Eating out, lack of social support and high-risk lifestyles are just some of the barriers that stop patients with type 2 diabetes from controlling their condition, according to a research review that covered 8,900 patients and 4,550 healthcare providers from 28 countries.
The study, published in the March issue of the Journal of Nursing and Healthcare of Chronic Illness, shows that psychosocial, socioeconomic, physical, environmental and cultural factors can provide major barriers to effective care.
Researchers from Hong Kong and Northern Ireland studied research carried out between 1986 and 2007 to try and identify how treatment regimes could be improved. Their findings have enabled them to come up with a three-point plan for nurses involved in diabetes care.
"Diabetes is a chronic condition and patients need to modify their lifestyle on a long-term basis to cope with it" says Sandra Pun from the School of Nursing at The Hong Kong Polytechnic University.
"According to the World Health Organization, up to 380 million people worldwide will suffer from diabetes by 2025 so it is important to identify and tackle any barriers that prevent people from making those changes."
Major barriers identified by the review included:
"Our review found that there are various barriers to achieving optimal self-care in type 2 diabetes" concludes co-author Professor Vivien Coates, from the Institute of Nursing Research at the University of Ulster, UK. "Some stem from limitations within the healthcare team, some from ineffective communication between providers and patients and some from the patient's lack of empowerment, motivation and involvement in their treatment.
"Better healthcare delivery systems and reforms that improve affordability, accessibility and efficiency of care are also essential to help both providers and patients to meet desirable standards of diabetes care."
As a result of the study, the researchers are advising that nurses to adopt a three-point plan to overcome patients' barriers to self-care:
1. Nurses should provide patients with enough information about their condition and its treatment to enable them to make informed decisions about their care. 2. Patients need to be motivated to take action to ensure that they manage their diabetes and prevent complications. 3. Nurses need to approach diabetes care in a holistic way that takes account of a wide range of physical, psychosocial, cultural, financial and environmental factors.
"Nurse need to address a number of key questions like what is important to the patient in terms of lifestyle changes and status quo and what patients would expect from the healthcare team" says Professor Coates.
"Understanding the barriers that prevent effective self-care from the perspective of both the patients and the healthcare provider is a vital part of this process."
Notes to editors
Barriers to the self-care of type 2 diabetes from both patients' and providers' perspectives: literature review. Pun et al. Journal of Nursing and Healthcare of Chronic Illness. 1, 4-19. (March 2009).
The Journal of Nursing and Healthcare of Chronic Illness is an international peer-reviewed journal for nurses and health care professionals who care for people with chronic illness and research in this area. The journal is published by Blackwell Publishing Ltd, part of the international Blackwell Publishing group. http://www.wiley.com/bw/journal.asp?ref=1752-9816
About Wiley-Blackwell. Wiley-Blackwell was formed in February 2007 as a result of the acquisition of Blackwell Publishing Ltd. by John Wiley & Sons, Inc., and its merger with Wiley's Scientific, Technical, and Medical business. Together, the companies have created a global publishing business with deep strength in every major academic and professional field. Wiley-Blackwell publishes approximately 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal. For more information on Wiley-Blackwell, please visit www.blackwellpublishing.com or http://interscience.wiley.com
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