Barriers and facilitators to effective type 2 diabetes management in a rural context: A qualitative study with diabetic patients and health professionals

Objectives: The literature has described several positive outcomes related to diabetes management via nurse-led clinics. This is especially true where a shortage of physicians is recorded within a team-based approach. We sought to explore the perceptions of patients with type 2 diabetes towards the current diabetes management visits at public primary health care centers in Muscat, Oman and their opinions towards nurse-led diabetes management clinics. Methods: This pilot qualitative study included seven semi-structured interviews with type 2 diabetes patients from four purposely selected public primary health care centers in Muscat. Qualitative thematic analysis was applied. Results: Patients with type 2 diabetes expressed their satisfaction with the present diabetes management visits at public primary health care. Their opinions towards nurse-led clinic were diverse and divided patients into three categories: those who totally refused the nurse-led clinics, those who accepted the clinics but with reservations, and patients that totally accepted the nurse-led clinics. The patients’ main concern was the nurses’ abilities to handle and understand the disease and its management. Conclusions: Our pilot study revealed type 2 diabetes patients’ satisfaction with the current diabetes management clinics. However, transformation to nurse-led clinics within team-based approach requires further studies with a bigger sample size. Further studies on requirements related to the Omani health care system and a better understanding of patients’ worries and their readiness to accept the concept of nurse-led clinics and their outcomes are also recommended.

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THE EFFECTIVENESS OF CELL PHONE-BASED MENTORING THROUGH SMS ON DIET COMPLIANCE AMONG TYPE 2 DIABETES MELLITUS (T2DM) PATIENTS

International Journal of Nursing and Health Services (IJNHS) ◽

10.35654/ijnhs.v2i3.214 ◽

2019 ◽

Vol 2 (3) ◽

pp. 135-141

Author(s):

Ratna Dewi ◽

Rostinah Manurung ◽

Sarmaida Siregar

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cell Phone ◽

Diabetes Management ◽

Control Group ◽

Diabetic Patients ◽

Dietary Compliance ◽

Diet Compliance

Appropriate diet and physical exercise is part of diabetes management. The role of health professionals is critical to regulating the lifestyle of type 2 DM patients. The study aimed at examining the effectiveness of cell phone-based mentoring on dietary compliance. A quasi-experimental study design, pre and post-test equivalent with the control group. The research was conducted at Bromo Medan Health Center. We recruited 84 diabetic patients and divided into the experimental and control group. The findings showed there was a positive effect on the patients in the experimental group who received the program than patients in the control group who did not receive the application. This strategy is essential and recommended to apply in the routine diet at home. Keywords: short message service (SMS), diet compliance, type 2 diabetes mellitus

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Effect of nutrition education on dietary diversity score of type 2 diabetes patients

10.21203/rs.3.rs-51087/v1 ◽

2020 ◽

Author(s):

Robert Mutagwanya ◽

Christine Magala Nyago ◽

Fredrick Nelson Nakwagala

Keyword(s):

Type 2 Diabetes ◽

Nutrition Education ◽

Diabetes Management ◽

Dietary Diversity ◽

Control Group ◽

Mulago Hospital ◽

Diabetic Patients ◽

The Impact ◽

Diabetes Patients

Abstract Background: Consumption of a varied diet reduces the risk of developing a deficiency or excess of any one nutrient. One of the three corner stones of diabetes management is diet and therefore, dietary diversity is key among diabetes patients. Objective: The objective of this study was to establish the impact of nutrition education on the dietary diversity scores (DDS) among type 2 diabetes patients. Methods: Kant et al method was used for scoring dietary diversity. Data were analyzed using the statistical package for social sciences (SPSS version 21). Pair sample t-test was used to compare total DDS after and before nutrition education. P< 0.05 was considered as statistically significant.Subjects: One hundred type 2 diabetic patients were randomly selected and divided into two groups of intervention and control (50 patients in each group) to participate in the study. Data were collected using a pre-tested questionnaire before and after intervention every after one month for a period of four months of intervention.Results: The average age of patients who participated in the study was 48 (40–51) years. Most of the patients were females (65.39%), compared to males (34.01%). At the end of the study period of four months, DDS in the control group decreased from 40.08% to 38.49% (p=0.064) while in the intervention group, DDS increased from 35.30 % to 54.20% (p<0.001). Conclusion: Dietary diversity increased after nutrition education among type 2 diabetes patients.Trial registration: The study was registered and approved on 17th April 2013 by the Research and Ethics committee of Mulago Hospital and Institutional Review Board of Mulago hospital (Protocol MREC 113).

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Preferring to manage by myself: A qualitative study of the perspectives of hardly reached people with type 2 diabetes on social support for diabetes management

Journal of Clinical Nursing ◽

10.1111/jocn.14783 ◽

2019 ◽

Vol 28 (9-10) ◽

pp. 1889-1898

Author(s):

Laura K. Bech ◽

Camilla Borch Jacobsen ◽

Anne Sophie Mathiesen ◽

Thordis Thomsen

Keyword(s):

Social Support ◽

Type 2 Diabetes ◽

Qualitative Study ◽

Diabetes Management

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Perceived Barriers, Benefits, Facilitators, and Attitudes of Health Professionals towards Multidisciplinary Team Care in Type 2 Diabetes Management: a Systematic Review

Current Diabetes Reviews ◽

10.2174/1573399816999201110200126 ◽

2020 ◽

Vol 16 ◽

Author(s):

Usman Sani Dankoly ◽

Dirk Vissers ◽

Zainab El Farkouch ◽

Esther Kolasa ◽

Abderrahim Ziyyat ◽

...

Keyword(s):

Type 2 Diabetes ◽

Health Professionals ◽

Multidisciplinary Team ◽

Healthcare Professionals ◽

Perceived Barriers ◽

Diabetic Patients ◽

Team Approach ◽

Team Care ◽

Multidisciplinary Team Approach

Background:: The need for a multidisciplinary team approach to provide physical exercise, diet, behavioral change and insulin therapy in type 2 diabetes mellitus (T2DM) treatment has long been recognized. However, often patients with T2DM do not have access to a multidisciplinary team. Introduction:: In developing countries most patients with T2DM receive their diabetes care in the office of an internist or family practice physician or in a primary level health center with a general practitioner. Knowing the perceived barriers, attitude, facilitators, and benefits in healthcare professionals toward multidisciplinary team approach in T2DM treatment can help to facilitate implementation of multidisciplinary care in T2DM. Methods:: A systematic search strategy was performed in six databases (PubMed, Web of Science, CINAHL, EMBASE, MEDLINE, and Cochrane) using different keyword combinations to identify studies describing healthcare professionals’ views of multidisciplinary team care in T2DM. Textual narrative synthesis was used to analyse data. The Critical Appraisals Skills Programme (CASP) tool for qualitative studies was used to assess risk of bias and transferability. Results:: The views of health professionals about multidisciplinary team care in T2DM were categorized into six major factors namely: working collaboratively to foster supportive relationships; strong committed organizational and team leadership; diversity in expertise, with team members tailored to local circumstances; shared goals and approaches to ensure consistency of message; clear and open communication with the team and with patients; and the patient at the center of decision-making. Conclusions:: There is a huge gap in shared roles among health professionals in T2DM therapy. Hence, there is need for allied health professionals such as physiotherapists, dieticians, and psychologists with expertise in diabetes to explore primary healthcare. Barriers and facilitators for successful integration of multidisciplinary team, seamlessly cut across three hierarchal levels namely, health management; health professionals; and diabetic patients.

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The Effect of Natural Soluble Polysaccharides On the Type 2 Diabetes through Modulating Gut Microbiota:A review

Current Medicinal Chemistry ◽

10.2174/0929867328666210309110352 ◽

2021 ◽

Vol 28 ◽

Author(s):

Lina Yang ◽

Li Li ◽

Xinghui Wu ◽

Wenqi Cai ◽

Qian Lin ◽

...

Keyword(s):

Type 2 Diabetes ◽

Gut Microbiota ◽

Diabetes Management ◽

Biological Activities ◽

Short Chain Fatty Acids ◽

Diabetic Patients ◽

Gut Health ◽

Pathogen Invasion ◽

Underlying Mechanisms

: Diabetes strongly influences patient quality of life. The incidence of type 2 diabetes (T2D) accounts for approximately 90% of diabetic patients. Natural polysaccharides have been widely used for diabetes management. Changes in gut microbiota can also be used for the prevention and treatment of diabetes. In this review, the effects of different natural polysaccharides on gut microbiota, as well as the relationship between diabetes and the gut microbiome are summarized. The intestine is the primary location in which natural polysaccharides exert their biological activities, and plays an important role in maintaining healthy bodily functions. Polysaccharides change the composition of the gut microbiota, which inhibits pathogen invasion and promotes beneficial bacterial growth. In addition, the gut microbiota degrade polysaccharides and produce metabolites to further modify the intestinal environment. Interestingly, the metabolites (short chain fatty acids and other bioactive components) have been shown to improve gut health, control glycemia, lower lipids, reduce insulin resistance, and alleviate inflammation. Therefore, understanding the underlying mechanisms by which soluble polysaccharides improve T2D through regulating the gut microbiota to provide a future reference for the management of T2D and its associated complications.

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

Chronic Illness ◽

10.1177/17423953211049438 ◽

2021 ◽

pp. 174239532110494

Author(s):

Arezoo Shahsavari ◽

Fatemeh Estebsari ◽

Foroozan Atashzadeh-Shoorideh ◽

Mahnaz Ilkhani

Keyword(s):

Type 2 Diabetes ◽

Content Analysis ◽

Qualitative Study ◽

Family Caregivers ◽

Diabetic Patients ◽

Structured Interviews ◽

Healthcare Organizations ◽

Support Resources ◽

Deprived Areas

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.

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Abstract 311: Facilitators and Barriers to Self-management of Patients with Type 2 Diabetes in Communities in China, a Qualitative Study

Hypertension ◽

10.1161/hyp.60.suppl_1.a311 ◽

2012 ◽

Vol 60 (suppl_1) ◽

Author(s):

Xiang Y Chen ◽

Peng Yue ◽

Yong L Wang ◽

Shu Q Xiao ◽

Xin W Feng ◽

...

Keyword(s):

Type 2 Diabetes ◽

Qualitative Study ◽

Management Practices ◽

Diabetes Management ◽

Financial Burden ◽

Chinese Patients ◽

Self Management ◽

Difficult Time ◽

Facilitators And Barriers

Background: Self-management has become a key strategy for caring chronic patients in community. However, little is known about peoples’ self-management experiences and their perceived cues and barriers to engagement in self-management. Objective: To explore issues patients with type 2 diabetes experienced in their self-management practices,to understand cues and barriers to engagement in self-management. Design: Qualitative study (Semi-structured interviews) Setting: 11 communities in Beijing, China Participants: Type 2 diabetes patients in community, aged >18, no admission in past 90 days. Methods: 40 critical incident interviews were run during Apr to Sep in 2011 using purposive sampling (20 interviews with patients whose HbA1c well-controlled (<6.5%), while 20 badly-controlled (≥8%)).Themes from interviews were identified using content analysis, which revealed cues and barriers to self-modification for diabetes management. Results: Implications for self- management practice included objectively understanding on the severity and complications of diabetes. In addition to family support such as supervision in family and fully-use of family resource, desires/duties to be responsible for whole family life as a breadwinner was emerged as a key cue to engagement in self-control. Barriers to engagement in self-management stemmed from financial burden to monitor blood glucose daily, dissatisfaction of HbA1c level after efforts, and malignant life events. It is worth mentioning that starving experience of difficult time with natural disasters in1960s- 1970s in China was identified also as a key barrier to engagement in diet management. Discussion and Conclusion: There was a strong desire for Chinese patients to comply with Chinese cultural norms; particularly those relating to family value. It was the patients’ power to be involved in self-management that they could devote their healthy life to family duty. Everyone had his/her own history so experiences in past shaped patients’ behaviors now. The findings highlighted the importance of understanding the family value and the personal experiences as facilitators and barriers to self-management of Chinese patients with type 2 diabetes living in community.

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