A qualitative study on self-monitoring of blood glucose by patients with type 2 diabetes mellitus using insulin in a Malaysian hospital / Ong Woon May
Self-monitoring of blood glucose (SMBG) improves glycaemic control and enhances patient empowerment. It is particularly useful for diabetes mellitus (DM) patients who are using insulin as it facilitates insulin titration and detection of hypoglycaemia as well as hyperglycaemia. Despite this, SMBG...
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| Format: | Thesis |
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2014
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| Online Access: | http://studentsrepo.um.edu.my/7072/ http://studentsrepo.um.edu.my/7072/1/MGN120022_(Ong_Woon_May).pdf |
| Summary: | Self-monitoring of blood glucose (SMBG) improves glycaemic control and enhances
patient empowerment. It is particularly useful for diabetes mellitus (DM) patients who
are using insulin as it facilitates insulin titration and detection of hypoglycaemia as well
as hyperglycaemia. Despite this, SMBG remains underutilised in many countries,
including in Malaysia, as only 15.3% of the patients with type 2 diabetes mellitus
(T2DM) practised SMBG. This study was conducted to explore the views and
experiences on SMBG by patients with T2DM using insulin. Factors influencing SMBG
practice as well as their suggestions to improve such practice were also explored.
Qualitative methodology was employed in this study. Semi-structured, individual indepth
interviews were conducted on patients with T2DM using insulin who have
practised SMBG. Patients were selected from the primary care family clinic of the
University Malaya Medical Centre in Malaysia. Patients were purposively sampled
from different age groups, ethnicity, educational levels and levels of glycaemic control
[as reflected by the glycosylated haemoglobin (HbA1c) levels] to achieve patient
variation in sampling. All interviews were conducted using an interview topic guide and
were audio-recorded, transcribed verbatim, checked by an independent person, and
analysed using a thematic approach. A total of 15 patients were interviewed and
thematic saturation was reached. The themes that emerged under the patients’ views and
experiences on SMBG included: initiation of SMBG; feasibility and practice patterns of
SMBG; actions in response to blood glucose readings; and the emotions related to
SMBG. Factors that influenced SMBG practice were mainly related to equipment,
psychological and social aspects. Barriers for practising SMBG included: cost of test
strips and needles; unavailability of test strips and needles; lack of reliability;
inconvenience; frustration related to high blood glucose readings; perception that
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SMBG was only for insulin titration; fear of needles and pain; lack of motivation,
knowledge and self-efficacy; forgetfulness; lack of patient education; stigma; and
unconducive workplace. Facilitators for practising SMBG were: desire to know if the
blood glucose levels were controlled; desire to please the physician; and motivation
from family. Suggestions by the participants to improve SMBG practice included: cost
reduction; patient attitudinal and behavioural change; and explicit patient education by
healthcare providers. The findings in this study revealed that healthcare providers can
affect patients’ SMBG practice and that abnormal blood glucose readings can change
their behaviour, where negative emotions may lead to their poor adherence to SMBG.
Healthcare providers should be made aware of the impact of their consultation in order
to improve patients’ utilisation of SMBG and decrease the negative impact of ‘poor’
blood glucose readings on their SMBG practice. Policy makers should consider the
impact of barriers to SMBG such as cost and accessibility issues to encourage optimal
utilisation of SMBG. |
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