title: Selection of Treatment Strategies among Patients with Type 2 Diabetes Mellitus in Malaysia: A Grounded Theory Approach.
abstract: BACKGROUND
  Diabetes Mellitus is a multifaceted chronic illness and its life-long treatment process requires patients to continuously engage with the healthcare system. The understanding of how patients manoeuvre through the healthcare system for treatment is crucial in assisting them to optimise their disease management. This study aims to explore issues determining patients' treatment strategies and the process of patients manoeuvring through the current healthcare system in selecting their choice of treatment for T2DM.
  
  
  METHODS
  The Grounded Theory methodology was used. Twelve patients with Type 2 Diabetes Mellitus, nine family members and five healthcare providers from the primary care clinics were interviewed using a semi-structured interview guide. Three focus group discussions were conducted among thirteen healthcare providers from public primary care clinics. Both purposive and theoretical samplings were used for data collection. The interviews were audio-taped and transcribed verbatim, followed by line-by-line coding and constant comparison to identify the categories and core category.
  
  
  RESULTS
  The concept of "experimentation" was observed in patients' help-seeking behaviour. The "experimentation" process required triggers, followed by information seeking related to treatment characteristics from trusted family members, friends and healthcare providers to enable decisions to be made on the choice of treatment modalities. The whole process was dynamic and iterative through interaction with the healthcare system. The decision-making process in choosing the types of treatment was complex with an element of trial-and-error. The anchor of this process was the desire to fulfil the patient's expected outcome.
  
  
  CONCLUSIONS
  Patients with Type 2 Diabetes Mellitus continuously used "experimentation" in their treatment strategies and help-seeking process. The "experimentation" process was experiential, with continuous evaluation, information seeking and decision-making tinged with the element of trial-and-error. The theoretical model generated from this study is abstract, is believed to have a broad applicability to other diseases, may be applied at varying stages of disease development and is non-context specific.
authors.affiliation: Medical Education and Research Development Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.|Institute for Health Systems Research, Ministry of Health Malaysia, Selangor, Malaysia.
authors.forename: Lee Lan
authors.initials: LL
authors.lastname: Low
authors.affiliation: Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
authors.forename: Seng Fah
authors.initials: SF
authors.lastname: Tong
authors.affiliation: Research and Management Center, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Wah Yun
authors.initials: WY
authors.lastname: Low
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D019468:Disease Management; D005260:Female; D066296:Grounded Theory; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D058996:Quality Improvement; D011788:Quality of Life
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