Perspectives of deprived patients on diabetes self-management programmes delivered by the local primary care team: a qualitative study on facilitators and barriers for participation, in France

Abstract

Background Diabetes self-management education (DSME) is an effective intervention for patients with type 2 diabetes mellitus (T2DM); nevertheless, patient participation in this type of programme is low. Implementation of DSME programmes in primary care practices by the local multi-professional team is a potential strategy to improve access to DSME for T2DM patients. The aim of this study was to identify perceived facilitators and barriers by patients to participation in local DSME delivered by primary care professionals in France. Method T2DM patients, informed and recruited during consulting with their usual care provider, who had attended a structured and validated DSME programme delivered by 13 primary care providers within a multi-professional primary care practice in a deprived area of 20,000 inhabitants, were invited to participate in this study. A qualitative study with semi-structured, in-depth interviews was conducted with study participants, between July 2017 and February 2018. A reflexive thematic analysis of the interviews was carried out. Coding schemes were developed to generate thematic trends in patient descriptions of facilitators and barriers to DSME participation. Results Nineteen interviews (mean length 31 min; [20–44 min]) were completed with T2DM patients. Four themes on facilitators for programme participation emerged from the data: geographical proximity of a DSME programme held in the local multi-professional primary care practice; effective promotion of the DSME programme by the local multi-professional team; pre-existing relationship between patients and their healthcare providers; and potential to establish new social interactions within the neighbourhood by participating in the programme. Three themes on barriers to attendance emerged: integrating the DSME programme into their own schedules; difficulties in expressing themselves in front of a group; and keeping the motivation for self-managing their T2DM. Conclusions From the patient perspective, the programme geographical proximity and the pre-existing patient-healthcare provider relationship were important factors that contributed to participation. Healthcare providers should consider these factors to improve access to DSME programmes and diabetes self-management in deprived populations. Longitudinal studies should be performed to measure the impact of these programmes.

Reasons for non-participation in a self-care training program for diabetic patients: a qualitative study

“…Individual, social and familial factors are other obstacles on the way to participating in the self-care training schemes. In line with the current study, previous studies have suggested hectic work and business and difficulty in getting time off work as social obstacles to the training and self-care of diabetic patients [ 23 , 24 ]. Previous studies showed that patients who are unemployed or retired are more likely to attend in self-management programs than those who work full or part-time [ 10 , 25 ].…”

“…Although training is one of the most effective ways to enhance self-care conduct, weakness in contents and unsuitable teaching techniques can hinder the use of the educational programs, which are also mentioned by the patients in the present study. In another study, unsuitable teaching content is said to be one reason for the disinterest in such schemes [ 24 ]. Using supplementary books and reflecting the experience of cured patients by themselves were suggested by the interviewees.…”

It Is “All About Relationships” in Lifestyle Programmes for Adults Living With Type Two Diabetes Underpinned by a Person/Whānau-Centred Care Approach

“…The key finding in this study was the importance of relationships, and how this underpinned engagement, echoing Mc Kenzie et al findings ( 37 ) and those of Allory et al ( 43 ). In the latter study, people with T2D living in a deprived area of France who attended a diabetes self-management education programme spoke of community relationships—the familiarity of environment (being in place) and with educators (being in relation)—as important facilitators in engagement ( 43 ). In our study, relationships were multi-directional between HCPs, between attendees, between HCPs and attendees, and between all and the external community, encapsulating the meaning of “whānau”.…”

“…This knowledge empowerment could be likened to social capital—a “knowledge capital”—that can only enhance “societies”-management of T2D, beyond that of “self”-management. Allory et al ( 43 ) stress that a key objective of T2D education programmes should be to develop new social links for attendees as social difficulties and concerns can create limited social access and promote isolation for marginalised populations. We suggest that growing both social and knowledge capital should be key aims of lifestyle programmes such as DCEP and primary care providers should be supported centrally (by government health policies and funding) to support such initiatives.…”

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

“…At the end of the program, interviews were conducted to identify perceived barriers to PCC delivery for patients with multimorbidity in the primary care setting. This approach is similar to that used in previous qualitative studies of barriers to primary care delivery [ 46 , 47 ]. Sampling was purposive, with the intent of interviewing at least one GP and one NP per practice.…”