Primary care providers' observations on diabetes management for young adults in Ontario: Barriers and enablers to care and patient-provider communication

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a global epidemic that is only projected to impact more people in the coming years. In Canada, there has been a steady increase of people living with T2DM, including an increase in young adults living with the disease. To manage T2DM and minimize the complications of T2DM, primary healthcare providers often encourage their patients to partake in self-management care. This is an effective strategy to managing T2DM; however, there are several barriers people face when trying to self-manage. For young adults living with T2DM, there is very limited research on what prevents them from managing their diabetes. The research that has been conducted on young adults (aged 20 – 39) with T2DM suggests this patient population faces different barriers to care than other age groups because of their different circumstances and access to resources. Moreover, there is also very limited research on how patient-provider communication takes place in primary care settings with young adults living with T2DM, which is also problematic because patient-provider communication is a key component of self-management care. Thus, there is a need for research examining what prevents this patient population from engaging in care and communication with their primary care providers.

Research aim and objectives: The aim of the present study was to explore the barriers and facilitators to self-management care and communication between young adults with T2DM and their primary care providers. To achieve this aim there were two objectives for the study, which were: (1) to understand what providers perceive as barriers to self-management care and communication during the clinical encounter. (2) To understand what providers perceive as facilitators to self-management and communication during the clinical encounter.

Methods: This study used a convergent parallel mixed methods design that employed surveys to collect contextual and quantitative data, and semi-structured interviews to collect qualitative data. Data collection took place between November 2015 and February 2017 throughout southwestern Ontario. Purposive and snowball sampling techniques were used to recruit participants into the study. Two study populations were included in this study, healthcare providers and young adults living with T2DM. The inclusion criteria for healthcare providers were: (1) they were primary care providers, and (2) had experience treating young adults with T2DM. The inclusion criteria for young adults were: (1) they were aged 20 – 39, (2) had T2DM, and (3) had been living with the disease for at least 6 months. The data collected were analyzed using Ritchie and Lewis’ framework approach, which is made up of nine stages that create a structured and iterative process during analysis. The framework approach also integrates data from different sources, such as interviews and surveys.

Results: A total of 13 participants were included in the study, 11 were primary care providers and two were young adults with T2DM. Facilitators to self-management care identified for young adults with T2DM included: (1) fewer comorbidities in young adults and (2) use of technology to manage the disease. The major themes identified as barriers to self-management care for young adults with T2DM were: (1) young adults' denial of their diabetes diagnosis, (2) their sense of invincibility, and (3) their many responsibilities and their low prioritization of their health.

Discussion: The study confirmed well-known approaches to care such as patient-centred care and patient-provider collaboration enabled care for young adults with T2DM. The findings also revealed providers’ roles during the clinical encounter were changing because of young adults use of technology to manage their diabetes. Additionally, young adults’ denial of their diabetes diagnosis and their sense of invincibility are difficult barriers for providers to overcome making them highly problematic given the more aggressive nature of diabetes. The study also suggested young adults are stigmatized because of their diagnosis, which is a known challenge for patients living with diabetes and is well documented in the literature.

Conclusions: The findings from this study support the current literature on diabetes care while adding new knowledge about the challenges and opportunities primary care providers in Canada face with their young adult patients with T2DM. More research is needed to more fully understand how technology usage, denial, a sense of invincibility, and their many responsibilities impact young adults’ self-management care and communication in Canada.