Diabetes care among urban women in Soweto, South Africa: a qualitative study
Diabetes care among urban women in Soweto, South Africa: a qualitative study
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DOI：
10.1186/s12889-015-2615-3
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发表时间：
2015-12-26
影响因子：
4.5
通讯作者：
Norris, Shane A.
中科院分区：
文献类型：
--
作者：
Mendenhall, Emily;Norris, Shane A.
背景资料：低收入和中等收入国家低收入人群中2型糖尿病等非传染性疾病的增加给卫生系统带来了挑战。然而，在这种情况下，对低收入人群的糖尿病护理经验知之甚少。在这种情况下，糖尿病护理的最大挑战之一是为那些面临贫困，医疗保健服务差以及并发身心状况的人提供护理。本文探讨妇女的经验与糖尿病护理在索韦托，一个乡镇Johannesburg，SouthAfrica.Methods：这项研究涉及照顾儿童参加了出生到二十（Bt 20）队列研究于1990年开始。参加这项研究超过二十年，以前被诊断患有2型糖尿病的妇女被邀请参加。我们围绕压力、糖尿病、心理健康和糖尿病护理等问题进行了27次深度访谈。我们转录访谈，并使用内容分析来分析紧急主题分为三类：咨询，治疗，和social supports.Results：第一，咨询集中在营养，但很少运动，和妇女有有限的了解什么是糖尿病或他们应该做什么来控制它;第二，妇女不一致的报告他们的糖尿病治疗程序，无论是坚持药物和寻求治疗。他们指出，结构性障碍，如过度拥挤的诊所和难以获得药品，是阻碍坚持治疗的因素。最后，女性确定了来自家人和朋友的支持，并认识到与这些食物关系相关的压力（例如，我们不吃这个！）结论：在临床环境中有效的糖尿病教育和管理需要对医疗保健进行系统的改变。公共和私人卫生系统在糖尿病咨询、药物供应、护理质量和患者等待时间方面的进展表明，患者将放弃临床就诊，而不是糖尿病自我护理。例如，公共卫生系统中的结构性障碍损害了服药的依从性。随着国家对糖尿病咨询和管理的医疗保健的更强有力的重视，这些系统性问题应该被重塑，以确保患者能够获得基本的药物和服务。
Background: Escalation of non-communicable diseases such as Type 2 diabetes among low-income populations in low- and middle-income countries presents challenges for health systems. Yet, very little is known about low-income people's diabetes care experiences in such contexts. One of the greatest challenges of diabetes care in such contexts is providing care for those who face poverty, poor healthcare access, and concurrent physical and mental conditions. This article investigates women's experiences with diabetes care in Soweto, a township of Johannesburg, South Africa.Methods: This study involved caregivers for children enrolled in the Birth to Twenty (Bt20) cohort study initiated in 1990. Enrolled in the study for more than two decades, women previously diagnosed with type 2 diabetes were invited to participate. We conducted 27 in depth interviews around issues of stress, diabetes, mental health, and diabetes care. We transcribed interviews and used content analysis to analyze emergent themes into three categories: counseling, treatment, and social support.Results: First, counseling focused on nutrition but very little on exercise, and women had limited understanding of what was diabetes or what they should do to control it. Second, women were inconsistent with reporting their diabetes treatment routines, both with adhering to medicines and seeking treatments. They identified structural barriers as overcrowded clinics and poor access to medicines as impeding adherence to treatment. Finally, women identified support from their families and friends and recognized stress associated with these relationships around food (e.g., we're not eating that!) and diabetes stigma.Conclusions: Effective diabetes education and management in the clinical setting will require systematic changes to healthcare. Inconsistencies across public and private health systems with regards to diabetes counseling, drug availability, quality of care, and patient wait times indicate patients will forego a clinical visit in lieu of diabetes self-care. For example, structural barriers in the public health system undermine medication adherence. With a stronger national emphasis in healthcare on diabetes counseling and management such systemic issues should be reshaped to ensure patients have access to essential medication and services.