Barriers to the self‐care of type 2 diabetes from both patients’ and providers’ perspectives: literature review

Abstract

Aim. To review systematically the literature about barriers to diabetes self‐care from both patients’ and healthcare providers’ perspectives. Background. Diabetes mellitus is a global health concern due to rapidly increasing prevalence. The healthcare costs for diabetes care and related complications are high. Tight glycaemic control achieved by intensive therapy has been shown to lower the risk of complications. Despite the provision of comprehensive management programmes, patients are often unable to achieve the desired outcomes. It is essential to understand the barriers to diabetes self‐care in order to promote successfully self‐care behaviours. Methods. A search of OVID Medline (R), CINAHL, Cochrane Library and British Nursing Index was carried out during 1986–2007 using keywords: Type 2 Diabetes Mellitus, self care, patient compliance, patient adherence and barriers to diabetes self care. Manual searching of relevant nursing journals and sourcing of secondary research extended the search. Results. A total of 16 original research papers using various methods including survey, descriptive correlational, sequential explanatory mixed‐method and qualitative exploratory design were reviewed. In total, over 8900 patients and 4550 healthcare providers were recruited from over 28 countries in these studies. Major barriers identified included psychosocial, socioeconomic, physical, environmental and cultural factors. Conclusions. Healthcare providers can enhance patient empowerment and participation with family support to achieve feasible targets. Better health care delivery systems and reforms that improve affordability, accessibility, and efficiency of care are essential for helping both providers and patients to meet desirable standards of diabetes care. Relevance to clinical practice. Understanding barriers to diabetes self‐care is the first step in facilitating providers to identify their role in enabling patients to overcome these barriers. Healthcare providers can develop strategies to clarify and individualise treatment guidelines, implement continuing education, improve communication skills, and help motivate patients to achieve desired behavioral changes.

Diabetes empowerment related to Pender's Health Promotion Model: A meta‐synthesis

“…The perceived barriers to diabetes education revealed in the present study were: the relevant information was not written in layman's terms; less well‐educated clients; language problems for ethnic minority clients; and an inconvenient venue. Other barriers that were identified included older age, male gender, disability, poor vision, and reading problems (Pun et al. , 2009).…”

“…The barriers to dietary management revealed in the present study were that the dietary advice provided was either too general or idealistic or not culture‐specific. Pun et al. (2009) stressed the need for educators to be aware of clients' favorite foods when discussing dietary management.…”

An ongoing process of inner negotiation – a Grounded Theory study of self‐management among people living with chronic illness

“…2004) and strategies to normalise life when having a chronic illness (Robinson 1993). Experiencing support and external resources is a commonly given explanation for success or failure in self‐management behaviour (Gallant 2003, Pun et al. 2009).…”

Comparison of Barriers Related to Medical-Health Systems for Controlling Diabetes Type II From the Viewpoints of Patients, Families and Nurses

“…As stated previously, the criteria for achieving success and controlling blood glucose is to have consistent teamwork and more coordination with the viewpoint of patients and their family; therefore, if planning designed by medical staff to control blood glucose and diabetes disease is not confirmed and accepted by patients and their family because of different viewpoints in this field, a rift being made in the function of these groups in practice that would not conform to each other and its result would be non-access or imperfect access to desirable controlling diabetes. In this direction, results of Pun's study (35) showed that people presenting health care can make their medical aims possible by making patients skilled and supporting family members, and the first step to make patients skilled is to overcome barriers and to know barriers for controlling diabetes from the viewpoints of medical staff and patients. In Shahady's study (36) that was conducted in Florida patients and their family members were among important members of diabetes-controlling team and their cooperation in treatment caused better self-management and medical staff were required to know the viewpoint of patients and their family about barriers.…”