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      Being tested but not educated – a qualitative focus group study exploring patients’ perceptions of diabetic dietary advice

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          Abstract

          Background

          Diet is a key component of the management of diabetes. Several studies suggest that patients receive insufficient and inadequate information. As a first step for developing an intervention for improving dietary advice in primary care, we aimed to explore patients’ experience of receiving dietary advice; their attitudes towards that advice; their perceived dietary advice needs, and any barriers faced in adopting a diet that supports the management of their diabetes.

          Methods

          A qualitative study with three focus groups (20 purposively sampled participants) was conducted with adult primary care patients with Type 2 diabetes in 2016. A semi-structured topic guide was developed from the literature. The focus groups were audio recorded and transcribed. The data were analysed by emergent themes analysis. Data saturation was achieved in the third focus group.

          Results

          The majority of participants were given dietary advice in the form of a generic healthy eating leaflet from a Practice Nurse. Participants had their Haemoglobin A1c (HbA1c) reviewed regularly, but the results seemed not to be linked with review of dietary habits. The test was perceived as being a “pass or fail”, judgmental experience. Participants felt tested but not educated.

          Conclusion

          Individuals with type 2 diabetes seem not to receive dietary advice according to their expectations. Information collected as part of the study can be used to inform the development of interventions aimed at improving dietary advice in this population.

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          Most cited references7

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          Perceived barriers and effective strategies to diabetes self-management.

          This paper reports the perceived barriers to and effective strategies for self-management of adults with type 2 diabetes in a rural setting. Worldwide, diabetes is a major public health concern and financial burden. Research shows that, for people with diabetes, adhering to programs of self-care is often problematic. Despite the potential for improved metabolic control and quality of life, little is published on the barriers and effective strategies that people with diabetes successfully use to incorporate plans of care into their lifestyles. Twenty-four adults diagnosed with type 2 diabetes were recruited from a rural primary care practice to participate in one of three audiotaped focus groups. Content analysis was conducted on the focus group transcripts and validity was strengthened through independent rankings of barriers and strategies by an expert panel and by the nurse researchers. The data were collected 2002. The most frequently reported barriers were lack of knowledge of a specific diet plan, lack of understanding of the plan of care and helplessness and frustration from lack of glycaemic control and continued disease progression despite adherence. Effective strategies identified were developing a collaborative relationship with a provider, maintaining a positive attitude that prompts proactive learning and having a support person who provides encouragement and promotes accountability. These data highlight the importance of barrier and strategy identification in developing and implementing realistic self-management plans and the significance of collaborative alliances between patients and practitioners. Awareness of barriers, identification of strategies to overcome obstacles and the opportunity to problem solve with practitioners assists patients in managing a chronic illness that requires numerous daily decisions.
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            Diabetes mellitus: a major risk factor for cardiovascular disease. A joint editorial statement by the American Diabetes Association; The National Heart, Lung, and Blood Institute; The Juvenile Diabetes Foundation International; The National Institute of Diabetes and Digestive and Kidney Diseases; and The American Heart Association.

            (1999)
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              Patients' perceptions of nutrition care provided by general practitioners: focus on Type 2 diabetes.

              In Australia, GPs are central to managing individuals with chronic disease. Due to the influence of lifestyle behaviour on chronic disease health outcomes, GPs may counsel an individual about nutrition to assist the individual to improve their nutrition behaviour. Patients with a positive regard for their health care are more likely to adhere to lifestyle changes which have been recommended by a health professional. It is unclear whether this relationship extends to the context of nutrition and general practice. The management of Type 2 diabetes presents as a relevant scenario to investigate patients' perceptions of nutrition care provided by Australian GPs. This study examines the perceptions of individuals with Type 2 diabetes regarding the nutrition care they have received from GPs. Nine hundred and thirty-nine individuals with Type 2 diabetes completed a 54-item online survey. Individual survey items related to demographic information, health-related attributes, perspectives on ideal care and reflections on previous care. Eighty-four per cent of respondents perceived that ideal management of Type 2 diabetes by GPs includes nutrition care, however, only 43% of respondents report to have received this care from a GP. Over 91% of respondents are satisfied with their GP regarding nutrition care, but only 34% of respondents believe this care has been effective in improving their personal nutrition behaviour. Patients do not receive nutrition care from GPs as often as they would like, and despite being satisfied with the overall care received, are concerned about the effectiveness of the nutrition care component.
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                Author and article information

                Contributors
                m.alonso-arana2@exeter.ac.uk
                J.M.Valderas@exeter.ac.uk
                jsolomon@dmu.ac.uk
                Journal
                BMC Fam Pract
                BMC Fam Pract
                BMC Family Practice
                BioMed Central (London )
                1471-2296
                3 January 2019
                3 January 2019
                2019
                : 20
                : 1
                Affiliations
                [1 ]ISNI 0000 0004 1936 8024, GRID grid.8391.3, Health Services and Policy Research, University of Exeter Medical School, ; Exeter, UK
                [2 ]ISNI 0000 0001 2153 2936, GRID grid.48815.30, Faculty of Health and Life Sciences, De Montfort University, ; Leicester, UK
                Author information
                http://orcid.org/0000-0003-1022-5759
                Article
                892
                10.1186/s12875-018-0892-5
                6317200
                30606122
                e0e98a36-e16c-4f1e-b0dc-ec459a45070c
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 August 2018
                : 13 December 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Medicine
                diabetes,type 2 diabetes,diet,dietary advice,patients’ perspectives,patient education,qualitative study

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