A qualitative study of the experiences of care and motivation for effective self-management among diabetic and hypertensive patients attending public sector primary health care services in South Africa.
A qualitative study of the experiences of care and motivation for effective self-management among diabetic and hypertensive patients attending public sector primary health care services in South Africa.
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DOI：
10.1186/s12913-015-0969-y
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发表时间：
2015-08-01
影响因子：
2.8
通讯作者：
Levitt N
中科院分区：
文献类型：
--
作者：
Murphy K;Chuma T;Mathews C;Steyn K;Levitt N
糖尿病和高血压是南非日益严重的疾病负担。目前，很少有患者能够达到足够的控制水平。为了改善结果，卫生部提议转向以患者为中心的慢性病护理模式，使患者能够通过增强知识、动力和技能，在自我管理中发挥积极作用。本研究的目的是探讨患者目前的慢性护理经历，以及他们自我管理和生活方式改变的动机和能力。该研究对在开普敦三个公共部门社区卫生中心就诊的高血压和糖尿病患者进行了 22 次个人定性访谈。参与者是讲科萨语和南非荷兰语的患者，社会经济地位较低。事实证明，自我决定理论中的相关性、能力和自主性概念对于探索患者对以患者为中心的护理模式的含义以及他们需要从医疗保健提供者那里得到什么的看法非常有价值。总体而言，本研究的结果表明，患者在有效的自我管理和行为改变方面遇到多重障碍，包括健康素养差、缺乏自我效能和感知的社会支持。除少数例外，大多数患者表示没有收到足够的信息；来自医疗保健提供者的咨询或自主支持。他们的经验表明，目前的慢性病护理方法很大程度上无法满足患者的动机需求，使他们中的许多人对自己的健康状况感到焦虑，并对护理质量感到沮丧。根据其他类似的研究，本研究采访的大多数高血压和糖尿病患者被发现不具备在自我护理方面发挥积极和自主作用的能力。很明显，患者希望从医疗保健提供者那里得到更多的帮助和支持。为了使南非的医疗保健提供者能够采取更加以患者为中心的方法，并更好地协助和激励患者成为有效的护理合作伙伴，需要培训、资源和工具。此外，提供商需要得到政策和组织变革的支持。
Diabetes and hypertension constitute a significant and growing burden of disease in South Africa. Presently, few patients are achieving adequate levels of control. In an effort to improve outcomes, the Department of Health is proposing a shift to a patient-centred model of chronic care, which empowers patients to play an active role in self-management by enhancing their knowledge, motivation and skills. The aim of this study was to explore patients’ current experiences of chronic care, as well as their motivation and capacity for self-management and lifestyle change. The study involved 22 individual, qualitative interviews with a purposive sample of hypertensive and diabetic patients attending three public sector community health centres in Cape Town. Participants were a mix of Xhosa and Afrikaans speaking patients and were of low socio-economic status. The concepts of relatedness, competency and autonomy from Self Determination Theory proved valuable in exploring patients’ perspectives on what a patient-centred model of care may mean and what they needed from their healthcare providers. Overall, the findings of this study indicate that patients experience multiple impediments to effective self-management and behaviour change, including poor health literacy, a lack of self-efficacy and perceived social support. With some exceptions, the majority of patients reported not having received adequate information; counselling or autonomy support from their healthcare providers. Their experiences suggests that the current approach to chronic care largely fails to meet patients’ motivation needs, leaving many of them feeling anxious about their state of health and frustrated with the quality of their care. In accordance with other similar studies, most of the hypertensive and diabetic patients interviewed for this study were found to be ill equipped to play an active and empowered role in self-care. It was clear that patients desire greater assistance and support from their healthcare providers. In order to enable healthcare providers in South Africa to adopt a more patient-centred approach and to better assist and motivate patients to become effective partners in their care, training, resources and tools are needed. In addition, providers need to be supported by policy and organisational change.