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Int J Environ Res Public Health. 2018 Aug 22;15(9). pii: E1810. doi: 10.3390/ijerph15091810.

Patient and Provider Dilemmas of Type 2 Diabetes Self-Management: A Qualitative Study in Socioeconomically Disadvantaged Communities in Stockholm.

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Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
Department of Public Health, Institute of Tropical Medicine, 43, 2000 Antwerp, Belgium.
Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 111, FI-80101 Joensuu, Finland.
Department of Molecular Medicine and Surgery, Karolinska University Hospital, SE-171 77 Stockholm, Sweden.
Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, 751 85 Uppsala, Sweden.
Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
Department of Food, Nutrition and Dietetics, Uppsala University, P.O. Box 560, 751 22 Uppsala, Sweden.


Studies comparing provider and patient views and experiences of self-management within primary healthcare are particularly scarce in disadvantaged settings. In this qualitative study, patient and provider perceptions of self-management were investigated in five socio-economically disadvantaged communities in Stockholm. Twelve individual interviews and four group interviews were conducted. Semi-structured interview guides included questions on perceptions of diabetes diagnosis, diabetes care services available at primary health care centers, patient and provider interactions, and self-management support. Data was analyzed using thematic analysis. Two overarching themes were identified: adopting and maintaining new routines through practical and appropriate lifestyle choices (patients), and balancing expectations and pre-conceptions of self-management (providers). The themes were characterized by inherent dilemmas representing confusions and conflicts that patients and providers experienced in their daily life or practice. Patients found it difficult to tailor information and lifestyle advice to fit their daily life. Healthcare providers recognized that patients needed support to change behavior, but saw themselves as inadequately equipped to deal with the different cultural and social aspects of self-management. This study highlights patient and provider dilemmas that influence the interaction and collaboration between patients and providers and hinder uptake of self-management advice.


Self-management; Sweden; chronic diseases; health systems; immigrants; lifestyle change; qualitative study; socioeconomically disadvantaged; thematic analysis; type 2 diabetes

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