Skip to main content
Key Specialties
Anesthesiology Cardiology Dermatology Diabetology Endocrinology Gastroenterology General Medicine Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Obstetrics and Gynecology Oncology Pediatrics Psychiatry Radiology Respiratory Medicine Rheumatology Surgery Urology
Congress Coverage
2024 ESMO Congress 2024 ERS Congress 2024 EASD Congress 2024 ESC Congress 2024 EAN Congress 2024 ASCO Annual Meeting 2024 ACC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote series | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the systemic effects of menopause, so you can help patients in your clinics through the transition.

Launching: Thursday 12th December 2024
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in:

Open Access 01-12-2024 | Insulins | Research

Perspectives of patients with type 1 and type 2 diabetes on barriers to diabetes care: a qualitative study

Authors: Sweta Shrestha, Sujata Sapkota, Khagendra Acharya, Sabin Chaulagain, Matina Sayami, Abhinav Dahal, Rajani Shakya, Biraj Man Karmacharya

Published in: BMC Health Services Research | Issue 1/2024

Login to get access

Abstract

Background

Diabetes care incorporates multiple integrated elements like self-care practices, patient education and awareness, societal support, equitable access to healthcare facilities and trained healthcare professionals, commitment from the diabetes associations and government policies. There is a dearth of research exploring the barriers experienced by both People with Type 1 diabetes (PwT1D) and People with Type 2 diabetes (PwT2D) in accessing the holistic elements of diabetes care. This study thus aimed at exploring the perceived barriers among PwT1D and PwT2D in accessing diabetes care services in urban and rural areas of Nepal.

Method

This study was a qualitative research using phenomenological approach where an in-depth interview with 23 participants on insulin was conducted. This included 15 PwT1D and 8 PwT2D, residing in the capital and rural areas and attending the hospitals and clinic in the urban and semi-urban regions in Nepal. A semi-structured questionnaire was used for the interview. The interviews were transcribed verbatim and deductive thematic analysis was done.

Results

Majority were female participants and most had received a formal education and were visiting the hospitals located in capital city. Mean age for PwT1D was (27.86 ± 1.85) years whereas the median age for PwT2D was [47.5 (IQR, 16.5)] years. Seven themes were generated from the study representing key barriers from patient’s perspective. These were: Theme (1) Double stigma: Diabetes diagnosis and insulin use, Theme (2) Non-adherence to insulin and Self-Monitoring of Blood Glucose (SMBG), Theme (3) Logistic challenges in rural areas: Scarcity of healthcare professionals and other healthcare facilities, Theme (4) Dissatisfaction with healthcare services, Theme (5) Patients seeking alternative treatment strategies over allopathic treatment, Theme (6) Limitations of health insurance scheme and Theme (7) Limited role of national diabetes organizations.

Conclusion

There is a need in raising awareness among general public especially on T1DM to address the issue of diabetes stigma. An effort in implementation of policies supporting diabetes care and refinement of National Health Insurance Scheme is equally essential. Similarly, strengthening of Health Care System by ensuring availability of insulin, laboratory facilities and trained healthcare professionals in rural areas should be focused to address the inequity in access to healthcare in rural and urban sectors.
Appendix
Available only for authorised users
Literature
1.
Ogrotis I, Koufakis T, Kotsa K. Changes in the global epidemiology of type 1 diabetes in an evolving landscape of environmental factors: causes, challenges, and opportunities. Med. 2023;59:59.
2.
Hossain MJ, Al-Mamun M, Islam MR. Diabetes mellitus, the fastest growing global public health concern: early detection should be focused. Heal Sci Rep. 2024;7:5–9.
3.
Dahal PK, Rawal L, Ademi Z, Mahumud RA, Paudel G, Vandelanotte C. Estimating the health care expenditure to manage and care for type 2 diabetes in Nepal: a patient perspective. MDM Policy Pract. 2023;8:1–13.
4.
Persson S. Socioeconomic consequences of childhood onset type 1 diabetes – a case study of the impact of an early life health shock. 2017.
5.
Kesavadev J, Sadikot SM, Saboo B, Shrestha D, Jawad F, Azad K. Review article challenges in type 1 diabetes management in South East Asia: descriptive situational assessment. Indian J Endocrinol Metab. 2014;18:600.PubMedPubMedCentralCrossRef
6.
Shrestha N, Mishra SR, Ghimire S, Gyawali B, Mehata S. Burden of diabetes and prediabetes in Nepal: a systematic review and meta-analysis. Diabetes Ther. 2020;11:1935–46.PubMedPubMedCentralCrossRef
7.
8.
Lebastchi J, Herold KC. Immunologic and metabolic biomarkers of β-cell destruction in the diagnosis of type 1 diabetes. Cold Spring Harb Perspect Med. 2012;2:1–13.CrossRef
9.
Lipscombe L, Booth G, Butalia S, Eurich Bsp DT, Goldenberg R, Khan N, et al. 2018 clinical practice guidelines. Pharmacologic glycemic management of type 2 diabetes in adults. Can J Diabetes. 2018;42:S88–103.PubMedCrossRef
10.
Jones Z, Akerman J, Bajurny V, Gaudreau A, Rochon P, Mason R. Exploring the lived experience of diabetes through an intersectional lens: a qualitative study of adults with type 1 and type 2 diabetes. Can J Diabetes. 2022;46:620–7.PubMedCrossRef
11.
Gopalan A, Mishra P, Alexeeff SE, Blatchins MA, Kim E, Man AH. Prevalence and predictors of delayed clinical diagnosis of type 2 diabetes: a longitudinal cohort study. Diabet Med. 2018;35:1655–62.PubMedPubMedCentralCrossRef
12.
Townson J, Gallagher D, Cowley L, Channon S, Robling M, Williams D. Keeping it on your radar—assessing the barriers and facilitators to a timely diagnosis of type 1 diabetes in childhood: a qualitative study from the early detection of type 1 diabetes in youth study. Endocrinol Diabetes Metab. 2018;1:1–8.CrossRef
13.
Ide N, LoGerfo JP, Karmacharya B. Barriers and facilitators of diabetes services in Nepal: a qualitative evaluation. Health Policy Plan. 2018;33:474–82.PubMedCrossRef
14.
Tegegne KD, Gebeyehu NA, Yirdaw LT, Yitayew YA, Kassaw MW. Determinants of poor glycemic control among type 2 diabetes in Ethiopia: a systematic review and meta-analysis. Front Public Heal. 2024;12:12.
15.
Farsaei S, Radfar M, Heydari Z, Abbasi F, Qorbani M. Insulin adherence in patients with diabetes: risk factors for injection omission. Prim Care Diabetes. 2014;8:338–45.PubMedCrossRef
16.
Ong WM, Chua SS, Jenn NC. Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: a qualitative study. Patient Prefer Adherence. 2014;8:237–46.PubMedPubMedCentral
17.
Divya S, Nadig P. Factors contributing to non-adherence to medication among type 2 diabetes mellitus in patients attending tertiary care hospital in South India. Asian J Pharm Clin Res. 2015;8:274–6.
18.
Pradhan A, Reji C, Shabaraya AR. Prevalence of different types of barriers to the use of glucometer in diabetic patients. Int J Heal Sci Res. 2021;11:181–6.CrossRef
19.
Gerada Y, Mengistu Z, Demessie A, Fantahun A, Gebrekirstos K. Adherence to insulin self administration and associated factors among diabetes mellitus patients at Tikur Anbessa specialized hospital. J Diabetes Metab Disord. 2017;16:1–6.CrossRef
20.
Wibisono AH, Lestari AN, Sorensen L, Hill P. Fear of injections among people with type 2 diabetes: overview of the problem. J Diabetes Nurs. 2017;21:91–5.
21.
Rezaei M, Valiee S, Tahan M, Ebtekar F, Gheshlagh RG. Barriers of medication adherence in patients with type-2 diabetes: a pilot qualitative study. Diabetes Metab Syndr Obes. 2019;12:589–99.PubMedPubMedCentralCrossRef
22.
Li X, Wu L, Yun J, Sun Q. The status of stigma in patients with type 2 diabetes mellitus and its association with medication adherence and quality of life in China: a cross-sectional study. Med (United States). 2023;102:E34242.
23.
Kangmennaang J, Siiba A, Dassah E, Kansanga M. The role of social support and the built environment on diabetes management among structurally exposed populations in three regions in Ghana. BMC Public Health. 2023;23:1–12.CrossRef
24.
Alromaihi D, Alamuddin N, George S. Sustainable diabetes care services during COVID-19 pandemic. Diabetes Res Clin Pract. 2020;166.
25.
Beran D, Yudkin JS, De Courten M. Assessing health systems for type 1 diabetes in sub-Saharan Africa: developing a “Rapid assessment protocol for insulin access.” BMC Health Serv Res. 2006;6:1–9.CrossRef
26.
Beran D, Yudkin JS. Looking beyond the issue of access to insulin: what is needed for proper diabetes care in resource poor settings. Diabetes Res Clin Pract. 2010;88:217–21.PubMedCrossRef
27.
Gyawali B, Ferrario A, van Teijlingen E, Kallestrup P. Challenges in diabetes mellitus type 2 management in Nepal: a literature review. Glob Health Action. 2016;9:9.CrossRef
28.
Wangnoo SK, Maji D, Das AK, Rao PV, Moses A, Sethi B. Barriers and solutions to diabetes management: an Indian perspective. Indian J Endocrinol Metab. 2013;17:594–601.PubMedPubMedCentralCrossRef
29.
Braun V, Clarke V. Qualitative research in psychology using thematic analysis in psychology using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef
30.
Ahmed SK. The pillars of trustworthiness in qualitative research. J Med Surg Public Heal. 2024;2:100051.CrossRef
31.
32.
Vijaya A, Bharat Rankhambe DH, Kumar S. Myths about treatment of diabetes in common public. Arch Intern Med Res. 2022;05:458–63.CrossRef
33.
Jaacks LM, Liu W, Ji L, Mayer-Davis EJ. Type 1 diabetes stigma in China: a call to end the devaluation of individuals living with a manageable chronic disease. Diabetes Res Clin Pract. 2015;107:306–7.PubMedCrossRef
34.
Chiang JL, Kirkman MS, Laffel LMB, Peters AL. Type 1 diabetes through the life span: a position statement. Am Diabetes Association. 2014;37:2034–54.
35.
36.
37.
38.
Browne JL, Ventura A, Mosely K, Speight J. “I call it the blame and shame disease”: a qualitative study about perceptions of social stigma surrounding type 2 diabetes. BMJ Open. 2013;3:e003384.PubMedPubMedCentralCrossRef
39.
Jeong YM, Quinn L, Kim N, Martyn-nemeth P. Health-related stigma in young adults with type 1 diabetes mellitus. J Psychosoc Nurs Ment Health Serv. 2018;56:44–51.PubMedCrossRef
40.
41.
42.
Shrestha N, Karki K, Poudyal A, Aryal KK, Mahato NK, Gautam N, et al. Prevalence of diabetes mellitus and associated risk factors in Nepal: findings from a nationwide population-based survey. 2022;12:1–8.
43.
Speight J, Holmes-Truscott E, Garza M, Scibilia R, Wagner S, Kato A. Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations. Lancet Diabetes Endocrinol. 2024;12:61–82.PubMedCrossRef
44.
Ellis K, Mulnier H, Forbes A. Perceptions of insulin use in type 2 diabetes in primary care: a thematic synthesis. BMC family practice. 2018;19:1–21.CrossRef
45.
Rafique G, Azam SI, White F. Diabetes knowledge, beliefs and practices among people with diabetes attending a university hospital in Karachi, Pakistan. East Mediterr Health J. 2006;12:590–8.PubMed
46.
Sapkota S, Brien JA, Aslani P. Nepalese patients’ perceptions of treatment modalities for type 2 diabetes. Patient Prefer Adherence. 2016;10:1777–86.PubMedPubMedCentralCrossRef
47.
Browne JL, Ventura A, Mosely K, Speight J. ‘I’m not a druggie, I’m just a diabetic’ : a qualitative study of stigma from the perspective of adults with type 1 diabetes. BMJ Open. 2014;4:1–10.CrossRef
48.
Hapunda G, Abubakar A, Vijver F. Living with type 1 diabetes is challenging for Zambian adolescents: qualitative data on stress, coping with stress and quality of care and life. BMC Endocr Disord. 2015;15:1–12.CrossRef
49.
Tewabe T, Kindie S. Level of insulin adherence among diabetes mellitus patients in Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia, 2017: a cross-sectional study. BMC Res Notes. 2018;11:1–6.CrossRef
50.
Gelaw BK, Mohammed A, Tegegne GT, Defersha AD, Fromsa M, Tadesse E, et al. Nonadherence and contributing factors among ambulatory patients with antidiabetic medications in Adama Referral Hospital. J Diabetes Res. 2014;2014:1–9.CrossRef
51.
Fayyaz F, Aghamahdi F, Noorian S. Associated factors to insulin adherence in type 1 diabetes in Tehran and Karaj. Iran J Diabetes Metab Disord. 2022;21:1591–7.PubMedCrossRef
52.
Mukherjee S, Sarkar BS, Das KK, Bhattacharyya A, Deb A. Original articlecompliance to anti-diabetic drugs:observations from the diabetic clinic of a medical college in Kolkata, India. J Clin Diagn Res. 2013;7:661–5.PubMedPubMedCentral
53.
Adler AJ, Trujillo C, Schwartz L, Drown L, Pierre J, Noble C. Experience of living with type 1 income country: a diabetes in a low- qualitative study from Liberia. BMJ Open. 2021;11:1–9.CrossRef
54.
Mariye T, Girmay A, Birhanu T, Tasew H, Teklay G, Baraki Z. Adherence to insulin therapy and associated factors among patients with diabetes mellitus in public hospitals of central zone of Tigray, Ethiopia, 2018: a cross-sectional study. Pan Afr Med J. 2019;33:1–10.
55.
Peyrot M, Barnett AH, Meneghini LF. Factors associated with injection omission/non-adherence in the global attitudes of patients and physicians in insulin therapy study. Diabetes Obes Metab. 2012;14:1081–7.PubMedCrossRef
56.
The Endocrine Society. Addressing insulin access and affordability: an Endocrine Society position statement. J Clin Endocrinol Metab. 2021;106:935–41.CrossRef
57.
Elsayed H, Abdu A, Mohamed MA, Saad AY. Adherence of patients with insulin dependent diabetes to therapeutic regimen. Egypt J Hosp Med. 2019;77:5784–94.CrossRef
58.
Shakya P, Shrestha A, Karmacharya BM, Morisky DE, Kulseng BE. Factors associated with medication adherence among patients with type 2 diabetes mellitus: a hospital-based cross-sectional study in Nepal. Int J Environ Res Public Health. 2023;20:1537.PubMedPubMedCentralCrossRef
59.
60.
Sharma A, Bhandari PM, Neupane D, Kaplan WA, Mishra SR. Challenges constraining insulin access in Nepal-a country with no local insulin production. Int Health. 2018;10:182–90.PubMedCrossRef
61.
Bayked EM, Kahissay MH, Workneh BD. Barriers and facilitators to insulin treatment: a phenomenological inquiry. J Pharm Policy Pract. 2022;15:1–11.CrossRef
62.
Shrestha D, Shrestha P, Sharma S, Bhattarai J, Shrestha HK, Pradhan A, et al. National consensus statement on the management of type 2 diabetes mellitus in Nepal. J Diabetes Endocrinol Assoc Nepal. 2019;3:38–57.CrossRef
63.
Sapkota S, Brien JE, Aslani P. Blood glucose monitoring in type 2 diabetes – Nepalese patients ’ opinions and experiences. Glob Health Action. 2017;10:1322400.PubMedPubMedCentralCrossRef
64.
Chubb SAP, Minnen K, Bruce DG, Davis TME. The relationship between self-monitoring of blood glucose results and glycated haemoglobin in type 2 diabetes: the fremantle diabetes study. Diabetes Res Clin Pract. 2011;94:371–6.PubMedCrossRef
65.
66.
Alburno H, Schneider F, Vries H. Determinants of adherence to insulin and blood glucose monitoring among adolescents and young adults with type 1 diabetes in Qatar: a qualitative study. F1000Research. 2022;11:907.PubMedCrossRef
67.
Bukhsh A, Goh B, Lo C, Chan KG. Type 2 diabetes patients ’ perspectives, experiences, and barriers toward diabetes-related self-care : a qualitative study from. Front Endocrinol (Lausanne). 2020;11:1–13.CrossRef
68.
Anene-okeke CG, Mosanya AU, Osakwe O. Knowledge, practice, and barriers regarding self-monitoring of blood glucose among patients with type 2 diabetes mellitus in Enugu State, Nigeria. J Diabetol. 2021;12:310–8.CrossRef
69.
Mak WH, Lau RWM. Predictors of self-monitoring of blood glucose among noninsulin-treated patients with type 2 diabetes in a primary care setting in Hong Kong: a cross-sectional study. Sage Open Med. 2021;9:1–8.CrossRef
70.
Terblanche LM, Stellenberg EL. Patient knowledge of HIV and its treatment in South Africa. Afr J Prim Heal Care Fam Med. 2014;6:1–7.
71.
Assayed AA, Muula AS, Nyirenda MJ. The quality of care of diabetic patients in rural Malawi: a case of Mangochi district. Malawi Med J. 2014;26:109–14.PubMedPubMedCentral
72.
Adhikari B, Mishra SR, Schwarz R. Transforming Nepal’s primary health care delivery system in global health era: addressing historical and current implementation challenges. Global Health. 2022;18:1–12.
73.
Ashworth HC, Roux TL, Buggy CJ. Healthcare accessibility in the rural plains (terai) of Nepal: physical factors and associated attitudes of the local population. Int Health. 2019;11:528–35.PubMedCrossRef
74.
Lewis CP, Newell JN. Patients’ perspectives of care for type 2 diabetes in Bangladesh - a qualitative study. BMC Public Health. 2014;14:1–7.CrossRef
75.
Joshi R, Alim M, Kengne AP, Jan S, Maulik PK, Peiris D, et al. Task shifting for non-communicable disease management in low and middle income countries - a systematic review. PLoS One. 2014;9:e103754.PubMedPubMedCentralCrossRef
76.
Zimmerman M, Shah S, Shakya R, Chansi S, Shah K, Munday D, et al. A staff support programme for rural hospitals in Nepal. Bull World Health Organ. 2016;94:65–70.PubMedCrossRef
77.
78.
Ayele AA, Emiru YK, Tiruneh SA, Ayele BA, Gebremariam AD, Tegegn HG. Level of adherence to dietary recommendations and barriers among type 2 diabetic patients: a cross-sectional study in an Ethiopian hospital. Clin Diabetes Endocrinol. 2018;4:1–7.CrossRef
79.
Ejeta F, Raghavendra Y, Mariam MW. Patient adherence to insulin therapy in diabetes type 1 and type 2 in chronic ambulatory clinic of Jimma University. Int J Pharma Sci Res. 2015;6:796–806.
80.
Paneru DP, Adhikari C, Poudel S, Adhikari LM, Neupane D, Paudel N, et al. Adopting social health insurance in Nepal: a mixed study. Front Public Heal. 2022;10:10.
81.
NHRC. Assessment of Social Health Insurance Scheme in Selected Districts of Nepal Assessment of Social Health Insurance Scheme in Selected Districts of Nepal. 2018.
82.
Ranabhat CL, Kim C, Park MB. A comparative study on outcome of government and co-operative community-based health insurance in Nepal. Front Public Heal. 2017;5:1–9.
83.
Sharma P, Yadav DK, Shrestha N, Ghimire P. Dropout analysis of a national social health insurance program at Pokhara Metropolitan City, Kaski, Nepal. Int J Heal Policy Manag. 2022;11:2476–88.
84.
85.
86.
87.
88.
89.
90.
Solomon P. Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatr Rehabil J. 2004;27:392–401.PubMedCrossRef
91.
Metadata
Title
Perspectives of patients with type 1 and type 2 diabetes on barriers to diabetes care: a qualitative study
Authors
Sweta Shrestha
Sujata Sapkota
Khagendra Acharya
Sabin Chaulagain
Matina Sayami
Abhinav Dahal
Rajani Shakya
Biraj Man Karmacharya
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-024-11925-w

Other articles of this Issue 1/2024

Implementing a new multidisciplinary, remote, dementia staff training program for Veterans affairs nursing homes

Factors influencing adoption of sexual and reproductive health intervention for adolescents in Ebonyi, Nigeria

  • Open Access
  • Research

Reduction in all-cause medical and caregiving costs through innovative health awareness projects in a rural area in Japan: a retrospective cohort study

Readiness of and barriers for community pharmacy professionals in providing and implementing vaccination services

Access to quality care after injury in Northern Malawi: results of a household survey

  • Open Access
  • Research

Are recent health, welfare and care graduates part of a rural and remote workforce solution? Evidence from Tasmania, Australia

  • Open Access
  • Research