Perceived barriers and effective strategies to diabetes self-management.
OBJECTIVE
This paper reports the perceived barriers to and effective strategies for self-management of adults with type 2 diabetes in a rural setting.


BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Academic Affairs and Professor of Nursing, Grand Valley State University, Grand Rapids, Michigan 49401, USA. nagelkej@gvsu.edu
Jean
J
Nagelkerk
Kay
K
Reick
Leona
L
Meengs
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002908:Chronic Disease; D003144:Communication Barriers; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods; D011320:Primary Health Care; D011369:Professional-Patient Relations; D012423:Rural Health; D012648:Self Care / Q000379:methods / Q000523:psychology*; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology