Type 2 diabetes patients’ perspectives on lifestyle counselling and weight management in general practice: a qualitative study

Abstract

BackgroundLifestyle counselling is a pivotal aspect of diabetes care. But general practitioners (GPs) often have problems in finding their role in patients’ weight management. The aims of this study were to investigate the experiences of type 2 diabetes patients with lifestyle counselling from their GPs and to explore how patients’ preferences regarding counselling are embedded in the context of self-management and wider cultural aspects of nutrition.MethodsNarrative interviews were conducted with 35 people with type 2 diabetes aged between 35 and 77 years. The interviews were transcribed verbatim and analysed using the thematic framework method.ResultsMany patients had a strong feeling of personal responsibility for weight reduction as integral to diabetes self-management but found it difficult to integrate the changes their disease requires into their self-management activities. They attached great importance to their GPs’ advice on diet. While some patients appreciated direct communication, others regarded dramatic pictures as either unhelpful or offending. A serious problem was the incompatibility of the dietary recommendations with daily life resulting in a reluctance to adjust the whole diet to the needs of diabetes care.ConclusionsAmbivalence towards patient self-management and tensions between the necessary changes to patients’ lifestyles and their culture, makes the GP’s role difficult and full of conflict. Instead of focusing exclusively on the guidelines of diabetes management and provision of information, GPs should explore the patients’ capabilities of self-management through open communication and accept their patients’ wishes to protect nutrition as part of their culture.

Patient perspectives on factors associated with enrollment and retention in chronic disease self-management programs: a systematic review

“…37 Patients with chronic lower respiratory conditions also reported negative attitudes toward participating in selfmanagement programs where sessions last over 3 hours. 50 This finding was similar to what was found among patients living with cardiovascular disease 44 and type 2 diabetes, 53 who reported that self-management instructions are too complex and time consuming, making the recommendations too difficult to understand and integrate into their everyday lifestyles. Finally, patients living with chronic disease (ie, chronic lower respiratory conditions, diabetes, heart disease) in three studies reported negative attitudes toward group selfmanagement programs, because they did not know or were …”

“…37 Enrollment in self-management interventions was also negatively influenced by patients' limited knowledge about the pathophysiology of their disease, possible benefits of participating in self-management, and understanding the best self-management behaviors for improving symptom management. 37,44,[46][47][48][49][50][51][52][53] Additionally, patients were less likely to enroll and participate in self-management programs if the content and instructional methods were perceived as too complex or difficult to understand. Interestingly, patients living with cancer reported accessing patient education resources available both online and offline about their condition.…”

“…48 Patients generally reported receiving chronic disease self-management support from their health care provider or pharmacist. 37,44,47 While some health care providers referred patients to organized group self-management programs, 53 others did not refer patients for reasons that were unknown and undisclosed. 44,51 Some patients living with type 2 diabetes reported they simply did not want to enroll or participate in a self-management program that fell outside of the care and support provided by their primary care provider.…”

Why patients suffering from diabetes do not adhere to the prescribed diet?

“…Такође је показано да када пацијенти почну да се придржавају дијете, после неког времена се осећају лоше и обично је преки-ну 13 . Wermeling 14 и остали аутори су дошли до резултата да пацијенти због одсуства бола и других знакова несхватају да су заиста бо-лесни и да морају правилније да се хране 14 . Од великог значаја је упућеност пацијента у своју болест, што често недостаје или се па-цијент информише из непоузданих извора.…”

How motivated are patients with type 2 diabetes to change their lifestyle? A survey among patients and healthcare professionals

“…Several barriers have been identified for lifestyle behavior change. Some of these are: patients do not regard diabetes as a serious disease [31], misperception of the patients' actual lifestyle behavior [32], decrease in wellbeing [33], asymptomatic disease, increased costs, cultural background [11], patients are satisfied with their behavior [34], frustration from lack of success [35], physical limitations, lack of time [36] and interference with work [37]. In the end however, without being motivated, acquiring and maintaining a healthy lifestyle will probably be impossible.…”