Differences between diabetic patients who do and do not respond to a diabetes care intervention: a qualitative...

We designed a qualitative case study to ascertain whether attitudes and views of diabetes differ between patients with diabetes who do and do not respond well to a diabetes care intervention.

Prospective epidemiological data were used to classify and sample graduates from an outpatient diabetes care program into one of two groups: 1) positive responders (n = 18) who had a 20% or greater improvement in glycemic control 6 months after the care program and 2) negative responders (n = 16) who had less than a 20% improvement in glycemic control 6 months after the care program. We collected data using depth interviews and focus groups. Transcriptions were summarized and analyzed using an editing approach. The themes from these two groups were summarized and compared to ascertain similarities and differences in attitudes and views of diabetes.

Four major themes emerged from the analysis. Positive and negative responders differed a) in their views of diabetes and its treatment, b) on how they incorporated diabetes care into their daily routines, c) in "conversion experiences" in which some patients became suddenly much more aware of the serious threat of diabetes to their health, and d) in their views of their medical care providers.

The conversion experiences observed in many of these subjects are not consistent with stage-of-change models of health-related behavior change. These data advance our understanding of patients' diabetes-related attitudes and behaviors and may be used by clinicians to monitor change in patients' attitudes and expectations over time and by researchers to develop and target novel patient-centered clinical interventions to improve patient satisfaction and clinical outcomes.