Department of Primary Care & Population Health, University College London, London, UK.
Department of Psychology, University of Bath, Bath, UK.
BMJ Open. 2019 Jul 16;9(7):e029961. doi: 10.1136/bmjopen-2019-029961.
Significant problems with patients engaging with diabetes self-management education (DSME) exist. The role of healthcare professionals (HCPs) has been highlighted, with a lack of enthusiasm, inadequate information provision and poor promotion of available programmes all cited as affecting patients' decisions to attend. However, little is known about HCPs' views towards DSME. This study investigates the views of HCPs towards self-management generally and self-management in the context of DSME more specifically.
A qualitative study using semi-structured interviews to investigate HCPs views of type 2 diabetes self-management and DSME. Data were analysed thematically and emergent themes were mapped on to the constructs of Normalisation Process Theory (NPT).
Two boroughs in London, UK.
Sampling was purposive to recruit a diverse range of professional roles including GPs, practice nurses, diabetes specialist nurses, healthcare assistants (HCAs), receptionists and commissioners of care.
Interviews were conducted with 22 participants. The NPT analysis demonstrated that while a self-management approach to diabetes care was viewed by HCPs as necessary and, in principle, valuable, the reality is much more complex. HCPs expressed ambivalence about pushing certain patients into self-managing, preferring to retain responsibility. There was a lack of awareness among HCPs about the content of DSME and benefits to patients. Commitment to and engagement with DSME was tempered by concerns about suitability for some patients. There was little evidence of communication between providers of group-based DSME and HCPs or of HCPs engaging in work to follow-up non-attenders.
HCPs have concerns about the appropriateness of DSME for all patients and discussed challenges to engaging with and performing the tasks required to embed the approach within practice. DSME, as a means of supporting self-management, was considered important in theory, but there was little evidence of HCPs seeing their role as extending beyond providing referrals.
患者参与糖尿病自我管理教育（DSME）存在重大问题。医疗保健专业人员（HCPs）的作用已得到强调，缺乏热情、信息提供不足以及对现有计划的推广不力都被认为影响了患者参加的决定。然而，人们对 HCPs 对 DSME 的看法知之甚少。本研究调查了 HCPs 对自我管理的一般看法，以及更具体地在 DSME 背景下对自我管理的看法。
一项使用半结构化访谈调查 HCPs 对 2 型糖尿病自我管理和 DSME 的看法的定性研究。数据进行了主题分析，并将新兴主题映射到正常化过程理论（NPT）的结构上。
英国伦敦的两个行政区。
抽样是为了招募各种专业角色，包括全科医生、执业护士、糖尿病专科护士、医疗保健助理（HCAs）、接待员和护理人员。
共对 22 名参与者进行了访谈。NPT 分析表明，虽然 HCPs 认为糖尿病护理的自我管理方法是必要的，原则上也是有价值的，但现实情况要复杂得多。HCPs 对将某些患者推向自我管理的做法持矛盾态度，他们更愿意保留责任。HCPs 对 DSME 的内容和对患者的益处缺乏认识。对 DSME 的承诺和参与受到对某些患者适用性的担忧的影响。没有证据表明基于小组的 DSME 提供者与 HCPs 之间进行了沟通，也没有证据表明 HCPs 参与了对未参加者的随访工作。
HCPs 对 DSME 是否适合所有患者存在担忧，并讨论了在实践中嵌入该方法所面临的挑战，包括参与和执行相关任务的问题。DSME 作为支持自我管理的一种手段，在理论上被认为是重要的，但几乎没有证据表明 HCPs 将自己的角色扩展到提供转介之外。
