Engaging patients in population-based chronic disease management: A qualitative study of barriers and intervention...

Area of Science:

• Public Health
• Behavioral Science
• Health Services Research

Background:

• Cardiovascular disease (CVD) is a major cause of U.S. morbidity.
• Managing CVD risk factors like diabetes and hypertension presents significant challenges for patients.
• Understanding patient barriers is crucial for improving chronic disease management.

Purpose of the Study:

• To investigate barriers experienced by patients struggling to achieve control over CVD risk factors.
• To identify factors hindering persistent engagement in chronic disease management programs.

Main Methods:

• Qualitative study involving 332 participants in a clinical trial for a skills-based group intervention.
• Data collected through patient, clinician, and researcher observations.
• Analysis using a general inductive approach, structured by the Capability-Opportunity-Motivation-Behavior framework.

Main Results:

• Identified barriers in communication skills, activation, care team relationships, and emotional factors.
• Persistent barriers included patient distrust of providers, shame, and dissatisfaction with impersonal/unresponsive care team interactions.
• Most participants benefited from skills training, but underlying issues remained.

Conclusions:

• Effective CVD risk factor management requires addressing patient and care team skills, opportunities, and confidence.
• Proactive communication, non-judgmental interactions, and rapport-building are essential for goal-setting and shared decision-making.
• Interventions should focus on overcoming emotional and relational barriers to improve healthcare engagement.