to select 80 women and 20 men who participated in 8 focus group discussions and 8 in-depth interviews. The socio-ecological model guided data analyses to identify micro-, meso-, and macro-level determinants of cervical cancer screening. Results Micro-level factors including lack of awareness and knowledge about cervical cancer, lack of access to information, excessive cost of cervical cancer screening, low risk perceptions, and poor health seeking behaviors were major barriers for women seeking cervical cancer screening. Meso-level factors, such as social networks, socio-cultural norms, perceptions of the role of men and HIV-related stigma when screening is integrated into HIV care, also engender negative attitudes and behaviors. Macro-level barriers to cervical cancer screening included poorly equipped health facilities and a lack of national cancer prevention policies and programs. Conclusion In the context of the call for elimination of cervical cancer as a public health problem, our findings highlight challenges and opportunities that should be considered when implementing interventions to increase uptake of cervical cancer screening in low-middle income settings.

scholarly journals TRACK (by NEHEP) Implementation: A Bangladesh Scenario

2019 ◽  
pp. 28-36
Author(s):  
Abdul Kader Mohiuddin
Keyword(s):  
Low Income ◽  
Diabetes Management ◽  
Health Care Cost ◽  
Lifestyle Changes ◽  
Health Concern ◽  
Diabetic Patients ◽  
Middle Income ◽  
Middle Income Countries ◽  
Hospitalization Costs ◽  
The Cost

With the increasing burden of non-communicable diseases in Low-Income and Middle-Income Countries (LMICs), biological risk factors, such as hyperglycemia, are a major public health concern in Bangladesh. Optimization of diabetes management by positive lifestyle changes is urgently required for prevention of comorbidities and complications, which in turn will reduce the cost. Diabetes had 2 times more days of inpatient treatment, 1.3 times more outpatient visits, and nearly 10 times more medications than non-diabetes patients, as reported by British Medical Journal. And surprisingly, 80% of people with this so called Rich Man’s Disease live in low-and middle-income countries. According to a recent study of American Medical Association, China and India collectively are home of nearly 110 million diabetic patients. The prevalence of diabetes in this region is projected to increase by 71% by 2035. Bangladesh was ranked as the 8th highest diabetic populous country in the time period of 2010-2011. In Bangladesh, the estimated prevalence of diabetes among adults was 9.7% in 2011 and the number is projected to be 13.7 million by 2045. The cost of diabetes care is considerably high in Bangladesh, and it is primarily driven by the medicine and hospitalization costs. According to Bangladesh Bureau of Statistics, in 2017 the annual average cost per Type 2 Diabetes Mellitus (T2DM) was $864.7, which is 52% of per capita Gross Domestic Product (GDP) of Bangladesh and 9.8 times higher than the general health care cost. Medicine is the highest source of direct cost (around 85%) for patients without hospitalization. The private and public financing of diabetes treatment will be severely constrained in near future, representing a health threat for the Bangladeshi population.

scholarly journals Understanding the Lived Experience of Children With Type 1 Diabetes in Kenya: Daily Routines and Adaptation Over Time

2021 ◽  
pp. 104973232110497
Author(s):  
Tom Palmer ◽  
Cynthia Waliaula ◽  
Geordan Shannon ◽  
Francesco Salustri ◽  
Gulraj Grewal ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Focus Group ◽  
Lived Experience ◽  
Diabetes Management ◽  
Structured Interviews ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Daily Routines ◽  
Over Time

Focusing only on biomedical targets neglects the important role that psychosocial factors play in effective diabetes self-management. This study aims to understand the lived experiences of children with Type 1 Diabetes (T1DM) in Kenya. Children ( n = 15) participated in focus group discussions and photo diary data collection. Focus group discussions and semi-structured interviews were also conducted with caregivers ( n = 14). We describe an adaptation to diabetes over time, identifying four overarching themes: knowledge and awareness, economic exclusion, the importance of social support, and striving for normality. Photo diaries are then categorized to explore daily realities of diabetes management. Children with T1DM in Kenya face varied barriers to care but can lead a “normal” and fulfilling life, provided adequate support is in place. To improve the lives of children with diabetes in this context and others like it, stakeholders must take note of children’s experiences and recognize their multidimensional needs.

scholarly journals Improving the use of focus group discussions in low income settings

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Pauline F. D. Scheelbeek ◽  
Yashua A. Hamza ◽  
Joanna Schellenberg ◽  
Zelee Hill
Keyword(s):  
Focus Group ◽  
Group Dynamics ◽  
Low Income ◽  
Complete Information ◽  
Story Telling ◽  
Quality Of Data ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
The Difference ◽  
Rich Data

Abstract Background The quality of data obtained through Focus Group Discussions (FGDs) is highly dependent on appropriate design and facilitation. In low-income settings steep power gradients between researcher and participants, as well as conversational norms, could reduce the ability of participants to voice personal opinions. Activity-oriented exercises have been suggested as a way overcoming these challenges, however little evidence exists - to date - on their use in low-income settings. We selected six exercises for use in Ethiopia and Nigeria and report our experiences. Methods The six exercises (picture sorting, associative pictures, picture ranking, decision trees, predictive story-telling and provocative statements) were used in 32 maternal and new-born care themed FGDs conducted in Amhara and Southern Nations Nationalities and People’s Regions (Ethiopia) and Gombe State (Nigeria). Six facilitators and two supervisors who used these exercises were interviewed about their experiences. FGD verbatim transcripts and interview notes were analysed to explore methodological effectiveness and respondents’ experience. All data were coded in NVIVO using a deductive coding frame. Results Facilitators and participants described the methods as ‘fun’ and ‘enjoyable’. The exercises yielded more in-depth and complete information than ‘normal’ FGDs, but facilitator’s probing skills and overall FGD group dynamics proved crucial in this success. Explaining and conducting the exercises increased FGD length. Data richness, participant reaction and understanding, and ease of facilitation varied by study site, exercise, and participant group. Overall, the exercises worked better in Nigeria than in Ethiopia. The provocative statement exercise was most difficult for participants to understand, the decision-tree most difficult to facilitate and the picture exercises most enjoyable. The story telling exercise took relatively little time, was well understood, yielded rich data and reduced social desirability bias. Discussion The majority of the exercises proved successful tools in yielding richer and less biased information from FGDs and were experienced as fun and engaging. Tailoring of the exercises, as well as thorough training and selection of the facilitators, were pivotal in this success. The difference in the two countries shows that adequate piloting and adaptation is crucial, and that some exercises may not be adaptable to all settings.

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