Demographic characteristics of the participants are available in Table 2. Demographic characteristics of participants. Five themes were identified: (1) Susceptibility to severe complications motivates action engagement; (2) Self-management is beneficial; (3) Barriers to self-management engagement; (4) Two sides of social environment; (5) Obtaining reliable information. The summary of the themes is available in Table 3. Summary of major themes.
Table 2
Demographic characteristics of participants
Demographic characteristics
|
Male (n = 15)
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Female (n = 11)
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Total (n = 26)
|
Age(mean)
|
44
|
48
|
46
|
Married
|
10
|
9
|
19
|
Primary school graduation
|
5
|
4
|
9
|
Middle school graduation
|
7
|
5
|
12
|
College university graduation
|
3
|
2
|
5
|
Employed
|
11
|
4
|
15
|
Unemployed
|
4
|
8
|
12
|
Table 3
Major themes
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Brief description of the themes
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Susceptibility to severe complications motivates action engagement
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Participants were aware of own susceptibility to severe complications that could be caused by poor blood glucose. The awareness could motivate action engagement.
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Self-management is beneficial
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Self-management, which included lifestyle management, medication therapy, and blood glucose monitoring, was believed by participants to be beneficial for improving blood glucose control. The perceived benefit facilitated self-management engagement.
|
Barriers to self-management engagement
|
Practical barriers to self-management engagement were identified. The barriers included:
(1) Uselessness of general knowledge about lifestyle management; (2) Difficulty in changing unhealthy habits; (3) Temporary remission and discontinuity of medication therapy engagement; (4) Blood glucose monitoring and physical symptoms.
|
Two sides of social environment
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The influence of social environment on self-management engagement could be both positive and negative
|
Obtaining reliable information
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Providing participants with reliable information about diabetes could improve self-management engagement, while reliable information was not always available
|
Susceptibility to severe complications motivates action engagement
Participants’ awareness of their own susceptibility to severe complications that might be caused by poor blood glucose control could facilitate self-management engagement. All participants were aware that their poor blood glucose control status had caused susceptibility to diabetic complications. The diabetic complications were regarded as severe conditions that could impact normal functions of their bodies, such as the functions of eyes, renal, and foot.
“Now I clearly understand that my status (poor blood glucose control) is easy to develop complications. I know it would be really bad for eye and feet.” (P-16)
The concern of susceptibility to the severe complications generated participants’ intention to prevent the complications. To avoid the complications, motivation to engage in specific actions was identified.
“Yes, I just want to try my best to control it (blood glucose). I'm still young and I have to keep away from them (complications).”(P-8)
“I understand complications are very bad, I planed to take some measures to control my blood glucose, and to avoid the complications. ”(P-14)
Emotional burdens were identified in some participants. The concern about poor blood glucose control and susceptibility to complications caused the emotional burdens.
“I didn't care before. Now I just feel that my body is not at a good status. My blood glucose was not well controlled. I'm afraid of renal complications, and other complications. I feel anxious.” (P-3)
“But my current situation (poor blood glucose control) is not good, it is also difficult to deal with it. I'm very anxious.”(P-11)
Self-management is beneficial
The participants thought self-management was beneficial approach to improve blood glucose control. The perceived benefit motivated self-management engagement. The specific contents of self-management included: (1) Lifestyle management; (2) Medication therapy; (3) Blood glucose monitoring.
Lifestyle management
Motivation to engage in lifestyle management was expressed by the participants, which was triggered by the perceived benefit of lifestyle management in improving blood glucose control. Lifestyle management included eating a healthy diet and doing more exercise. The participants believed that engaging in lifestyle management was beneficial in improving blood glucose control. Some participants stated that they used to achieve good blood glucose control when they engaged in lifestyle management. The perceived benefits generated participants’ intention to engage in lifestyle management to improve blood glucose control.
“I would pay more attention to my diet. I plan to increase my intake of vegetables. I hope I could control it (blood glucose).”(P-9)
“I would try to do more exercise.”(P-15)
Medication therapy
The participants believed that medication therapy was the most effective approach for blood glucose control. The participants thought it was impossible to get blood glucose under control without taking medications. This perception generated a positive attitude toward medication therapy engagement.
“I used to take the medications three times a day, I could stick to the regimens at that time. If you can't stick to the regimens, your blood sugar will be high. If you can do it, your blood sugar will be normal.”(P-7)
Blood glucose monitoring
Some participants showed good blood glucose monitoring engagement, which was associated with awareness of benefits of blood glucose monitoring. These participants stated that they knew blood glucose monitoring could indicate how their blood glucose was controlled and whether their diet and medication regimens demanded adjustment. Because the awareness of benefits of blood glucose monitoring, the participants showed good blood glucose monitoring engagement.
“I also knew that. I would measure my blood glucose. If it was not high, I would know how much to eat. For example, eating a boiled egg, a cake and a cup of soybean milk in the morning could ensure that the blood glucose after meals is not high.” (P-21)
“I would measure my blood glucose, to adjust my medication and diets.” (P-22)
Barriers to self-management engagement
Although the motivation for action engagement and belief on benefits of self-management were identified, practical barriers to self-management engagement were recognized. The barriers included four dimensions: (1) Uselessness of general knowledge about lifestyle management; (2) Difficulty in changing unhealthy habits; (3) Temporary remission and discontinuity of medication therapy engagement; (4) Blood glucose monitoring and physical symptoms.
Uselessness of general knowledge about lifestyle management
Providing participants with general knowledge about lifestyle management was useless for achieving successful lifestyle management engagement. Although the participants possessed general knowledge about lifestyle management, various everyday living experiences and living patterns of individual participants caused difficulty in using the general knowledge to formulate personal and practical lifestyle management schemes, which impeded lifestyle management engagement.
“I know I need to control my diets, to control energy intake and do more exercise. But all these are too general, it didn’t make sense for me because I live a life in my own way. I believed everyone has their own ways for living. I still don’t know how to make my life more health. I still don’t have my own plans for adjusting my diets and exercise.” (P-17)
Difficulty in changing unhealthy habits
To live the lifestyles proposed for people with diabetes, some participants stated that they had to change their unhealthy habits formed by long-term periods. Although the unhealthy habits caused poor blood glucose control, it was still a challenge to break the habits.
“My poor blood glucose control might be caused by my diets. I know what kind of food is good for me, but I just couldn’t control myself. I know I couldn’t eat too much fried food, but I like fried hairtail very much and often ate too much. After eating, you regretted it. When you ate, you just couldn’t stop it.” (P-8)
“I do little exercise in daily life, that is a habit formed for a long time.. I don't like running, I don't like sports, and I don't like dancing.” (P-15)
Temporary remission and discontinuity of medication therapy engagement
Discontinuity of medication therapy engagement was identified. The discontinuity was caused by temporary remission of hyperglycemia and physical symptoms. Some participants stopped taking medications when their blood glucose was temporarily under control or no physical symptoms were perceived. The temporary remission was considered the signal of stopping medication therapy.
“I used to take medicine according to the regimens proposed by my doctor. I insisted on taking drugs, and my blood sugar was well controlled at that time. After that, I didn't insist on taking medication. I felt that my condition was under control and felt no discomfort. I didn't take medication after that.” (P-22)
Two participants stated that they did not take medication because potential side effects and drug dependence. However, the concerns did not influence medication therapy engagement of the majority of participants. Despite potential side effects and drug dependence, other participants thought taking medication to control blood glucose was more critical.
“I don't care about side effect. I know that drugs could damage the liver and kidney, but I must control my blood glucose. I often watched videos introducing western medicine would have side effects on my mobile phone, but you couldn't make it (good blood glucose control) without taking the medications.”(P-7)
“If you don't take medication, it would be troublesome in case of poor blood glucose control. Now I don't care about the side effects and dependence of drugs, because now my live is threatened and I must insist on taking drugs. I'm more worried about the poor control of blood glucose.”(P-10)
Blood glucose monitoring and physical symptoms
The majority of participants in this study did not engage in regular blood glucose monitoring because the function of blood glucose monitoring was misunderstood. The participants believed that blood glucose monitoring should only be performed when physical symptoms occurred. The participants thought it was unnecessary to measure their blood glucose when no physical symptoms were perceived. No perceived physical symptoms was considered as an indicator of healthy status. Because the healthy status, blood glucose monitoring was believed to be unnecessary. The participants would only measure blood glucose when physical symptoms were perceived.
“I didn't feel uncomfortable before, but now I feel it. I can't see clearly, and my feet are swollen. It was only when the body began to change that I began to do it (blood glucose monitoring).” (P-19)
“Well, I only measured my blood glucose when I felt uncomfortable. I didn’t measure it when I felt good. I didn’t measure it regularly.” (P-24)
Two sides of social environment
The social environment of participants was identified as both facilitator and barrier to self-management engagement. The social environment included family and work environment.
The roles of family environment were determined by how family members influenced self-management. On one side, the family members who had positive attitudes toward assisting the participants in managing diabetes could facilitate self-management engagement. These family members facilitated self-management engagement by playing the role of offering healthy diets, promoting physical activity engagement, and reminding blood glucose monitoring.
“I’m living with my wife. My wife made a healthy lifestyle plans for me. She wanted me to do more exercise, to eat more vegetables. And I would try to do what she wants me to do.” (P-11)
“My family was worried about my current health status. They wanted me to have a healthy diet. For me to have a healthy diet, my daughter formulated a diabetes diet plans for me.” (P-18)
“My family would remind me to measure my blood sugar regularly and do more exercise.” (P-27)
On the other side, unhealthy living habits of family members could reduce self-management engagement. The unhealthy living habits could lead to a diabetes-unfriendly family environment that could impede self-management.
“My family's eating habits are not healthy, but I have to live in the way as my family live because we are living together now. My family doesn't understand what kinds of diets were good for diabetes, they can give me no support.” (P-13)
“There are no people around who love sports. My family doesn't like sports either. No one urged me to exercise. My family doesn't exercise either.” (P-23)
Work environment where healthy diet and exercise facilities were accessible in workplaces could facilitate self-management engagement. Some participants stated that the availability of healthy diet and exercise facilities in workplaces increased convenience of self-management engagement.
“I work in school. Our school has a gym for employees. I could do exercises during the leisure times.” (P-4)
“The diets are OK. The place where I work provide diabetes meals, and I could have diabetes meals during work times.” (P-11)
However, restrictions on accessing healthy diet and doing exercise in workplaces were also identified. Some participants expressed that the diet provided in workplaces was unsuitable for people with diabetes, which caused difficulty in engaging in lifestyle management. Furthermore, exercise opportunities were limited because tight work schedules. These restrictions impeded self-management engagement.
“Now I work for nearly 11 hours a day. I had no time to exercise outside of work, and I were very tired after work.” (P-2)
“I didn’t eat regularly when I were on business. But I often went on business because of work. When I went on business, my diet was not easy to control, because I need to eat with my clients and my colleagues, but the food was not suitable for me.” (P-8)
Barriers to medication taking and blood glucose monitoring in workplaces were identified.
“However, it was inconvenient at work because the equipment was not easy to carry with you.” (P-12)
“I have the problem of insulin injections, because I work in sale department, sometimes insulin couldn’t be injected on time, and it was also a problem to bring it to workplace.” (P-19)
Obtaining reliable information
Obtaining diabetes-related information could facilitate self-management engagement. The information included diabetic complications, lifestyle advice, and effects of medications. This information clarified the necessity of diabetes self-management and how diabetes could be managed, which might facilitate self-management engagement.
However, some information obtained from various resources was unreliable, especially information from the internet and social networks. Some participants stated that their friends and colleagues told them diet management was unnecessary for people with diabetes. Furthermore, some participants expressed that they obtained information from the internet that advertised health products could instead of medications for blood glucose control. This information could form incorrect perceptions and attitudes of participants regarding diabetes self-management, which might reduce self-management engagement. Compared with the information from the internet and social networks, participants preferred to obtain information from healthcare professionals.
“I usually look through the information on the internet, but I needed to check the correctness of the information by myself. If I could communicate directly with my doctors, there would be no such problems. After all, they are professional. It would be great if you could get information about diabetes directly from the medical staff.” (P-17)