Perception of Barriers to Self-care Management Among Diabetic Patients
Perception of Barriers to Self-care Management Among Diabetic Patients
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DOI：
10.1177/0145721709338527
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发表时间：
2009-09-01
影响因子：
3.9
通讯作者：
Barnes, Catherine
中科院分区：
文献类型：
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作者：
Gazmararian, Julie A.;Ziemer, David C.;Barnes, Catherine
本研究的目的是探索限制低收入糖尿病患者实现最佳糖尿病自我管理能力的个人、教育和制度障碍。方法使用佐治亚州亚特兰大Grady Health System糖尿病诊所的经济困难的糖尿病患者参加了3个焦点小组讨论。结果与主要是非洲裔美国人(n=35)的讨论旨在探索实现最佳糖尿病自我管理的障碍。大多数参与者未婚，大约三分之一的人阅读能力低于高中水平，40%的人目前没有工作。就个体障碍而言，诊断和改变生活方式以治疗糖尿病造成的情感损失是一个反复出现的主题，包括压力、挫折、社会孤立、人际冲突、抑郁和恐惧。否认经常被认为是阻碍坚持健康生活方式的关键因素。教育障碍是未能认识到无症状情况的风险和后果。许多参与者不了解A1C。最后，确定了几个制度障碍。参与者确定了需要的服务，包括跟踪和复习课程，支持小组讨论，营养和药物教育，不同教育形式的可用性，以及延长门诊时间。结论焦点小组讨论确定了糖尿病管理的障碍和改善对服务不足的糖尿病患者的护理的机会。研究结果有助于改善护理服务的提供，并有助于开展量化研究，以探索感兴趣的特定领域。基于这些结果，目前的系统需要为糖尿病患者提供更多的支持和教育。
PurposeThe 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.MethodsEconomically disadvantaged patients with diabetes who used the Diabetes Clinic of Grady Health System in Atlanta, Georgia, participated in 3 focus group discussions.ResultsThe 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.ConclusionsThe 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.