Identifying and Prioritizing the Barriers and Facilitators to the Self-Management of Type 2 Diabetes Mellitus: A Community-Centered Approach
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Self-management of type 2 diabetes mellitus is crucial to controlling the disease and preventing harm. Multiple factors have been identified in the literature as potential barriers and facilitators to self-management, but the magnitude and directionality of these factors are seldom studied. We sought to develop and test an instrument to identify and quantify the barriers and facilitators to self-management of type 2 diabetes.
A community-centered approach was used to design, implement, and interpret the results of a stated-preference study. All activities were guided by a diverse stakeholder board. Based on previously reported development work, a novel survey instrument consisting of 13 potential barriers and facilitators was pretested and piloted in our local community. Participants were asked to discuss, rate, and rank each factor. A simple self-explicated method was used to quantify the data and Z scores were used for hypothesis testing.
In total, 25 patients with self-reported type 2 diabetes (64% female; 92% minorities) participated in the pretest and pilot. Time commitments (Z = −3.72), lack of active support groups (Z = −3.39) and other resources in the local community (Z = −2.96), and language/culture (Z = −2.69) were identified as barriers to self-management. Access to healthy food (Z = +5.68), personal understanding (Z = +4.81), and communication with healthcare providers (Z = +4.62) were identified as facilitators.
We demonstrate that factors impacting self-management can be quantified and categorized as barriers and facilitators. While further refinement to some factors and investigation into alternative prioritization methods is necessary, our stakeholder board endorsed moving this to a large nationally representative study to see how these factors vary across different people.
KeywordsStrong Positive Effect Rating Exercise Family Commitment Personal Understanding Ranking Exercise
The research team sincerely thanks the Johns Hopkins Institute for Clinical and Translational Research Community Research Advisory Council and members of the Diabetes Action Board for their valuable contributions and engagement in this study. The authors also thank Ellen M. Janssen and Thomas Lynch for their involvement in the project. Finally, the authors thank the respondents who participated in the study.
JFPB contributed to the study design and conceptualization and is the guarantor of this work. VSG, LRB, DRL, JBS, and JFPB were responsible for the acquisition of the data, interpretation of data, and manuscript preparation. AHO was responsible for data analysis, interpretation of results, and synthesizing the discussion and conclusions.
Compliance with Ethical Standards
This work was supported through the Patient-Centered Outcomes Research Institute Methods Program Award (ME-1303-5946) titled “Advancing stated-preference methods for measuring the preferences of patients with type 2 diabetes”, the Johns Hopkins Center of Excellence in Regulatory Science and Innovation and the US Food and Drug Administration (1U01FD004977-01), and the Agency for Healthcare Research and Quality (T32HS000029). The statements in this work are solely the responsibility and views of the authors.
Conflict of interest
Allison H. Oakes, Vincent S. Garmo, Lee R. Bone, Daniel R. Longo, Jodi B. Segal, and John F. P. Bridges have no competing financial or non-financial interests to disclose.
This research was conducted in accordance with the Declaration of Helsinki and the study protocol was reviewed by the Johns Hopkins Institutional Review Board (IRB 6001).
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