64
VOLUME 11 NUMBER 2 • JUNE 2014
RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
preferred methods of identification. The most common deciding
factor that made participants visit their doctor for follow-up
care was an emergency office visit followed by an appointment
scheduled by the primary care physician. This study also provides
additional evidence that inadequate health literacy can lead to an
inefficient use of health services.
34,35
Lack of awareness of target blood glucose and blood pressure
goal was acknowledged by an overwhelming majority of both
the intervention and non-intervention participants. The lack
of awareness of target blood glucose may provide a possible
explanation for suboptimal self-monitoring of blood glucose seen
in previous studies.
17,18
Conclusion
The focus group discussions revealed many similar experiences
and perceptions among the 31 participants, yet there also were
important differences across certain issues. Several themes relating
to barriers to self-management of diabetes were highlighted
during the focus group discussions. First, several of the participants
found some of the health information received on diabetes to be
quite confusing, despite the source of the information. Secondly,
physicians are not forthcoming with information pertaining to
diabetes. Lastly, a lack of awareness of target blood glucose and
blood pressure goal was acknowledged by an overwhelming
majority of participants.
The aim of these focus groups was to identify perceptions and
behaviours related to diabetes self-management that do exist in the
real world setting, and possible explanations for these behaviours.
There aremany documented factors that contribute to successful blood
glucose control, but the ability of patients to manage their diabetes is
critical because adherence with therapeutic regimens may prevent or
delay the onset of complications and improve health outcomes. The
key to successful diabetes management is heavily dependent upon the
education, knowledge and diabetes self-management skills of each
individual. Interventions directed towards improvement of outcomes
in diabetes management should focus on behavioural change, which
is developed on the basis of self-efficacy in the context of social
cognitive theory.
36
Motivation and self-efficacy in the management of
chronic illnesses are known to be important determinants of patients’
performance of self-care. A patient’s ability to care for themselves
is enhanced by first identifying barriers and developing effective
strategies to overcome them.
The findings of this research indicate that most patients do not
know their target blood glucose and blood pressure goals and/
or the importance of those values. Physicians should inform their
patients that knowledge of target blood glucose and blood pressure
goals is necessary for effective diabetes self-management but is not
sufficient to achieve successful health-related outcomes.
Acknowledgments
The project described was supported by Grant Number
5U01HL079151 from the National Heart, Lung, and Blood Institute.
Its contents are solely the responsibility of the authors and do not
necessarily represent the official views of the NIH.
References
1.
American Diabetes Association. Economic costs of diabetes in the U.S. in 2002.
Diabetes Care
2003;
26
(3): 917–932.
2. Centers for Disease Control and Prevention.
National Health and Nutrition Survey
,
1999– 2000.
3. Bloomgarden ZT. American Diabetes Association annual meeting, 1998. Insulin
resistance, exercise, and obesity.
Diabetes Care
1999;
22
(3): 517–522.
4. Dagogo-Jack S. Ethnic disparities in type 2 diabetes: pathophysiology and
implications for prevention and management.
J Natl Med Assoc
2003;
95
(9):
779–789.
5. Gary TL, Crum RM, Cooper-Patrick L, Ford D, Brancati FL. Depressive symptoms
and metabolic control in African-Americans with type 2 diabetes.
Diabetes Care
2000;
23
(1): 23–29.
6. Osei K, Gaillard T, Schuster DP. Pathogenetic mechanisms of impaired glucose
tolerance and type II diabetes in African-Americans. The significance of insulin
secretion, insulin sensitivity, and glucose effectiveness.
Diabetes Care
1997;
20
(3): 396–404.
7. Polonsky KS, Sturis J, Bell GI. Seminars in Medicine of the Beth Israel Hospital,
Boston. Non-insulin-dependent diabetes mellitus – a genetically programmed
failure of the beta cell to compensate for insulin resistance.
N Engl J Med
1996;
334
(12): 777–783.
8. Rabi DM, Edwards AL, Southern DA,
et al.
Association of socio-economic status
with diabetes prevalence and utilization of diabetes care services.
BMC Health
Serv Res
2006;
6
: 124.
9.
Andersen R, Newman JF. Societal and individual determinants of medical care
utilization in the United States.
Milbank Mem Fund Q Health Soc
1973;
51
(1):
95–124.
10. Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies.
Health Aff
2002;
21
(2): 60–76.
11. Harris MI. Health care and health status and outcomes for patients with type 2
diabetes.
Diabetes Care
2000;
23
(6): 754–758.
12. Schillinger D, Grumbach K, Piette J,
et al.
Association of Health Literacy with
Diabetes Outcomes.
J Am Med Assoc
2002;
288
(4): 475–482.
13. Pladevall M, Williams LK, Potts LA, Divine G, Xi H, Lafata JE. Clinical outcomes
and adherence to medications measured by claims data in patients with diabetes.
Diabetes Care
2004;
27
(12): 2800–2805.
14. Ho PM, Rumsfeld JS, Masoudi FA,
et al
. Effect of medication nonadherence on
hospitalization and mortality among patients with diabetes mellitus.
Arch Intern
Med
2006;
166
(17): 1836–1841.
15. Cramer JA. A systematic review of adherence with medications for diabetes.
Diabetes Care
2004;
27
: 1218–1224.
16. Lerman I, Lozano L, Villa AR,
et al
. Psychosocial factors associated with poor
diabetes self-care management in a specialized center in Mexico City.
Biomed
Pharmacother
2004;
58
(10): 566–570.
17. Vincze G, Barner JC, Lopez D. Factors associated with adherence to self-
monitoring of blood glucose among persons with diabetes.
Diabetes Educ
2004;
30
(1): 112–125.
18. Zgibor JC, Simmons D. Barriers to blood glucose monitoring in a multiethnic
community.
Diabetes Care
2002;
25
: 1772–1777.
19. Ciechanowski PS, Katon WJ, Russo JE, Walker EA. The patient-provider
relationship: attachment theory and adherence to treatment in diabetes.
Am J
Psychiatry
2001;
158
(1): 29–35.
20. Sprague MA, Shultz JA, Branen LJ, Lambeth S, Hillers VN. Diabetes educators’
perspectives on barriers for patients and educators in diabetes education.
Diabetes Educ
1999;
25
: 907–916.
21. Gazmararian JA, Baker DW, Williams MV,
et al.
Health literacy among Medicare
enrollees in a managed care organization.
J Am Med Assoc
1999;
281
(6): 545–
551.
22. Sudore RL, Mehta KM, Simonsick EM,
et al.
Limited literacy in older people and
disparities in health and healthcare access.
J Am Geriatr Soc
2006;
4
(5): 770–
776.
23. Bayliss EA, Steiner JF, Fernald DH, Crane LA, Main DS. Descriptions of barriers to
self-care by persons with comorbid chronic diseases.
Ann Fam Med
2003;
1
(1):
15–21.
24. Peyrot M, Rubin RR, Lauritzen T, Snoek FJ, Matthews DR, Skovlund SE.
Psychosocial problems and barriers to improved diabetes management: results of
the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) Study.
Diabet
Med
2005;
22
(10): 1379–1385.
25. Walker EA, Usher JA. Understanding and enhancing adherence in adults with
diabetes.
Curr Diab Rep
2003;
3
(2): 141–148.
26. Brown JB, Harris SB, Webster-Bogaert S, Wetmore S, Faulds C, Stewart M. The
role of patient, physician and systemic factors in the management of type 2
diabetes mellitus.
Fam Pract
2002;
19
(4): 344–349.
27. American Diabetes Association. Standards of medical care for patients with
diabetes mellitus.
Diabetes Care
2003;
26
(1): S33–S50.
28. Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education
for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control.
Diabetes Care
2002;
25
(7): 1159–1171.
