title: Knowledge, attitudes, practices, and barriers reported by patients receiving diabetes and hypertension primary health care in Barbados: a focus group study.
abstract: BACKGROUND
  Deficiencies in the quality of diabetes and hypertension primary care and outcomes have been documented in Barbados. This study aimed to explore the knowledge, attitudes and practices, and the barriers faced by people with diabetes and hypertension in Barbados that might contribute to these deficiencies.
  
  
  METHODS
  Five structured focus groups were conducted for randomly selected people with diabetes and hypertension.
  
  
  RESULTS
  Twenty-one patients (5 diabetic, 5 hypertensive, and 11 with both diseases) with a mean age of 59 years attended 5 focus group sessions.Patient factors that affected care included the difficulty in maintaining behaviour change. Practitioner factors included not considering the "whole person" and patient expectations, and not showing enough respect for patients. Health care system factors revolved around the amount of time spent accessing care because of long waiting times in public sector clinics and pharmacies. Society related barriers included the high cost and limited availability of appropriate food, the availability of exercise facilities, stigma of disease and difficulty taking time off work.Attendees were not familiar with guidelines for diabetes and hypertension management, but welcomed a patient version detailing a place to record results, the frequency of tests, and blood pressure and blood glucose targets. Appropriate education from practitioners during consultations, while waiting in clinic, through support and education groups, and for the general public through the schools, mass media and billboards were recommended.
  
  
  CONCLUSIONS
  Primary care providers should take a more patient centred approach to the care of those with diabetes and hypertension. The care system should provide better service by reducing waiting times. Patient self-management could be encouraged by a patient version of care guidelines and greater educational efforts.
authors.affiliation: Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, St, Michael, Barbados. peter.adams@cavehill.uwi.edu
authors.forename: O Peter
authors.initials: OP
authors.lastname: Adams
authors.forename: Anne O
authors.initials: AO
authors.lastname: Carter
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D001460:Barbados; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000191:economics / Q000592:standards; D017064:Process Assessment, Health Care / Q000592:standards; D011787:Quality of Health Care; D057566:Self Report; D011795:Surveys and Questionnaires; D014850:Waiting Lists