Self management of Type 2 Diabetes considering gender differences. A qualitative study.

Transcription

1 Self management of Type 2 Diabetes considering gender differences. A qualitative study. Berenguera, A; Millaruelo, L; Buil, P; Gómez, C; Mora, G; Cos, X. IDIAP Jordi Gol Primary Care Research Unit, Barcelona (Spain); Network of Diabetes Study Groups in Primary Health Care Barcelona (Spain);Azpilagaña Health Centre, Pamplona (Spain);Vélez Norte Clinical Management Unit, Málaga (Spain);Los Alpes Health Centre, Madrid (Spain); Sant Martí Psycho Pedagogical Advisory Teams, Barcelona (Spain)

2 Objective To explore the barriers, knowledge, attitudesand behaviours in selfmanagement of poorly controlled type 2 diabetes (T2DM) considering differences between genders.

3 Theoretical approach Design and Methods Study setting Sample design PHENOMENOLOGY We explored the discourses of T2DM through people s actual experiences Individual living experiences in selfmanagement of T2DM 8 Primary Health Care Centres 4 regions of Spain Barcelona Madrid Pamplona/Basque Country Málaga People over 40 years of age diagnosed with T2DM Purposeful sampling Gender Age Years with diabetes Type of treatment Presence or absence of cardiovascular disease

4 Technique to generate data: Focus group discussions Mixed group Men s group Women s group

5 Informants characteristics

6 Results

7 Emerging categories in the thematic content analysis Diagnostic impact Disease attribution Beliefs about impact of the disease Self care and caregiver Patient Professional relationship

8 Diagnostic impact Variability on the impact of T2DM Life threatening disease Just another life event Denial of the disease, to be accepted as it evolves Women High levels of concern The diagnostic was an extremely difficult moment Men Lowerlevelof concern Less emotional impact

9 Disease attribution Search for an explanation Patients seek a causal explanation for their illness T2DM associated with: Hospital admissions, operations, family deaths and any stressful life event Attribution to poor self care I m paying the consequences of a poor self care (male, 52 years old)

10 Beliefs about impact of the disease Some of patients belived that had diabetes for hereditary factors The absence of symptoms or pain do not favor to change sedentary behaviour and self management "It's a disease from which I will not die, my mum died at 90 years old with diabetes" (female, 50) "Silent disease which does not hurt you..." (woman 71a) "The poison does not kill you, the dose kills... This can kill you" (male, 50)... "I eat everything... It does not hurt anything and I'm great" (male, 65)

11 Self care and caregivers Women are the support within the family Caretakers of their families, children. Have a multi caregiver role Prioritize care for family members before care for themselves. Some are aware of their difficulties and self criticize The family is the men s support Men identify their wives as support and as monitors of their disease. Their care is on their wives' hands Men attribute the poor level of self care to mood, motivation or fatigue and have more issues related to work and personal life balance.

12 Patient professional relationship Patients feel insecure about asking questions on the disease, emotional aspects and other such as impact on sexuality The doctor s consultation room seems to be a place to review only the laboratory tests or the medication Nurses are the key professionals to change lifestyle behaviours A harsh and alarmist tone does not contribute to a good selfmanagement Professionals need training to improve patients motivation

13 Conclusions Beliefs about T2DM The beliefs about T2DM do not favor proper management of the disease. Multicaregiver role Prioritize care versus self care in women. Their awareness in this area is important to generate a shift Person centredapproach The person centred approach in primary care is important to consider the differences between genders in order to understand the causes of poor self management of T2DM

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