title: A qualitative study on why did the poorly-educated Chinese elderly fail to attend nurse-led case manager clinic and how to facilitate their attendance.
abstract: OBJECTIVE
  This study explored the views, barriers and facilitators of the poorly-educated elderly who were non-attendee of the nurse-led case manager clinic. The case managers provide assessment for diabetes complication screening and can refer patients to the appropriate multidisciplinary team in public outpatient primary care setting.
  
  
  METHODS
  We adopted qualitative research method by individual semi-structured face to face interviews. Nineteen Chinese type 2 diabetes mellitus subjects aged ≥ 60 who failed to attend the nurse-led case manager clinic were interviewed. They all came from a socially deprived urban district in Hong Kong. Content and thematic analysis was performed.
  
  
  RESULTS
  Seven men and twelve women aged 60 to 89 were interviewed. Nine of them received no formal education and ten of them attended up to primary school. The reasons for non-attendance included attitude and poor knowledge towards diabetes complication screening and confusion of the nurse-led clinic as an educational talk. Most respondents could not understand the reason for the screening of diabetic complications, the concept of multidisciplinary care and the procedure and outcomes of nurse assessment. Five respondents were unable to follow multiple appointments because they could not read. Other reasons included physical barriers and comorbidity, family and financial constraint. They either had a tight daily schedule because of the need to take care of family members, or the family members who brought them to clinic had difficulty in attending multiple appointments. Enhanced understanding of the importance and procedure of diabetes multidisciplinary management, a flexible appointment system and a single clear appointment sheet may facilitate their attendance.
  
  
  CONCLUSIONS
  Poorly-educated Chinese elderly with DM and their care givers faced physical, social and psychological barriers when attending the nurse-led case manager clinic. Strategies targeting on their low literacy include effective communication and education by health care professionals to arrive a shared understanding of care plan as well as a flexible appointment and schedule system.
authors: Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, 1/F, Our Lady of Maryknoll Hospital, Wong Tai Sin, Kowloon, Hong Kong S.A.R., China. hll744@ha.org.hk.
authors: Susanna Lok Lam
authors: SL
authors: Hung
authors: Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, 1/F, Our Lady of Maryknoll Hospital, Wong Tai Sin, Kowloon, Hong Kong S.A.R., China. fsn299@ha.org.hk.
authors: Sau Nga
authors: SN
authors: Fu
authors: Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, 1/F, Our Lady of Maryknoll Hospital, Wong Tai Sin, Kowloon, Hong Kong S.A.R., China. lps488@ha.org.hk.
authors: Po Shan
authors: PS
authors: Lau
authors: Division of Family Medicine and Primary Healthcare, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, 4/F, School of Public Health, Prince of Wales Hospital, Shatin, N.T., Hong Kong S.A.R., China. yeungshanwong@cuhk.edu.hk.
authors: Samuel Yeung Shan
authors: SY
authors: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D019090:Case Management / Q000706:statistics & numerical data*; D002681:China; D003920:Diabetes Mellitus / Q000628:therapy; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D036301:Qualitative Research
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