Comparing and contrasting healthcare professionals’ and patients’ perceptions, understanding and experiences of Type 2 Diabetes (T2D) and its management: A qualitative study.

摘要

Background The increased prevalence of Type 2 Diabetes (T2D) in the UK has seen the adoption of empowerment models of T2D management. Research exists which contrasts patients’ and healthcare professionals’ perspectives of T2D management. However, no studies explicitly contrast healthcare professionals’ and patients’ perspectives within the empowerment approach. The overall aim of this study was to explore healthcare professionals’ and patients’ perspectives of managing T2D in a context where empowerment is the prevailing health paradigm. The three research questions informing the aim sought to explore: 1) What are patients’ and healthcare professionals’ perceptions, understanding and experiences of successful and unsuccessful (un/successful) T2D management? 2) What barriers and enablers do patients and healthcare professionals perceive, understand and experience in relation to managing T2D on a day-to-day basis? and 3) What similarities and differences emerge in patients’ and professionals’ perceptions, understanding and experiences of managing T2D on a day-to-day basis? Methods This is cross-sectional, qualitative research using maximum-variation sampling with healthcare professional and patient participants in an empowerment-based T2D patient participation group. Semi-structured interviews (N = 25 patients / N=10 healthcare professionals), focus groups (3 x N = 12 patients) and open-ended questionnaires (N = 6 patients) were used. Data were analysed thematically using framework analysis.Findings Patient management of T2D developed from factors in their personal and social contexts. T2D affected patients in differing ways across the course of the illness (i.e. diagnosis, adaption and eventual self-management) and patients had different resources available in their social contexts with which to manage these effects. Diagnosis was shaped largely by the different types of uncertainty patient participants experienced on their diagnostic route, and the progession of the illness prior to detection and diagnosis which shaped the barriers and enablers they experienced. Healthcare professionals, on the other hand saw diagnosis as a springboard to self-management and tended to interpret patients’ experiences of uncertainty as ‘resistance’. Therefore, barriers to responding to diagnosis were seen as largely patient-related. Patient participants reported adapting to living with T2D as an ongoing process of adjusting their personal (and wider) relationships, as well as social activities, to ensure their T2D-related needs were met. Conversely, although healthcare professionals saw adaption as important, it was seen as a brief adjustment period after diagnosis and before full self-management. This highlighted another area where healthcare professionals and patients gauged successful management differently, and saw different barriers and enablers. Patients also experienced varied barriers and enablers and evaluated successful management using diverse criteria, largely shaped by factors in their social context. Healthcare professionals expected patients to ‘own their illness’ which was seen to reduce pressure on finite health resources, and that clinical advice would create behaviour change. Healthcare professionals’ perspectives on successful self-management revolved around clinical evidence, the healthcare system and socio-contextual constraints, and portrayed barriers and enablers to managing T2D largely as patient or healthcare system related. DiscussionSimilarities and differences in healthcare professionals’ and patients’ perspectives of T2D management were seen. These occurred as a result of the fit between patients’ styles of self-management and healthcare professionals’ expectations surrounding behaviour change and health resources management. These differences were also evident during the diagnosis and adaption stages of the illness. Conclusion Management of T2D was seen and experienced differently by healthcare professionals and patients where empowerment of the patient to self-manage was the prevailing paradigm. The lack of fit develops largely due to the different evaluative contexts and criteria which healthcare professionals and patients use to manage T2D, and the different expectations that healthcare professionals and patients have of one another.