A Qualitative Study Exploring the Barriers to Attending Structured Education Programmes Among Adults with Type 2 Diabetes

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2022 May 3

PMID 35501809

Authors

Imogen Coningsby

Ben Ainsworth

Charlotte Dack

Affiliations

Soon will be listed here.

Abstract

Background: Diabetes self-management education, a universally recommended component of diabetes care, aims to support self-management in people with type 2 diabetes. However, attendance is low (approx. 10%). Previous research investigating the reasons for low attendance have not yet linked findings to theory, making it difficult to translate findings into practice. This study explores why some adults with type 2 diabetes do not attend diabetes self-management education and considers how services can be adapted accordingly, using Andersen's Behavioural Model of Health Service Utilisation as a framework.

Methods: A cross-sectional semi-structured qualitative interview study was carried out. Semi-structured interviews were conducted by telephone with 14 adults with type 2 diabetes who had verbally declined their invitation to attend diabetes self-management education in Bath and North East Somerset, UK, within the last 2 years. Data were analysed using inductive thematic analysis before mapping the themes onto the factors of Andersen's Behavioural Model.

Results: Two main themes were identified: 'perceived need' and 'practical barriers'. The former theme explored participants' tendency to decline diabetes education when they perceived they did not need the programme. This perception tended to arise from participants' high self-efficacy to manage their type 2 diabetes, the low priority they attributed to their condition and limited knowledge about the programme. The latter theme, 'practical barriers', explored the notion that some participants wanted to attend but were unable to due to other commitments and/or transportation issues in getting to the venue.

Conclusions: All sub-themes resonated with one or more factors of Andersen's Behavioural Model indicating that the model may help to elucidate attendance barriers and ways to improve services. To fully understand low attendance to diabetes education, the complex and individualised reasons for non-attendance must be recognised and a person-centred approach should be taken to understand people's experience, needs and capabilities.

Citing Articles

Quality priorities related to the management of type 2 diabetes in primary care: results from the COMPAS + quality improvement collaborative.

Gaid D, Giasson G, Gaboury I, Houle L, Layani G, Menear M BMC Prim Care. 2024; 25(1):397.

PMID: 39550565 PMC: 11568624. DOI: 10.1186/s12875-024-02641-9.

Factors associated with attendance at a pharmacist-led group diabetes self-management education class and impact on health outcomes.

Ramey O, Gildea C Explor Res Clin Soc Pharm. 2024; 16:100526.

PMID: 39498229 PMC: 11532769. DOI: 10.1016/j.rcsop.2024.100526.

Diabetes self-management education programs: Results from a nationwide population-based study on characteristics of participants, rating of programs and reasons for non-participation.

Weise S, Du Y, Heidemann C, Baumert J, Frese T, Heise M PLoS One. 2024; 19(9):e0310338.

PMID: 39264968 PMC: 11392325. DOI: 10.1371/journal.pone.0310338.

Accessibility of diabetes education in the United States: barriers, policy implications, and the road ahead.

Tharakan A, McPeek Hinz E, Zhu E, Denmeade B, German J, Huang W Health Aff Sch. 2024; 2(8):qxae097.

PMID: 39206435 PMC: 11350287. DOI: 10.1093/haschl/qxae097.

Author Response to Comment on: "Benefit-Risk Assessment of ChatGPT Applications in the Field of Diabetes and Metabolic Illnesses: A Qualitative Study".

Jairoun A, Al-Hemyari S, Shahwan M, Al-Qirim T, Shahwan M Clin Med Insights Endocrinol Diabetes. 2024; 17:11795514241260240.

PMID: 38894857 PMC: 11184991. DOI: 10.1177/11795514241260240.

References

Wens J, Vermeire E, Van Royen P, Sabbe B, Denekens J . GPs' perspectives of type 2 diabetes patients' adherence to treatment: A qualitative analysis of barriers and solutions. BMC Fam Pract. 2005; 6(1):20. PMC: 1156882. DOI: 10.1186/1471-2296-6-20. View

Lo R, Maclean D . The dynamics of coping and adaptating to the impact when diagnosed with diabetes. Aust J Adv Nurs. 2002; 19(2):26-32. View

Ducat L, Philipson L, Anderson B . The mental health comorbidities of diabetes. JAMA. 2014; 312(7):691-2. PMC: 4439400. DOI: 10.1001/jama.2014.8040. View

Winkley K, Evwierhoma C, Amiel S, Lempp H, Ismail K, Forbes A . Patient explanations for non-attendance at structured diabetes education sessions for newly diagnosed Type 2 diabetes: a qualitative study. Diabet Med. 2014; 32(1):120-8. DOI: 10.1111/dme.12556. View

Cooper H, Booth K, Gill G . Patients' perspectives on diabetes health care education. Health Educ Res. 2003; 18(2):191-206. DOI: 10.1093/her/18.2.191. View

Stolar M . Glycemic control and complications in type 2 diabetes mellitus. Am J Med. 2010; 123(3 Suppl):S3-11. DOI: 10.1016/j.amjmed.2009.12.004. View

Beverly E, Wray L, Chiu C, Weinger K . Perceived challenges and priorities in co-morbidity management of older patients with Type 2 diabetes. Diabet Med. 2011; 28(7):781-4. PMC: 4839190. DOI: 10.1111/j.1464-5491.2011.03282.x. View

Hardy K, OBrien S, Furlong N . Information given to patients before appointments and its effect on non-attendance rate. BMJ. 2001; 323(7324):1298-300. PMC: 1121755. DOI: 10.1136/bmj.323.7324.1298. View

Horigan G, Davies M, Findlay-White F, Chaney D, Coates V . Reasons why patients referred to diabetes education programmes choose not to attend: a systematic review. Diabet Med. 2016; 34(1):14-26. DOI: 10.1111/dme.13120. View

10.

Deakin T, Cade J, Williams R, Greenwood D . Structured patient education: the diabetes X-PERT Programme makes a difference. Diabet Med. 2006; 23(9):944-54. DOI: 10.1111/j.1464-5491.2006.01906.x. View

11.

Norris S, Engelgau M, Narayan K . Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care. 2001; 24(3):561-87. DOI: 10.2337/diacare.24.3.561. View

12.

Sav A, King M, Whitty J, Kendall E, McMillan S, Kelly F . Burden of treatment for chronic illness: a concept analysis and review of the literature. Health Expect. 2013; 18(3):312-24. PMC: 5060781. DOI: 10.1111/hex.12046. View

13.

Johnson J, Weinert C, Richardson J . Rural residents' use of cardiac rehabilitation programs. Public Health Nurs. 1998; 15(4):288-96. DOI: 10.1111/j.1525-1446.1998.tb00352.x. View

14.

Glasgow R, Anderson R . In diabetes care, moving from compliance to adherence is not enough. Something entirely different is needed. Diabetes Care. 1999; 22(12):2090-2. DOI: 10.2337/diacare.22.12.2090. View

15.

Ahola A, Groop P . Barriers to self-management of diabetes. Diabet Med. 2013; 30(4):413-20. DOI: 10.1111/dme.12105. View

16.

Heckman B, Mathew A, Carpenter M . Treatment Burden and Treatment Fatigue as Barriers to Health. Curr Opin Psychol. 2015; 5:31-36. PMC: 4465180. DOI: 10.1016/j.copsyc.2015.03.004. View

17.

van der Heide I, Uiters E, Rademakers J, Struijs J, Schuit A, Baan C . Associations among health literacy, diabetes knowledge, and self-management behavior in adults with diabetes: results of a dutch cross-sectional study. J Health Commun. 2014; 19 Suppl 2:115-31. DOI: 10.1080/10810730.2014.936989. View

18.

Norris S, Lau J, Smith S, Schmid C, Engelgau M . Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care. 2002; 25(7):1159-71. DOI: 10.2337/diacare.25.7.1159. View

19.

Winkley K, Upsher R, Keij S, Chamley M, Ismail K, Forbes A . Healthcare professionals' views of group structured education for people with newly diagnosed Type 2 diabetes. Diabet Med. 2018; 35(7):911-919. DOI: 10.1111/dme.13637. View

20.

Gucciardi E, DeMelo M, Offenheim A, Stewart D . Factors contributing to attrition behavior in diabetes self-management programs: a mixed method approach. BMC Health Serv Res. 2008; 8:33. PMC: 2277391. DOI: 10.1186/1472-6963-8-33. View