Diet and physical activity in the self-management of type 2 diabetes: barriers and facilitators identified by patients and health professionals

Abstract

Aim: To explore the views of individuals recently diagnosed with type 2 diabetes in relation to self-management of dietary intake and physical activity, and to compare these with the views of health professionals (HPs). Background: Diabetes education has become a priority area in primary and secondary care, and many education programmes are now embedded within a patient's care package. There are few contemporaneous explorations of patients' views about lifestyle self-management. Such research is vital in order to identify areas that require further support, refinement or enhancement in terms of patient education. Methods: Focus groups were held with patients recently diagnosed with type 2 diabetes (n 5 16, 38% female, aged 45-73 years). In-depth semi-structured interviews were conducted with HPs (n 5 7). Discussions focussed on self-management specifically in relation to making dietary and physical activity changes. All discussions were tape recorded, transcribed and analysed by emergent themes analysis using NVivo to manage the coded data. Findings: Barriers were divided into six main categories: difficulty changing well-established habits, negative perception of the 'new' or recommended regimen, barriers relating to social circumstances, lack of knowledge and understanding, lack of motivation and barriers relating to the practicalities of making lifestyle changes. HPs generally echoed the views of patients. In conclusion, even against a background of diabetes education, recently diagnosed patients with type 2 diabetes discussed a wide range of barriers to self-management of diet and physical activity. The findings could help to provide HPs with a deeper understanding of the needs of recently diagnosed patients and may help refine current diabetes education activities and inform the development of educational resources.

Lifestyle Changes in Diet and Physical Activities after Group Education for Type 2 Diabetes—The Active Ingredient in the Education. A Qualitative Study

“…Several barriers in lifestyle changes for patients with type 2 diabetes have been found, including difficulties in changing well-established habits, negative perception of the "new" or recommended regimen, lack of knowledge and understanding, lack of motivation, barriers relating to the practicalities of making lifestyle changes, ineffective multidisciplinary approaches, and communication [32] [33].…”

Application of Elaborated Intrusion Theory to the Measurement and Enhancement of Motivation in Type 2 Diabetes

“…Specifically, fatalistic expectations of negative health outcomes seem to decrease motivation . This can be in part due to a lack of success after previous attempts to self-manage (Booth et al, 2013), or in part due to a general pessimism about one's capability to change behaviour . Indeed, individuals with a clinical diagnosis of depression can tend to feel out of control and incompetent, subsequently struggling with motivation to self-manage their condition .…”

“…Weight loss not only lowers blood pressure, reducing cardiovascular risk, but additionally promotes sensitivity to insulin within the body . More effective use of insulin can in turn lower HbA1c, as it increases the level of metabolised glucose (Booth et al, 2013). Thus, promotion of a diet that reduces fat intake and increases consumption of healthy alternatives can assist in achieving glycaemic control and preventing long-term complications in type 2 diabetes (Aucott et al, 2004;Booth et al, 2013).…”

“…More effective use of insulin can in turn lower HbA1c, as it increases the level of metabolised glucose (Booth et al, 2013). Thus, promotion of a diet that reduces fat intake and increases consumption of healthy alternatives can assist in achieving glycaemic control and preventing long-term complications in type 2 diabetes (Aucott et al, 2004;Booth et al, 2013). However, adherence to a strict diet can be difficult for individuals with type 2 diabetes, and they commonly report dieting as a burden (Gorter et al, 2010), and in some instances have not made an association between their diet and their experience of diabetes (Nouwen et al, 2011).…”

“…As with a balanced diet, increased physical activity is associated with better health outcomes for sufferers of type 2 diabetes (Booth et al, 2013), as gross movement, including exercise, also promotes insulin sensitivity and thus contributes to better glycaemic control . Indeed, even a modest increase in physical activity can reduce HbA1c levels (Dye, Haley-Zitlin, & Willoughby, 2003;Hays & Clark, 1999;Lawton, Ahmad, Hanna, Douglas, & Hallowell, 2006).…”