A Qualitative Exploration of Self-Management Behaviors and Influencing Factors in Patients With Type 2 Diabetes

Abstract

Background and AimsThe self-management behavior of patients with diabetes involves a complex set of actions involving medication therapy, lifestyle changes, and management of complications in the daily routine. Our study aims to explore adherence to self-management behaviors by patients with type 2 diabetes and the potential factors influencing those behaviors.MethodsThis qualitative study used semi-structured interviews conducted with patients who have type 2 diabetes and who were recruited from the department of endocrinology in a tertiary teaching hospital. Data were analyzed thematically using the interview framework.ResultsOverall, 28 patients with type 2 diabetes were recruited and interviewed. Three types of medication noncompliance behaviors were coded. In particular, blindly optimistic attitudes toward the condition in younger patients who had a short duration of diabetes and fear of or pain from medication therapy were key influencing factors. Irregular monitoring and missed follow-up visits were the most frequently mentioned noncompliance behaviors. Poor understanding of blood glucose monitoring, selective ignorance due to pressure of uncontrolled blood glucose, and blindly optimistic attitudes were also identified as key influencing factors. Dietary behaviors were characterized by an overemphasis on the amount of food in the diet and the preference or declination for particular types of food; ignorance of the dietary structure was present. Misconceptions about dietary and exercise practices were the main types of lifestyles’ noncompliance.ConclusionOur study showed the complex picture of noncompliance with self-management behaviors by patients with type 2 diabetes. Noncompliance covered disordered and arbitrary changes in medication therapy, blood glucose monitoring with poorest adherence, lifestyle modifications and complication management. The study findings identify clear challenges to self-management behavior and identify potential key influencing factors. Future interventions and strategies should aim to help patients translate healthcare provider’s information and instructions into action that improve compliance.

Exploring facilitators and barriers to self-management engagement of Chinese people with type 2 diabetes mellitus and poor blood glucose control: A descriptive qualitative study

“…This nding is consistent with the principle of HBM, which demonstrated that perceived susceptibility and severity of speci c diseases could motivate health behavior engagement [38]. However, this nding is different from a previous study that reported that Chinese people with diabetes tended to be blindly optimistic about their health conditions [42]. The inconsistent ndings could be caused by that this study focused on people with poor blood glucose control, which might trigger the concern about the susceptibility to severe complications [38, [43][44].…”

“…The participants thought it was unnecessary to measure blood glucose when no subjective symptoms were perceived. A previous study also reported that having no severe symptoms or events could impede blood glucose monitoring of Chinese people with diabetes [42]. However, in this study, some participants showed good blood glucose monitoring engagement because they understood the value of regular blood glucose monitoring on adjusting lifestyle and medication regimens.…”

“…Concern about side effects might be the barrier to medication therapy engagement [42][43]48]. However, in this study, the concern did not impact medication therapy engagement of the majority of participants because they thought taking medications to improve blood glucose control was the more important thing.…”

“…Discontinuity of medication therapy engagement was mainly caused by temporary remission of hyperglycemia and physical symptoms. A previous study also reported that temporary remission of hyperglycemia and no subjective feelings could impede medication taking in Chinese people with diabetes [42]. The ndings could be caused by lack of knowledge about pathophysiology and natural progression of diabetes.…”

“…The ndings could be caused by lack of knowledge about pathophysiology and natural progression of diabetes. The lack of knowledge might lead to the misunderstanding that temporary remission of hyperglycemia and no perceived physical symptoms indicated diabetes was cured and medication therapy could be stopped [42][43][44]48].…”