title: A qualitative study of the experiences of care and motivation for effective self-management among diabetic and hypertensive patients attending public sector primary health care services in South Africa.
abstract: BACKGROUND
  Diabetes and hypertension constitute a significant and growing burden of disease in South Africa. Presently, few patients are achieving adequate levels of control. In an effort to improve outcomes, the Department of Health is proposing a shift to a patient-centred model of chronic care, which empowers patients to play an active role in self-management by enhancing their knowledge, motivation and skills. The aim of this study was to explore patients' current experiences of chronic care, as well as their motivation and capacity for self-management and lifestyle change.
  
  
  METHODS
  The study involved 22 individual, qualitative interviews with a purposive sample of hypertensive and diabetic patients attending three public sector community health centres in Cape Town. Participants were a mix of Xhosa and Afrikaans speaking patients and were of low socio-economic status.
  
  
  RESULTS
  The concepts of relatedness, competency and autonomy from Self Determination Theory proved valuable in exploring patients' perspectives on what a patient-centred model of care may mean and what they needed from their healthcare providers. Overall, the findings of this study indicate that patients experience multiple impediments to effective self-management and behaviour change, including poor health literacy, a lack of self-efficacy and perceived social support. With some exceptions, the majority of patients reported not having received adequate information; counselling or autonomy support from their healthcare providers. Their experiences suggests that the current approach to chronic care largely fails to meet patients' motivation needs, leaving many of them feeling anxious about their state of health and frustrated with the quality of their care.
  
  
  CONCLUSIONS
  In accordance with other similar studies, most of the hypertensive and diabetic patients interviewed for this study were found to be ill equipped to play an active and empowered role in self-care. It was clear that patients desire greater assistance and support from their healthcare providers. In order to enable healthcare providers in South Africa to adopt a more patient-centred approach and to better assist and motivate patients to become effective partners in their care, training, resources and tools are needed. In addition, providers need to be supported by policy and organisational change.
authors.affiliation: Chronic Disease Initiative for Africa and Division of Diabetes and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa. km.murphy@uct.ac.za.|Chronic Diseases Initiative for Africa, Department of Medicine, Groote Schuur Hospital, Observatory, J 47-85 Old Main Building, 792 5, Cape Town, South Africa. km.murphy@uct.ac.za.
authors.forename: Katherine
authors.initials: K
authors.lastname: Murphy
authors.affiliation: Chronic Disease Initiative for Africa and Division of Diabetes and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa. thandiec@gmail.com.
authors.forename: Thandie
authors.initials: T
authors.lastname: Chuma
authors.affiliation: Department of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. cathy.mathews@mrc.ac.za.
authors.forename: Catherine
authors.initials: C
authors.lastname: Mathews
authors.affiliation: Chronic Disease Initiative for Africa and Division of Diabetes and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa. krisela.steyn@gmail.com.
authors.forename: Krisela
authors.initials: K
authors.lastname: Steyn
authors.affiliation: Chronic Disease Initiative for Africa and Division of Diabetes and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa. naomi.levitt@uct.ac.za.
authors.forename: Naomi
authors.initials: N
authors.lastname: Levitt
mesh_terms: D000328:Adult; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006282:Health Personnel; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007407:Interviews as Topic; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011320:Primary Health Care; D017150:Public Sector; D036301:Qualitative Research; D012648:Self Care; D020377:Self Efficacy; D012944:Social Support; D013019:South Africa