Perspectives of Patients with Type 1 and Type 2 diabetes on barriers to diabetes care: A qualitative study

Abstract

Background Diabetes care incorporates multiple integrated elements like self-care practices, patient education and awareness, societal support, equitable access to healthcare facilities and trained healthcare professionals, commitment from the diabetes associations and government policies. There is a dearth of research viewing into the barriers experienced by both People with Type 1 diabetes (PwT1D) and People with Type 2 diabetes (PwT2D) in accessing the holistic elements of diabetes care. This study thus aims to explore the perspectives of PwT1D and PwT2D towards barriers in receiving diabetes care services in urban and rural areas in Nepal. Method This study uses a qualitative research method where an in-depth interview of 23 participants on insulin was conducted using a semi-structured questionnaire. This included 15 PwT1D and 8 PwT2D, residing in the capital and rural areas and attending the hospitals and clinic in the urban and semi-urban regions in Nepal. The interviews were transcribed verbatim and thematically analyzed. Results Seven themes emerged from the study representing key barriers from patient’s perspective. These were: Theme 1) Diabetes stigma, Theme 2) Non-adherence to insulin and Self-Monitoring of Blood Glucose (SMBG), Theme 3) Lack of availability of healthcare professionals and other healthcare facilities, Theme 4) Dissatisfaction with healthcare services, Theme 5) Preference of alternative treatment strategies, Theme 6) Limitations of health insurance and Theme 7) Limited role of national diabetes organizations. Conclusion There is a need in raising awareness among general public especially on Type 1 Diabetes to address the issue of diabetes stigma. An effort in implementation of policies supporting diabetes care and refinement of National Health Insurance Scheme is equally essential. Similarly, strengthening of Health Care System by ensuring availability of insulin, laboratory facilities and trained healthcare professionals in rural areas should be focused to address the inequity in access to healthcare in rural and urban sectors.