title: Understanding barriers to glycaemic control from the patient's perspective.
abstract: BACKGROUND
  To better understand barriers to glycaemic control from the patient's perspective.
  
  
  METHODS
  An interpretative phenomenological approach was used to study the experiences of 15 adults with Type 2 diabetes. Participants each gave a semi-structured interview of their experiences of living with diabetes. Interviews were transcribed, and themes extracted and organised using a patientcentred framework.
  
  
  RESULTS
  Participants' stories confirmed many of the barriers in the literature, particularly those related to context, such as family, finances, work. Barriers also related to negative emotional reactions to diabetes: fear of new events (diagnosis, starting pills/insulin); guilt about getting diabetes and not controlling it; and shame about having diabetes. Barriers also related to unscientific beliefs and personal beliefs. There were additional barriers related to poor clinician-patient relationships. Overall, participants had a poor understanding of diabetes, and complained that their clinician simply 'told them what to do'.
  
  
  CONCLUSIONS
  Using a patient-centred approach, this study identified many barriers to glycaemic control. We suggest that a key barrier is clinician ignorance of their patients' fears, beliefs, expectations, context; of what constitutes a positive therapeutic relationship; and of the limitations of a biomedical approach to patient non-adherence. Faced with both a worsening diabetes epidemic and increasing health care workforce shortages, clinicians urgently need to understand that it is they, not their patients, who must change their approach if diabetes care is to be improved.
authors.affiliation: Wairoa Medical Centre, 24 Kitchener St, PO Box 341, Wairoa, New Zealand. ronjanes@xtra.co.nz
authors.forename: Ron
authors.initials: R
authors.lastname: Janes
authors.forename: Janet
authors.initials: J
authors.lastname: Titchener
authors.forename: Joseph
authors.initials: J
authors.lastname: Pere
authors.forename: Rose
authors.initials: R
authors.lastname: Pere
authors.forename: Joy
authors.initials: J
authors.lastname: Senior
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D003142:Communication; D003469:Culture; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000523:psychology*; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011320:Primary Health Care; D011369:Professional-Patient Relations
chemical_list: D001786:Blood Glucose