Berenguera Anna, Molló-Inesta Àngels, Mata-Cases Manel, Franch-Nadal Josep, Bolíbar Bonaventura, Rubinat Esther, Mauricio Dídac
Scientific Department, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Cerdanyola del Vallès, Spain; Primary Care Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
Scientific Department, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Cerdanyola del Vallès, Spain; Cervera Primary Health Care Centre, Ileida, Spain; Diabetes Association in Primary Health Care (RedGDPS), Institut Català de la Salut, Barcelona, Spain.
Patient Prefer Adherence. 2016 Nov 9;10:2323-2332. doi: 10.2147/PPA.S116173. eCollection 2016.
The purpose of this study was to identify the perceptions, barriers, and facilitators of self-management of Type 2 diabetes mellitus (T2DM) to determine the factors to consider when developing and implementing a person-centered intervention in patients with poor glycemic control attending primary care.
This was a qualitative study conducted in 6 primary care health centers in Catalonia. Patients who had been diagnosed with T2DM and had glycated hemoglobin of 9% or more were included. The sampling method was opportunistic, accounting for gender, age, duration of diabetes, and type of treatment. Forty-three semi-structured interviews were conducted. Thematic content analysis was performed.
The patients perceived the diagnosis of T2DM as a threat to their health, and the diagnosis generated cognitive and emotional representations of T2DM. The emotions associated with the diagnosis included fear of the future, worry, denial, sadness, and dejection. The patients also wondered if there could have been an error in their test results because they did not present any symptoms. These representations, both cognitive and emotional, can produce specific effects in adaptation processes and require different approach strategies, specifically regarding diet, physical activity, and pharmacological treatment. Finally, specific aspects regarding the acceptability and adaptability of the implementation of a new intervention were expressed.
Patients with T2DM and very poor glycemic control expressed difficulty achieving a balance between the needs and demands of managing and controlling T2DM because they felt it strongly interfered in their daily lives.
本研究旨在确定2型糖尿病(T2DM)自我管理的认知、障碍和促进因素,以确定在为血糖控制不佳的初级保健患者制定和实施以患者为中心的干预措施时应考虑的因素。
这是一项在加泰罗尼亚6个初级保健健康中心进行的定性研究。纳入已诊断为T2DM且糖化血红蛋白≥9%的患者。抽样方法为机会抽样,考虑了性别、年龄、糖尿病病程和治疗类型。共进行了43次半结构式访谈,并进行了主题内容分析。
患者将T2DM诊断视为对其健康的威胁,该诊断产生了对T2DM的认知和情感表征。与诊断相关的情绪包括对未来的恐惧、担忧、否认、悲伤和沮丧。患者还怀疑自己的检测结果是否有误,因为他们没有任何症状。这些认知和情感表征会在适应过程中产生特定影响,需要不同的应对策略,特别是在饮食、体育活动和药物治疗方面。最后,患者表达了关于新干预措施实施的可接受性和适应性的具体方面。
T2DM且血糖控制极差的患者表示,在管理和控制T2DM的需求与要求之间难以取得平衡,因为他们觉得这严重干扰了他们的日常生活。