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VOLUME 11 NUMBER 2 • JUNE 2014
RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
The University of Maryland Baltimore (UMB), the research intensive
medical center, partnered with the Bon Secours Baltimore Health
System (BSBHS), the minority serving system, as part of a NIH-funded
multi-year prospective study. The partnership was intended to offer
a unique opportunity to investigate how a partnership between
BSBHS and UMB, supported by the community, can provide a
platform to improve patient, physician and system adherence.
The study enrolled primary-care physicians and patients of these
physicians. Patients were recruited from both clinics. Within each
clinic, they were randomised to either patient education group or
to the control group.
To underscore the collaborative partnership and the interactive
learning between the two institutions, complementary disease areas
were examined where UMB focused on hypertension and BSBHS
focused on diabetes. As part of this partnership study, the overall
objective of this research was to explore the patients’ perceptions
about barriers to self-management of diabetes from the target
population. Several focus group interviews of the target population
were conducted and this article presents the methodology and key
findings of the four focus group sessions.
Methods
This was a qualitative study conducted among 31 predominately
African-American patients with diabetes who were enrolled in the
multi-year prospective partnership study. Each participant was told
the purpose of the focus group and asked to complete an informed
consent to allow the tape recording of the focus group.
Study sample
The sample for this analysis was restricted to patients enrolled in the
U-01 grant described in the introduction. The sampling technique
used purposive sampling for the selection of individuals in order to
yield some information about barriers to the self-management of
their diabetes. The sampling method allowed recruiting participants
who were more likely to participate in a focus group session and who
possessed characteristics relevant to the aim of the study. To reach
the target sample quickly and since sampling for propor-tionality
was not a concern, we sampled participants with a diagnosis of
diabetes enrolled in the U-01 grant who were aged 50 to 90 years
and who were more likely to be available during daytime hours. A
purposive sample of 150 participants was selected and contacted
from a list of patients in the diabetes section of the U-01 grant.
Data collection
To meet the objectives of this research, four traditional interactive
and focused discussions were conducted between December 2007
and April 2008, with a minimum of five people in each group.
Each focus group followed a similar format. The focus groups were
used to explore perceptions about barriers to self-management of
diabetes from the target population and to aid in the development
of a quantitative access to care questionnaire. A structured topic
guide that consisted of a series of open-ended questions was used
to collect information about knowledge of current health status,
medication use, continuity of care, blood glucose level and nutrition.
These topics were selected after careful review of the literature on
diabetes self-management. Appendix A contains the topic guide
used in the study.
The focus group interviews were moderated by a diabetes nurse
educator and a graduate student. Discussions were audiotaped and
written notes were taken.
Analysis
From the tape recordings of the focus group interviews, the
extensive conversations were transcribed verbatim within the
relevant response topics. An independent assessment of the tran-
scripts by another researcher was not conducted; however, notes
taken by the moderator and by the assistant were compared.
Results
From the purposive sample of 150 patients in the diabetes section
of the U-01 grant, all participants were contacted by telephone.
After a series of follow-up calls, a total of 31 patients, 23 inter-
vention and 11 non-intervention, participated in the four focus
groups. Several patients did not participate due to refusal, change
of address/number disconnected, and not being home at the time
of the phone call.
Four focus groups were completed where intervention and non-
intervention participants were mixed to allow different opinions or
views. The majority of the participants were African-American and
females. The mean age of the participants was 74, with a range of
43 to 81 years. None of the patients participated in more than one
group. The majority of the respondents felt comfortable enough
during the 60-minute session to discuss their opinions openly while
others only responded when asked.
Knowledge of current health status
Participants’ understanding and knowledge about diabetes came
from various sources. For example, participants identified the Bon
Secours Health System, TV/radio, physician, insurance company,
library, pamphlets in the mail, glucose meter, diabetes clinic, church,
a family member and the news as sources of health information.
More participants identified their physician, insurance company
and a family member as sources of health information. The majority
of the participants thought the health information received was
great and very useful. One patient stated, ‘The information was
very helpful and I’m always eager to read more.’ The patient went
further to say that he eats three meals a day, exercises and watches
his carbohydrate and sugar intake. The patient also mentioned that
this led him to get involved in a community service programme
that grows organic vegetables and teaches people how to buy
and cook healthy foods. Another patient said, ‘The information I
received from my doctor was wonderful. It helped me to get my
blood sugar under control.’
Although the majority of the participants made positive com-
ments about the health information they received from their doctor,
a few of the participants were not so pleased. One woman, who was
newly diagnosed with diabetes, was disappointed with the lack of
information she received. ‘I did not find the information I received
from my doctor as useful. The doctor just wrote something down
on a piece of paper and gave it to me.’ Another woman pointed
out that her doctor is not very forthcoming with information. ‘It’s
like pulling teeth to get him to say something.’ Several of the
participants mentioned that they try to exercise like the doctor told
them, but their arthritis prevents them from doing so.
The participants’ perceptions about eating habits seem to
be quite diverse. ‘I have learnt how to discipline myself, so I can
eat anything I want,’ said one patient. ‘I took myself off of red
meat, so I don’t care for it anymore,’ said another patient. One
patient mentioned that she doesn’t eat when she’s hungry, but
acknowledged that ‘skipping meals is not good.’ There seemed
