Diabetes prevention in primary care: a systematic review and qualitative study of patient and health professional experiences

  • Josie Messina

Student thesis: Phd

Abstract

Background: Primary care is seeing a rapid rise in diabetes cases which could potentially be prevented through lifestyle interventions. Some clinical trials indicate that diabetes risks can be cut by as much as 60% through lifestyle interventions; however very little is known about the practicalities of providing such services in primary care. Aims: to explore how diabetes prevention is conceptualised by patients and health practitioners within a primary care setting, as well as to understand the factors associated with diabetes prevention delivery by practitioners and uptake by patients. Methods: A narrative synthesis systematic review, including qualitative and quantitative evidence was completed, in addition to primary research. Four medical centres serving mixed urban city populations in the UK, recruited 32 ‘at risk’ patients for routine appointment observations. Follow-up interviews with 30 patients and 20 professions (13 nurses, 2 health care assistants, 5 GPs) were completed. Thematic analysis, drawing on techniques of grounded theory, uncovered three major themes within the data. Results: The review examined 18 papers and found mixed evidence on the importance of diabetes prevention in primary care, but it pointed to the importance of understanding diabetes risks factors. Patient and professional factors impacting on prevention include patient knowledge, motivation, use/trust of healthcare, and professional factors include workload, resources, knowledge, and perceptions of patient motivation. The empirical study uncovered three major themes: The first theme focused on how patients made sense of diabetes and revealed that conceptualisations of diabetes risk was an important factor in prevention as it influenced experiences and interpretations of risk, as well as any preventative actions. This study provided novel insights into ways patients used knowledge sources such as co-constructed knowledge from health professionals, as well as family, and friends to make sense of diabetes risks, which in turn informed their views of candidacy and behaviour modifications. Claims to candidacy were mainly based on family history and lifestyle factors; however, a few patients were deemed ‘unlikely candidates’ in the absence of these factors. Within the second theme, patient factors affecting diabetes prevention, participants placed a high value on preventative services in primary care and this allowed for a preventative focus in consultations which focused on achievable lifestyle changes. However, there were several obstacles that impacted on lifestyle modification such as physical limitations and difficulties with engaging in change. Despite obstacles, many patients had a fear of developing diabetes and desire to stay healthy for the future, which acted as a motivator in tackling their potential ‘diabetes in waiting’/risks. Finally, the third theme, professional views of prevention, professionals (mainly nurses and healthcare assistants rather than GPs) assumed the responsibility for preventative services although competing interests, lack of time, and motivation to change proved to be barriers to prevention. Opportunities for change arose from a new diagnosis of pre-diabetes or a patient’s family history and professionals provided lifestyle advice depending on a patient’s level of risk, health literacy and lifestyle. Despite challenges, this study points to the growing role of primary care professionals in engaging the patients in change, within the demanding workload of an already stretched primary care system. Conclusion: This study demonstrated that primary care can play an integral role in promoting healthy lifestyles for diabetes prevention as part of routine primary care appointments, despite challenges. This study is timely and fits with the introduction of the new National Diabetes Prevention Programme which advocates for primary care to play more central role in preventing diabetes. Key messages for policy
Date of Award1 Aug 2018
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorStephen Campbell (Supervisor), Caroline Sanders (Supervisor) & Rebecca Morris (Supervisor)

Keywords

  • Qualitative
  • Primary care
  • Diabetes prevention

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