Background More than three decades of research and study for overcoming the problem of “non-acceptance/non-compliance” of patients has neither resolved nor reduced the severity of this problem. This phenomenological study aimed to identify barriers of adherence to medical advice among type 2 diabetic patients. Methods This study was a qualitative research using phenomenology approach, and the data were analyzed using content analysis approach. Participants were 69 type 2 diabetic patients covered by the diabetes unit of West and East Community Health Centers of Ahvaz, Iran. The views and attitudes of patients about the barriers of adherence to medical advice were elicited by conducting 20–45 min sessions of semi-structured interviews. Data analysis was performed following Colaizzi’s seven-step method. Results Barriers of adherence to medical advice were classified into systemic and individual barriers. Individual barriers included 11 codes and 5 categories, and systemic barriers contained within 5 codes and 3 categories. Physiologic and physical factors, financial problems, occupational factors, attitudinal problems and lack of knowledge, and social and family problems were identified as individual barriers. Systemic barriers included inadequate publicizing and limited notification, inadequate equipment and facilities, and poor inter-sectional coordination. Conclusions Generally, problems stated by diabetic patients at the individual level can partly be solved by training patients and the people around them. However, as for the systemic problems, it seems that solving the barriers of adherence to medical advice requires coordination with other organizations as well as intersection coordination. Overall, these problems require not only comprehensive health service efforts, but also the support of policymakers to resolve barriers at infrastructure level.
Background: The needs and demands of patients as one of the pillars of marketing in the health field require the right tools to identify consumers’ requests. Objectives: This study was conducted to develop a tool to evaluate services utilization behavior by type 2 diabetics in health centers based on a social marketing model (ie, 7 Ps). Methods: This study was conducted in two main stages. The first stage was performed with the aim of the initial design of the tool (ie, a questionnaire) through a literature review and professionals’ opinions. The second stage was performed to confirm the validity and reliability of the prepared questionnaire in the previous stage through calculating the impact score, content validity index (CVI), content validity ratio (CVR), and Cronbach’s alpha coefficient. The study participants included 8 academic and executive experts in the field of health and diabetes, 30 diabetic patients to calculate the impact score, and 50 patients with diabetes to calculate the Cronbach’s alpha through test-retest. The data were analyzed using SPSS software (version 18). Results: According to the results of the first stage of the study, a questionnaire with 46 items was designed. After determining the formal and content validity quantitatively and qualitatively, 8 items were deleted, and a questionnaire with 38 items was provided. Finally, the validity and reliability of the instrument were confirmed (CVI = 0.91; CVR = 0.92; intraclass correlation coefficient = 0.89; Cronbach’s alpha = 0.92). Conclusions: This questionnaire with confirmed validity and reliability helps analyze the diabetics’ behavior and specifies the reasons for the acceptance or rejection of the services of the diabetes unit by patients. Therefore, it can be used in health centers providing services for diabetics.
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