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Patients diagnosed with diabetes mellitus are expected to make life-long changes related to their health that are aimed at improving overall disease outcomes and avert long-term health complications. The operationalization of these life-long changes are manifest in self- management, although such patients need to be empowered to make decisions. One strategy of empowering such patients with diabetes mellitus to make life-long changes is through providing health information.
Health information is provided through various health communication strategies. Such strategies include patient-provider interactions, grouped sessions and the use of media both electronic and print (Wright, Spark & O’ Hair, 2013:91). These communication strategies maybe under the control of health care workers such as nurses and to some extent transeed through to the community. The appropriateness of the communication techniques is based on contextual underpinnings which may include; the purpose of the communication and the targeted audience incorporating the setting in which this information is being conveyed. It is the hope of the health care worker that health messages conveyed through these various communication strategies are able to enhance the decision making ability of patients.
Perceptions are an overall interpretation of a phenomenon by an individual (Bruner, 1957:52) and are built up on and based on experience of a particular event. They affect how individuals carry on with their lives and essentially all the decisions they make are based on their interpretation of their world. In the context of diabetes mellitus education, the perceptions of patients regarding how health information is communicated to them is essential for any interventions related to diabetes education and care (Murphy, Casey, Dinnen, Lawton & Brown, 2012:1284). The perceptions of patients with diabetes in the Free State province in South Africa regarding health communication strategies were are unknown. South Africa is a made up of a diverse multicultural and multi-lingual society comprising eleven official languages. The Free State, a province in South Africa, has an above national average prevalence of diabetes mellitus. The majority of the population in this province is black and they are in the low income bracket. Patients access their health care through public health structures namely Community Health Centres (CHC’s) and Primary Health Clinic (PHC’s).
This study was one of the initial studies carried out to support the development of a health dialogue model for patients with diabetes within low and middle income countries.
Purpose: , The study explored the perceptions of patients with diabetes mellitus regarding health communication strategies in the Free State, South Africa
Methods: , The perceptions of patients were determined through a descriptive, exploratory, qualitative research design. Data was generated through semi- structured individual interviews from 34 men and women above the age of 18, with atleast a year of being medically diagnosed with type two diabetes mellitus. The study participants were purposively selected incorporating the opinion of the professional nurses in charge of the data collection sites. Data was generated in the languages preferred by the participants namely to Afrikaans, English, Sotho and Xhosa.
Data was collected from 16 sites within the Free State province. These data collection sites were limited to CHC’s and PHC’s within the various districts of the province, because the majority of the patients received their diabetes related health information within these sites.
The data generated from the interview was transcribed and translated from either Sesotho or Afrikaans, or Xhosa to English. Analysis incorporated Creswell’s steps of qualitative data analysis. ATLAS.ti electronic software was used a platform for data analysis (Friese, 2014).
Results: , Two themes emerged; Guidance and Self- management. The theme Guidance was divided into five categories; motive, content, source, technique and evaluation. The theme Self- management was divided into two categories; influencing factors and lifestyle modifications. The category influencing factors was further divided into two sub-categories; intrapersonal factors and interpersonal factors while the category lifestyle modification was further divided into two sub-categories; nutrition and outcomes.
Discussion:
Health specific signs and symptoms pressed patients with diabetes to seek guidance from the health delivery systems however, they struggled to link their specific signs and symptoms with diabetes mellitus. Health information was provided through direct and in-direct sources. Some of the direct sources included other patients with diabetes mellitus, health care workers and family members diagnosed with diabetes. In-direct sources included the media in the form of electronic and print however, due to the personal nature of some of the symptoms related to diabetes mellitus for example erectile dysfunction, some of the in-direct sources of health information were deemed as not ideal for dissemination of health information
Patients recived information limited to nutrition and lifestyle modifications. This information reflected on what food to eat and also how to care for their feet. The personality of the health care worker was essential in the transmission and understanding of the health messages communicated. Some of the health care workers were upfront and stern and thus were interpreted as ‘meaning business’ while on the other hand some health care workers reflected empathy.
The appropriateness of the language provided by the health care workers enhanced understanding of the health message. In South Africa, there are eleven official languages, it is not always guaranteed that a patient will be matched with a health worker who speaks their native language. However, patients in this study revealed that a health care worker speaking their native language made it easy for them to comprehend health information. Conversely, the ability to question health information sources was limited. This limitation was associated with inherent cultural practices where questioning is interpreted as a sign of disrespect and that elders or authorities are always right (Valchev, 2012: 25).
Positive experiences seemed to reinforce self-management, while negative influences inclusive of thoughts seemed to harmfully influence self-management of patients with diabetes and one such negative influence resulted in suicidal ideation. Family support particularly from family members diagnosed with diabetes mellitus also influenced self- management, inclusive of other patients with diabetes and the religion of the patient. Patients were able to understand and change their nutrition and adjust to the requirements associated with diabetes mellitus although there were challenges associated with the expense of food appropriate for diabetes and also the blunt taste of such foods. Finally, patients reflected improved disease outcomes.
Recommendations:
A standardised screening tool should be crafted to assess potential diabetes patients, thus enhancing a linkage between some signs and symptoms to diabetes mellitus to enhance early diagnosis. The health department of the province should develop contextually appropriate diabetes health information applications for smartphones to increase sources of diabetes health information. Research can be engaged in evaluating the health literacy of patients with diabetes in the Free State, such a study will enhance tailor making of health information related health interventions for such communities. There is need for early identification of patients that are not coping with the diagnosis of diabetes mellitus for immediate interventions to avoid adverse ideation. While communities around a clinic may involve a local food vendor to provide diabetes mellitus appropriate food for patients diagnosed with diabetes to increase availability
Conclusion: ,
Patients with diabetes appreciated the supportive role various health communication strategies play in their illness-wellness continuum. Addressing identified needs regarding diabetes-related health communication strategies and strengthening positive outcomes of current health communication strategies in the Free State could enhance the impact of health communication strategies in this province. Findings of this study will further inform the development of a health dialogue model for patients with diabetes in the Free State.
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