title: Barriers and facilitating factors for disease self-management: a qualitative analysis of perceptions of patients receiving care for type 2 diabetes and/or hypertension in San José, Costa Rica and Tuxtla Gutiérrez, Mexico.
abstract: BACKGROUND
  The burden of cardiovascular disease is growing in the Mesoamerican region. Patients' disease self-management is an important contributor to control of cardiovascular disease. Few studies have explored factors that facilitate and inhibit disease self-management in patients with type 2 diabetes and hypertension in urban settings in the region. This article presents patients' perceptions of barriers and facilitating factors to disease self-management, and offers considerations for health care professionals in how to support them.
  
  
  METHODS
  In 2011, 12 focus groups were conducted with a total of 70 adults with type 2 diabetes and/or hypertension who attended urban public health centers in San José, Costa Rica and Tuxtla Gutiérrez, Chiapas, Mexico. Focus group discussions were transcribed and coded using a content analysis approach to identify themes. Themes were organized using the trans-theoretical model, and other themes that transcend the individual level were also considered.
  
  
  RESULTS
  Patients were at different stages in their readiness-to-change, and barriers and facilitating factors are presented for each stage. Barriers to disease self-management included: not accepting the disease, lack of information about symptoms, vertical communication between providers and patients, difficulty negotiating work and health care commitments, perception of healthy food as expensive or not filling, difficulty adhering to treatment and weight loss plans, additional health complications, and health care becoming monotonous. Factors facilitating disease self-management included: a family member's positive experience, sense of urgency, accessible health care services and guidance from providers, inclusive communication, and family and community support.Financial difficulty, gender roles, differences by disease type, faith, and implications for families and their support were identified as cross-cutting themes that may add an additional layer of complexity to disease management at any stage. These factors also relate to the broader family and societal context in which patients live.
  
  
  CONCLUSIONS
  People living with type 2 diabetes and hypertension present different barriers and facilitating factors for disease self-management, in part based on their readiness-to-change and also due to the broader context in which they live. Primary care providers can work with individuals to support self-management taking into consideration these different factors and the unique situation of each patient.
authors.affiliation: Comprehensive Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panamá, Calzada Roosevelt 6-25, Zona 11, Guatemala City, Guatemala. mpfort@uw.edu.
authors.forename: Meredith P
authors.initials: MP
authors.lastname: Fort
authors.forename: Nadia
authors.initials: N
authors.lastname: Alvarado-Molina
authors.forename: Liz
authors.initials: L
authors.lastname: Peña
authors.forename: Carlos
authors.initials: C
authors.lastname: Mendoza Montano
authors.forename: Sandra
authors.initials: S
authors.lastname: Murrillo
authors.forename: Homero
authors.initials: H
authors.lastname: Martínez
mesh_terms: D000328:Adult; D000368:Aged; D003364:Costa Rica; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000523:psychology* / Q000628:therapy; D019468:Disease Management; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000523:psychology* / Q000628:therapy; D008297:Male; D008800:Mexico; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D012648:Self Care / Q000379:methods / Q000523:psychology*; D014505:Urban Population