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Diabetes Educ. 2017 Apr;43(2):190-205. doi: 10.1177/0145721717697243.

Understanding Challenges, Strategies, and the Role of Support Networks in Medication Self-management Among Patients With Type 2 Diabetes.

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Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany (Mrs Bernhard, Dr Ose, Dr Baudendistel, Prof Szecsenyi, Prof Wensing, Dr Mahler).
Department of Population Health Sciences, Health System Innovation and Research, University of Utah, Salt Lake City, Utah (Dr Ose).
Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany (Dr Seidling, Dr Stützle).
Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany (Dr Seidling, Dr Stützle).


Purpose The purpose of this qualitative study was to investigate the challenges and strategies of patients with type 2 diabetes mellitus (T2DM) regarding daily management of their medication regimen focusing on the role of their support networks. Methods A purposeful sample of 25 patients with T2DM was recruited from local self-help groups, general practitioner practices, and a university hospital in southwestern Germany. Four semi-structured focus groups were conducted to identify the challenges patients experienced, the strategies they used, and their collaboration with support networks to assist them in self-managing their medication regimen. Sessions were audio- and video-recorded, fully transcribed, and subjected to computer-aided qualitative content analysis, guided by the Self- and Family Management Framework (SFMF). Results Patients with T2DM experienced numerous challenges affecting medication self-management arising from their personal situation, health status and resources, characteristics of their regimen, and how health care is currently organized. Patients' self-initiated strategies included activating health care, community, social, and online resources; taking ownership of medication-related needs; and integrating medication-taking into daily life. Patients drew on self-help groups, family, and friends to discuss concerns regarding medication safety and receive experience-based information and advice for navigating within the health care system as well as practical hands-on support with daily medication self-management. Conclusions Understanding the challenges and building on strategies patients with T2DM devised help diabetes educators to better address patients' needs and priorities and guide patient-centered interventions to support patients' self-management activities. Community and social support networks operating in patients' lives need to be engaged in the self-management support.

[Indexed for MEDLINE]

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