Lau Kimberley, Escudero Carlos, Lee Irene, Yu Catherine
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Can J Diabetes. 2024 Aug;48(6):355-363.e1. doi: 10.1016/j.jcjd.2024.04.008. Epub 2024 Apr 18.
The purpose of this qualitative study is to identify barriers minimizing the effectiveness of motivational interviewing during virtual clinic encounters for individuals with type 2 diabetes based on the capability, opportunity, motivation, and behaviour (COM-B) model.
One-on-one semistructured interviews were conducted from March to June 2023, with 17 adults with type 2 diabetes (64.7% female; median age 69 years [range 47 to 83 years]) followed at St. Michael's Hospital (Toronto, Canada). Themes from transcribed interviews were identified through descriptive analysis using a grounded theory approach.
The following main themes were identified: 1) face-to-face appointments strengthen provider-patient rapport and collaboration; 2) virtual encounters reduce patient accountability and hinder health-seeking behaviour; and 3) individuals with physical disabilities and/or low technological proficiency experience decreased provider accessibility. Protective factors that can mitigate these negative impacts include establishing rapport during in-person appointments before transitioning to virtual appointments and incorporating a video component during virtual encounters.
Several barriers of virtual appointments currently limit the effectiveness of motivational interviewing for individuals with type 2 diabetes and make it difficult to provide person-centred care, especially by phone. However, there are protective factors that help to maintain healthy lifestyle behaviours, even after transitioning to virtual settings, and are areas for optimization moving forward.
本定性研究旨在基于能力、机会、动机和行为（COM-B）模型，识别在2型糖尿病患者虚拟诊所问诊过程中降低动机性访谈效果的障碍。
2023年3月至6月，对加拿大多伦多圣迈克尔医院随访的17名2型糖尿病成年人（64.7%为女性；中位年龄69岁[范围47至83岁]）进行了一对一的半结构化访谈。通过使用扎根理论方法的描述性分析，从转录访谈中识别出主题。
确定了以下主要主题：1）面对面预约加强了医患关系和协作；2）虚拟问诊降低了患者的责任感并阻碍了寻求健康的行为；3）身体残疾和/或技术熟练程度低的个体就医时与医护人员接触减少。可以减轻这些负面影响的保护因素包括在过渡到虚拟预约之前在面对面预约期间建立融洽关系，以及在虚拟问诊期间加入视频组件。
目前，虚拟预约的几个障碍限制了对2型糖尿病患者进行动机性访谈的效果，并且难以提供以患者为中心的护理，尤其是通过电话。然而，即使在过渡到虚拟环境后，也有一些保护因素有助于维持健康的生活方式行为，这些是未来需要优化的领域。
