Skip to main content
Top
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Care | Research article

Active participation of patients with type 2 diabetes in consultations with their primary care practice nurses – what helps and what hinders: a qualitative study

Authors: E. du Pon, A. T. Wildeboer, A. A. van Dooren, H. J. G. Bilo, N. Kleefstra, S. van Dulmen

Published in: BMC Health Services Research | Issue 1/2019

Login to get access

Abstract

Background

Patients with type 2 diabetes mellitus (T2DM) receiving primary care regularly visit their practice nurses (PNs). By actively participating during medical consultations, patients can better manage their disease, improving clinical outcomes and their quality of life. However, many patients with T2DM do not actively participate during medical consultations. To understand the factors affecting engagement of patients with T2DM, this study aimed to identify factors that help or hinder them from actively participating in consultations with their primary care PNs.

Methods

Two semi-structured focus groups and 12 semi-structured individual interviews were conducted with patients with T2DM (n = 20) who were undergoing treatment by primary care PNs. All interviews were transcribed verbatim and analyzed using a two-step approach derived from the context-mapping framework.

Results

Four factors were found to help encourage patients to actively participate in their consultation: developing trusting relationships with their PNs, having enough time in the appointment, deliberately preparing for consultations, and allowing for the presence of a spouse. Conversely, four factors were found to hinder patients from participating during consultations: lacking the need or motivation to participate, readjusting to a new PN, forgetting to ask questions, and ineffectively expressing their thoughts.

Conclusion

Patients lacked the skills necessary to adequately prepare for a consultation and achieve an active role. In addition, patients’ keen involvement appeared to benefit from a trusting relationship with their PNs. When active participation is impeded by barriers such as a lack of patient’s skills, facilitators should be introduced at an early stage.

Trial registration

Current Controlled Trials NTR4693 (July 16, 2014).
Literature
2.
go back to reference Rubin RR, Anderson RM, Funnell MM. Collaborative DiabetesCare. Pract Diebetol. 2002;21:29–32. Rubin RR, Anderson RM, Funnell MM. Collaborative DiabetesCare. Pract Diebetol. 2002;21:29–32.
3.
go back to reference Greenfield S, Kaplan SH, Ware JE Jr, Yano EM, Frank HJ. Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3:448–57.PubMedCrossRef Greenfield S, Kaplan SH, Ware JE Jr, Yano EM, Frank HJ. Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3:448–57.PubMedCrossRef
4.
go back to reference Greenfield S, Kaplan S, Ware JE Jr. Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985;102:520–8.PubMedCrossRef Greenfield S, Kaplan S, Ware JE Jr. Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985;102:520–8.PubMedCrossRef
7.
go back to reference Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European association for the study of diabetes (EASD). Diabetes Care. 2012. https://doi.org/10.2337/dc15-0812.CrossRefPubMed Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European association for the study of diabetes (EASD). Diabetes Care. 2012. https://​doi.​org/​10.​2337/​dc15-0812.CrossRefPubMed
8.
go back to reference Charles C, Gafni A, Whelan T. Decisionmaking in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med. 1999;49:651–61.PubMedCrossRef Charles C, Gafni A, Whelan T. Decisionmaking in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med. 1999;49:651–61.PubMedCrossRef
10.
go back to reference Goetz K, Szecsenyi J, Campbell S, Rosemann T, Rueter G, Raum E, Brenner H, Miksch A. The importance of social support for people with type 2 diabetes - a qualitative study with general practitioners, practice nurses and patients. Psychosoc Med. 2012;9. https://doi.org/10.3205/psm000080. Goetz K, Szecsenyi J, Campbell S, Rosemann T, Rueter G, Raum E, Brenner H, Miksch A. The importance of social support for people with type 2 diabetes - a qualitative study with general practitioners, practice nurses and patients. Psychosoc Med. 2012;9. https://​doi.​org/​10.​3205/​psm000080.
13.
go back to reference Heiligers PJM, Noordman J, Korevaar JC, Dorsman S, Hingstman L, van Dulmen AM, et al. Praktijkondersteuners in de huisartspraktijk (POH’s), klaar voor de toekomst (in Dutch) [Practice nurses in general practice, ready for the future?]. 1st ed. Utrecht: NIVEL; 2012. Heiligers PJM, Noordman J, Korevaar JC, Dorsman S, Hingstman L, van Dulmen AM, et al. Praktijkondersteuners in de huisartspraktijk (POH’s), klaar voor de toekomst (in Dutch) [Practice nurses in general practice, ready for the future?]. 1st ed. Utrecht: NIVEL; 2012.
14.
go back to reference Bensing JM, Tromp F, van Dulmen S, van den Brink-Muinen A, Verheul W, Schellevis FG. Shifts in doctor-patient communication between 1986 and 2002: a study of videotaped general practice consultations with hypertension patients. BMC Fam Prac. 2006. https://doi.org/10.1186/1471-2296-7-62. Bensing JM, Tromp F, van Dulmen S, van den Brink-Muinen A, Verheul W, Schellevis FG. Shifts in doctor-patient communication between 1986 and 2002: a study of videotaped general practice consultations with hypertension patients. BMC Fam Prac. 2006. https://​doi.​org/​10.​1186/​1471-2296-7-62.
16.
go back to reference van den Brink-Muinen A, van Dulmen A, Schellevis FG, Bensing JM. Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk. Oog voor communicatie: huisarts-patiënt communicatie in Nederland (in Dutch) [Second Dutch national survey of general practice – focus on qualty of general practice care]. Utrecht: NIVEL; 2004. van den Brink-Muinen A, van Dulmen A, Schellevis FG, Bensing JM. Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk. Oog voor communicatie: huisarts-patiënt communicatie in Nederland (in Dutch) [Second Dutch national survey of general practice – focus on qualty of general practice care]. Utrecht: NIVEL; 2004.
24.
go back to reference Pooley CG, Gerrard C, Hollis S, Morton S, Astbury J. 'Oh it's a wonderful practice... you can talk to them': a qualitative study of patients' and health professionals' views on the management of type 2 diabetes. Health Soc Care Community. 2001;9(5):318–26.PubMedCrossRef Pooley CG, Gerrard C, Hollis S, Morton S, Astbury J. 'Oh it's a wonderful practice... you can talk to them': a qualitative study of patients' and health professionals' views on the management of type 2 diabetes. Health Soc Care Community. 2001;9(5):318–26.PubMedCrossRef
25.
go back to reference du Pon E, Kleefstra N, van Dooren AA, Bilo HJG, van Dulmen AM. DESTINE: a practice-based intervention to increase empowerment in patients with type 2 diabetes - a study protocol of a randomized controlled trial. Diabetes Manag. 2017;7(4):330–6. du Pon E, Kleefstra N, van Dooren AA, Bilo HJG, van Dulmen AM. DESTINE: a practice-based intervention to increase empowerment in patients with type 2 diabetes - a study protocol of a randomized controlled trial. Diabetes Manag. 2017;7(4):330–6.
28.
go back to reference Glasgow RE, Toobert DJ. Social environment and regimen adherence among type II diabetic patients. Diabetes Care. 1988;11:377–86.PubMedCrossRef Glasgow RE, Toobert DJ. Social environment and regimen adherence among type II diabetic patients. Diabetes Care. 1988;11:377–86.PubMedCrossRef
31.
go back to reference Sanders EB-N, William CT. Harnessing people’s creativity: ideation and expression through visual communication. In focus groups: supportive effective product development. London: Taylor and Francis; 2001. Sanders EB-N, William CT. Harnessing people’s creativity: ideation and expression through visual communication. In focus groups: supportive effective product development. London: Taylor and Francis; 2001.
32.
go back to reference Ritchie J, Lewis J. Qualitative research practice: a guide for social science students and researchers. London: Sage; 2003. Ritchie J, Lewis J. Qualitative research practice: a guide for social science students and researchers. London: Sage; 2003.
33.
go back to reference Sandelowski M. The problem of rigor in qualitative research. ANS Avd Nurs Sci. 1986;8:27–37.CrossRef Sandelowski M. The problem of rigor in qualitative research. ANS Avd Nurs Sci. 1986;8:27–37.CrossRef
35.
go back to reference MAXQDA, software for qualitative data analysis, 1989-2010, VERBI software. Consult. Sozialforschung GmbH, Berlin-Marburg-Amöneburg, Germany. MAXQDA, software for qualitative data analysis, 1989-2010, VERBI software. Consult. Sozialforschung GmbH, Berlin-Marburg-Amöneburg, Germany.
36.
go back to reference Feldman-Stewart D, Brundage MD, Tishelman C. SCRN communication team. A conceptual framework for patient-professional communication: an application to the cancer context. Psychooncology. 2005;14:801–9 discussion 810-1.PubMedCrossRef Feldman-Stewart D, Brundage MD, Tishelman C. SCRN communication team. A conceptual framework for patient-professional communication: an application to the cancer context. Psychooncology. 2005;14:801–9 discussion 810-1.PubMedCrossRef
37.
go back to reference Seale C. Grounding theory. In: Seale C, editor. The quality of qualitative research. London: SAGE Publications Ltd; 1999. p. 87–105.CrossRef Seale C. Grounding theory. In: Seale C, editor. The quality of qualitative research. London: SAGE Publications Ltd; 1999. p. 87–105.CrossRef
42.
go back to reference Gorter KJ, Tuytel GH, De Leeuw RRJ, Rutten GEHM. Huisarts of ketenzorg: wat wilde de diabetespatiënt? (in Dutch) [Who should treat diabetes patients?]. Huisarts Wet. 2011;54:238–43.CrossRef Gorter KJ, Tuytel GH, De Leeuw RRJ, Rutten GEHM. Huisarts of ketenzorg: wat wilde de diabetespatiënt? (in Dutch) [Who should treat diabetes patients?]. Huisarts Wet. 2011;54:238–43.CrossRef
49.
go back to reference Giacomini MK, Cook DJ. Users’ Guides to the medical literature: XXIII. Qualitative research in health care. Are the results of the study valid? Evidence-based medicine working group. JAMA. 2000;284:357–62.PubMedCrossRef Giacomini MK, Cook DJ. Users’ Guides to the medical literature: XXIII. Qualitative research in health care. Are the results of the study valid? Evidence-based medicine working group. JAMA. 2000;284:357–62.PubMedCrossRef
52.
53.
go back to reference Taylor B. The experience of overseas nurses working in the NHS: result of a qualitative study. Div Health Soc Care. 2005;2:17–27. Taylor B. The experience of overseas nurses working in the NHS: result of a qualitative study. Div Health Soc Care. 2005;2:17–27.
54.
go back to reference van Weert J, Jansen J, Spreeuwenberg P, van Dulmen S, Bensing J. Effects of communication skills training and a question prompt sheet to improve communication with older cancer patients: a randomized controlled trial. Crit Rev Oncol Hematol. 2011;80:145–15.PubMedCrossRef van Weert J, Jansen J, Spreeuwenberg P, van Dulmen S, Bensing J. Effects of communication skills training and a question prompt sheet to improve communication with older cancer patients: a randomized controlled trial. Crit Rev Oncol Hematol. 2011;80:145–15.PubMedCrossRef
Metadata
Title
Active participation of patients with type 2 diabetes in consultations with their primary care practice nurses – what helps and what hinders: a qualitative study
Authors
E. du Pon
A. T. Wildeboer
A. A. van Dooren
H. J. G. Bilo
N. Kleefstra
S. van Dulmen
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4572-5

Other articles of this Issue 1/2019

BMC Health Services Research 1/2019 Go to the issue