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

Abstract

BackgroundDiabetes 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.MethodsThe 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.ResultsThe 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.ConclusionsIn 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.

Self-Management Support Needs of Patients with Chronic Diseases in a South African Township: A Qualitative Study

“…Patient health education is haphazard and may result in conflicting or confusing messages received from different providers. Other South African studies report on the lack of training of primary healthcare providers in behavior-change counselling skills and recommend effective training, accompanied by health-system reform that supports health promotion and self-management (Dube et al, 2015a;Malan, Mash, & Everett-Murphy, 2015;Murphy, Chuma, Mathews, Steyn, & Levitt, 2015).…”

Family member-based supervision of patients with hypertension: a cluster randomized trial in rural China

“…There exists an obvious gap between the health care need and the services provided by community health facilities. 19, 20 It was estimated that only 20% of patients' health care occurred in a doctor's office and that the other 80% was performed at patients' homes. 21 Traditional medical care focuses on one-on-one doctor/patient interactions during the medical centre visit, missing many opportunities to positively influence patient care.…”

“It’s got its own life, and you can’t contain it”: A qualitative study of patient and health professional experiences of diabetes care

“…The findings suggest that our research site has some elements that contribute to what has been described as “good care” by other authors (Murphy et al, ; Penn & Watermeyer, ): for example, attention to patient‐centredness and a focus on providing care that is multidisciplinary and holistic; attempts to ensure continuity of care and a focus on relationship; provision of information about the disease; some awareness of patient and community needs, particularly around education and knowledge of the disease; and some awareness of cultural and contextual influences on adherence. Despite these elements of care being present in this clinic, however, it would appear that the stresses and challenges of successfully treating and integrating this complex disease into daily life place significant pressures on patients, health professionals and the healthcare system.…”