Abstract
OBJECTIVE
The study explored the perceptions of Australian immigrants about their interactions with doctors regarding the diagnosis, treatment, and management of type 2 diabetes mellitus.
RESEARCH DESIGN AND METHODS
In-depth interviews were conducted with 30 men and women from Greek, Indian, Chinese, and Pacific Island backgrounds living in Melbourne, Australia, to elicit their perceptions of the management of diabetes and its impact. Participants were recruited through a convenience sample of general practitioners and community organizations providing support to people living with diabetes. Topics discussed included initial reaction to diagnosis, patient—health care provider communication, and the influence of message framing on the perception of the quality of the doctor–patient relationship. Transcripts were coded and analyzed by both authors.
RESULTS
Numerous issues facilitate or inhibit constructive and positive relationships between doctors and patients with type 2 diabetes. Patients reported difficulty in absorbing all the information provided to them at early consultations, and experienced difficulty comprehending the practical aspects of management. Styles of communication and discourses of normalization and catastrophe influenced participants’ responses.
CONCLUSION
Doctors face a complex task in encouraging behavioral change and adherence and establishing and maintaining a supportive relationship with patients. The timing and technical complexity of communication about diabetes, its management, and the prevention of complications require further attention.
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References
Alcozer F. Secondary analysis of perceptions and meanings of type 2 diabetes among Mexican American women. Diabetes Educ. 2000;26:785–95.
Arcury TA, Skelly AH, Gesler WM, Dougherty MC. Diabetes meanings among those without diabetes: explanatory models of immigrant Latinos in rural North Carolina. Soc Sci Med. 2004;59:2183–93.
Chun KM, Chesla CA. Cultural issues in disease management for Chinese Americans with type 2 diabetes. Psychol Health. 2004;19:767–85.
Hjelm KG, Bard K, Nyberg P, Apelqvist J. Beliefs about health and diabetes in men of different ethnic origin. J Adv Nurs. 2005;50:47–59.
Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005;353:487–97.
Delamater AM. Improving patient adherence. Clin Diabetes. 2006;24: 71–7.
Hampson SE, McKay GH, Glasgow RE. Patient–physician interactions in diabetes management:2 consistencies and variation in the structure and content of two consultations. Patient Educ Couns. 1996; 29:49–58.
Australian Institute of Health and Welfare. Diabetes: Australian Facts. Canberra: National Centre for Monitoring Diabetes, Australian Institute of Health and Welfare; 2002.
Holdenson Z, Ctanzariti L, Phillips G, Waters A. A Picture of diabetes in overseas-born Australians. Bulletin No 9. AIHW Cat. No. AUS 38. Canberra: Australian Institute of Health and Welfare; 2003.
Maldonato A, Bloke D, Ceci M, Fraticelli E, Fallucca F. Diabetes mellitus: lessons from patient education. Patient Educ Couns. 1995;26: 57–66.
Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001;24:1069–78.
Parsons J, Wilson D, Scardigno A. The Impact of Diabetes in South Australia 2000. Adelaide: South Australian Department of Human Services Epidemiology Branch; 2000.
Walsh ME, Katz MA, Sechrest L. Unpacking cultural factors in adaptation to type 2 diabetes mellitus. Med Care. 2002;40:129–39 (Suppl).
Broom D, Whittaker A. Controlling diabetes, controlling diabetics: moral language in the management of diabetes type 2. Soc Sci Med. 2004;58:2371–82.
Heisler M, Vijan S, Anderson RM, Ubel PA, Bernstein SJ, Hofer TP. When do patients and their physicians agree on diabetes treatment goals and strategies, and what difference does it make? J Gen Intern Med. 2003;18:893–902.
Huang ES, Gorawara-Bhat R, Chin MH. Self-reported goals of older patients with type 2 diabetes mellitus. J Am Geriatr Soc. 2005;53: 306–11.
Hiss R. Barriers to care in Non-Insulin-dependent diabetes mellitus: the Michigan experience. Ann Intern Med. 1996;124(1S-II):146–8 (Suppl).
Larme AC, Pugh JA. Attitudes of primary care providers towards diabetes: barriers to guideline implementation. Diabetes Care. 1998;21:1391–6.
Wens J, Vermeire E, Van Royen P, Sabbe B, Denekens J. GPs perspectives of type 2 diabetes patients’ adherence to treatment: a qualitative analysis of barriers and solutions. BMC Fam Pract 2005; 6 (http://www.biomedcentral.com).
Helme DW, Harrington NG. Patient accounts for noncompliance with diabetes self-care regimens and physician compliance-gaining response. Patient Educ Couns. 2004;55:281–92.
Grant RW, Pirraglia PA, Meigs JB, Singer DE. Trends in complexity of diabetes care in the United States from 1991 to 2000. Arch Intern Med. 2004;164:1134–9.
Ashton CM, Haidet P, Paternitti DA, et al. Racial and ethnic disparities in the use of health services: bias, preferences or poor communication? J Gen Intern Med. 2003;18:146–52.
McKinstry B. Do patients wish to be involved in decision making in the consultation? A cross sectional survey with video vignettes. Br Med J. 2006;321:867–71.
Perloff RM, Bonder B, Ray GB, Ray EB, Siminoff L. Doctor–patient communication, cultural competence, and minority health: theoretical and empirical perspectives. Am Behav Sci 2006;49:835–52.
Mays N, Pope C. Qualitative research in health care: assessing quality in qualitative data. Br Med J. 2000;320:50–2.
Pope C, Ziebland S, Mays N. Qualitative research in health care: analysing qualitative data. Br Med J. 2000;320:114–6.
Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.
Diabetes Control and Complications Trial/Epidemiology of Diabetes and Complications Research Group. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N Engl J Med. 2000;342:381–9.
Nair KM, Dolovich LR, Ciliska DK, Lee HN. The perception of continuity of care from the perspective of patients with diabetes. Fam Med. 2005;37:118–24.
Schillinger D, Grumbach K, Piette J, et al. Association of health literacy with diabetes outcomes. J Am Med Assoc. 2002;288:475–82.
Brown JB, Harris S, Webster-Bogaert S, Wetmore S, Faulds C, Stewart M. The role of patient, physician and systemic factors in the management of type 2 diabetes mellitus. Fam Pract. 2002;19:344–9.
Puder FF, Keller U. Quality of diabetes care: problem of patient or doctor adherence? Swiss Med Wkly. 2003;133:530–4.
Rubin RR, Peyrot M, Siminerio LM. Health care and patient-reported outcomes: results of the cross-national diabetes attitudes, wishes and needs (DAWN) study. Diabetes Care. 2006;29:1249–55.
Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient–physician relationship. J Am Med Assoc. 1999;282:583–9.
Freedman J, Loewe R. Barriers to communication about diabetes mellitus. J Fam Pract. 2000;49:507–12.
Peel E, Parry O, Douglas M, Lawton J. Blood glucose self-monitoring in non-insulin-treated type 2 diabetes: a qualitative study of patients’ perspectives. Br J Gen Pract. 2004;54:183–8.
Parry O, Peel E, Douglas M, Lawton J. Issues of cause and control in patient accounts of type 2 diabetes. Health Educ Res. 2006;21:97–107.
Acknowledgements
This work was supported in part by beyondblue: the national depression initiative and the Victorian Centre for Excellence in Depression and Related Disorders, the Australian Research Council, and by the Victorian Government Science, Technology, and Innovation Grant. We are grateful for the support of The University of Melbourne and Monash University, to the doctors who collaborated in the recruitment of participants, and to the men and women participated in the study.
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Kokanovic, R., Manderson, L. Exploring Doctor–Patient Communication in Immigrant Australians with Type 2 Diabetes: A Qualitative Study. J GEN INTERN MED 22, 459–463 (2007). https://doi.org/10.1007/s11606-007-0143-2
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DOI: https://doi.org/10.1007/s11606-007-0143-2