Experiences of self-management support in patients with diabetes and multimorbidity: a qualitative study in Norwegian general practice

Abstract

Aim: The purpose of this study was to explore how patients with diabetes and multimorbidity experience self-management support by general practitioners (GPs), nurses and medical secretaries in Norwegian general practice. Background: Self-management support is recognised as an important strategy to improve the autonomy and well-being of patients with long-term conditions. Collaborating healthcare professionals (cHCPs), such as nurses and medical secretaries, may have an important role in the provision of self-management support. No previous study has explored how patients with diabetes and multimorbidity experience self-management support provided by cHCPs in general practice in Norway. Methods: Semi-structured interviews with 11 patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) with one or more additional long-term condition were performed during February–May 2017. Findings: Patients experienced cHCPs as particularly attentive towards the psychological and emotional aspects of living with diabetes. Compared to GPs, whose appointments were experienced as stressful, patients found cHCPs more approachable and more likely to address patients’ questions and worries. In this sense, cHCPs complemented GP-led diabetes care. However, neither cHCPs nor GPs were perceived to involve patients’ in clinical decisions or goal setting during consultations.

What do patients experience? Interprofessional collaborative practice for chronic conditions in primary care: an integrative review

“…1 ) shows the search retrieved 6692 articles after de-duplication; 47 studies met inclusion criteria and one additional study was identified through hand-searching of reference lists. Studies used a range of methodological designs, including qualitative focus groups and/or interviews ( n = 34) [ 9 , 26 – 58 ], mixed method studies ( n = 7) [ 59 – 65 ], quantitative descriptive studies ( n = 4) [ 66 – 69 ], and intervention studies ( n = 2) [ 70 – 72 ]. Across studies there was a total of n = 3803 participants, including patients, informal carers and family members.…”

“…Across studies there was a total of n = 3803 participants, including patients, informal carers and family members. Studies were mostly conducted in the USA ( n = 13) [ 29 , 40 , 42 , 44 , 54 , 55 , 59 , 61 , 65 , 67 – 69 , 72 ], Australia ( n = 11) [ 26 – 28 , 30 , 34 , 36 , 41 , 52 , 57 , 63 , 66 ], UK ( n = 7) [ 31 , 39 , 46 – 48 , 53 , 60 ], Sweden ( n = 4) [ 38 , 49 – 51 ], Canada ( n = 3) [ 32 , 35 , 45 ] and The Netherlands ( n = 2) [ 9 , 64 ] with one study undertaken each in Belgium [ 62 ], Italy [ 71 ], France [ 33 ], New Zealand [ 43 ], Norway [ 58 ], Qatar [ 56 ] and, Spain [ 70 ], and one study conducted across multiple European countries [ 37 ]. Key characteristics of included studies are outlined in Additional file 3 .…”

“…The methodological quality of studies varied according to the MMAT outlined in Additional file 4 . Common limitations in the qualitative studies were an unclear explanation for the selected methodological approach [ 26 , 32 , 37 , 41 , 43 , 66 ], findings were inadequately derived from the data [ 36 , 42 , 47 , 52 , 55 ], or supported by the data including too few quotes to support thematic analysis [ 33 , 36 , 41 – 43 , 47 , 48 , 52 , 55 , 57 ], and a lack of coherence between qualitative data, collection, analysis and interpretation [ 36 , 41 , 47 , 48 , 54 , 57 , 58 ]. Limitations for the single randomized-controlled trial was the low response rate of < 50% and that the randomization was inadequately described in the report [ 72 ].…”

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

“…Existing studies have investigated the potential barriers associated with self-management in patients with diabetes; these include inadequate information or knowledge about diabetes management and distress or insufficient social support (9)(10)(11). Some studies have explored the psychological factors that affect patients with diabetes, such as poor awareness, insufficient self-efficacy, and lack of motivation (12)(13)(14)(15).…”

Easier Said Than Done: Healthcare Professionals’ Barriers to the Provision of Patient-Centered Primary Care to Patients with Multimorbidity

“…Second, the sample of nine healthcare professionals may be considered to be small. However, this sample size is similar to those used in other qualitative health and well-being studies [ 67 , 68 , 69 , 70 ]. We selected it carefully, inviting 50% of all healthcare professionals from the GP practices participating in the PCC improvement program.…”