Patients’ beliefs on the impediments to good diabetes control: a mixed methods study of patients in general practice

Amanda Jane Elliott, Fiona Harris, Sandra G Laird

Most people with diabetes are not attaining desirable levels of HbA1c (glycated haemoglobin), or of blood pressure and cholesterol, leaving them at risk of developing complications. To identify ways of improving diabetes control by gaining insight into patients' attitudes/beliefs. Questionnaires were offered to patients attending for a diabetes review in the 24 GP practices of North East Hampshire and Farnham Clinical Commissioning Group. Infrequent attenders were contacted by post. Volunteers then participated in focus groups. Self-reported medication adherence was good with 83% (98/118) of responders recording ≥9 on a 10-point scale. Patients generally accepted they 'needed' and 'could take' medication. A substantial minority reported 'not liking' taking tablets. Focus groups confirmed this and revealed a reluctance to change lifestyle, with medication reported as a way to evade it. A total of 68 out of 112 responders (60.7%) knew their HbA1c value. However, focus groups identified little understanding of HbA1c, with responders perceiving it as medical jargon. Phrases such as 'stuck-on-sugar' or 'sugarload' were suggested as being semantically easier to understand. The questionnaire revealed trust in clinicians. This was confirmed in focus groups but confounded by frequent reports of healthcare providers giving inadequate/incorrect advice. Investment in lifestyle change is needed. Participants were reluctant to change and saw medication as a way of avoiding it. HbA1c needs to be better explained. Intuitive phrases such as 'stuck-on-sugar' or 'sugarload' could be adopted into common parlance. Inadequate/incorrect advice seems to be hampering diabetes management and there appears to be a need for more diabetes-trained clinicians.