An Interpretive Description of Nigerian Healthcare Providers’ Perspectives, Experiences and Practices of Self-Management Support for Persons with Type 2 Diabetes

  • Author / Creator
    Iregbu, Sandra, Chinwe
  • Background: Studies show that most people living with diabetes in Nigeria have inadequate knowledge of their condition, poor self-management, and poor glycemic control. Many of these studies focused on patients who were often blamed by healthcare providers (HCPs) for their situation. There is a paucity of research focused on how HCPs may support patients to manage their diabetes. Therefore, it was vital to explore self-management support (SMS) from the perspective of Nigerian HCPs to understand their SMS experiences and practice.
    Purpose: I aimed to explore the perspectives, experiences, and practices of SMS among Nigerian HCPs providing direct care to persons with type 2 diabetes (T2DM) in two endocrinology clinics in the southeastern part of Nigeria.
    Design: In this interpretive description (ID) study, I collected data in two hospitals between August 2018 and September 2019 from 19 HCPs, including doctors, nurses, dieticians, and health educators who had worked in the clinics for at least 1 year.
    Data generation: I conducted a total of 23 interviews, including 17 face-to-face interviews and six phone interviews. Four HCPs were interviewed twice. The semistructured interview guide evolved as concurrent data generation and analysis continued. I observed participants as they provided care to persons with diabetes at the clinics. I recorded field notes immediately following each observation period. I also reviewed documents used for educating patients.
    Data analysis: I used a constant comparative and thematic analysis approach to analyze data. Concurrent data generation and analysis allowed emerging findings to guide the process of data generation. Interview data were self-transcribed verbatim, reviewed for accuracy, and all data—including transcripts and field notes—were uploaded to Quirkos©. I immersed myself in the data by reading and rereading the interview transcripts and field notes and listening to the audiotapes to gain a global understanding of participants' experiences. I used the following strategies to ensure rigour within the study: theoretical and maximal variation sampling, concurrent data generation and analysis, multiple data sources to obtain multiple perspectives on the issue of SMS in Nigeria, debriefing with doctoral supervisors, reflexive journals, and memos.
    Results/findings: Four themes emerged from this study. The first theme was the cultural and social context of SMS. This theme included cultural beliefs and practices (belief in the supernatural origin of disease and individual-family interdependence), myths and limited understanding of diabetes, absence of health insurance, and the structure of diabetes care. The second theme was navigating the sociocultural terrain; this theme included strategies used by HCPs to adapt care to their patients’ cultural beliefs and practices and contained subthemes such as involving God, prayer, and family members. The third theme was the compliance-oriented medical model, which included participants’ mindset and approach to SMS. In this approach, a focus on the disease and patient compliance with their instructions was the goal. Subthemes for the compliance-oriented medical model included priority on normal blood glucose, focus on compliance, HCPs as experts, and SMS as advice, informal counselling, and education. The fourth theme was SMS within the context of the traditional hierarchical structure. This theme involves HCPs’ experiences as they adapted SMS within a system that was not originally designed to support it. Subthemes within the above theme included role validity, role boundaries and poor teamwork, inertia in HCPs and organization, and lack of infrastructure support.
    Implications: The study findings emphasize the need to improve patients’ self-management by strengthening HCPs’ SMS knowledge, practices, and organizational support. Besides the lack of essential resources and compliance perspective described by participants, the conceptualization of SMS in this setting was oriented to collectivism, interdependence, and family. Participants emphasized the family as an essential source of support for patients. It is vital to focus on a familial rather than an individualistic approach to management. Measures to bypass challenges while providing culturally acceptable care to patients should be identified and strengthened. These measures could have an immediate impact on self-management and SMS.
    Conclusion: The study findings demonstrate the need to reevaluate the current understandings and practices of diabetes SMS in Nigeria and identify other available resources in the community that could enhance self-management capacities. Recommendations for healthcare practice, education, policy, and future research are advocated to strengthen SMS for persons with T2DM in Nigeria.

  • Subjects / Keywords
  • Graduation date
    Spring 2021
  • Type of Item
  • Degree
    Doctor of Philosophy
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.