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Title: An ethnographic study of factors associated with poorly controlled Type-2 diabetes and its management among patients accessing primary care services in Jordan
Author: Al-Sahouri, Amer M.
ISNI:       0000 0004 7961 1196
Awarding Body: Swansea University
Current Institution: Swansea University
Date of Award: 2019
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Poorly controlled Type-2 diabetes is considered a major public health problem and associated with adverse outcomes in Jordan. However, there is a shortfall in qualitative research relating to diabetes. There are no published studies that have sought to explore the meaning behind people's health behaviours and the influence of socio-cultural norms on the management of Type-2 diabetes in Jordan. This study aimed to explore the reasons why glycaemic control was poor among patients with Type-2 diabetes who used primary care services provided by a selected health care comprehensive centre in Jordan. An ethnographic approach was used encompassing a mixed methods data collection strategy which included: 80 hours of participant observation, semi-structured interviews with 10 health care workers and 6 family carers, 8 focus groups with 38 patients with poorly controlled Type- 2 diabetes and documentary review of health promotion resources. The study findings suggested that influences on patients' diabetes management occurred at multiple levels rather than one level. Intrapersonal factors included the difficulty in maintaining adherence to the management plan, fatalistic attitudes and misconceptions related to diabetes. Sociocultural factors included: eating habits, the stigma of the disease, social embarrassment with physical activity and medication and seeking complementary therapies. The health care system factors included: medication insecurity, health insurance policies and unavailability of laboratory tests. Staff shortages, patient-staff communication and being task-focused were challenges relating to health care workers. Continuity of care and health education were suggested as facilitators and using the mass media, schools and religion were also proposed to promote the health of the public. Effective health promotion interventions and health education need to be tailored to meet the individual, social and cultural needs of patients. A patient-centred, and holistic approach is recommended. Interventions at multiple levels from the individual to the policy level are required in order to address the complexity of factors affecting patients' adherence to their diabetes management plan in Jordan. This study has particular relevance for primary care clinics in Jordan but may also more generally contribute towards an understanding of poor glycaemic control in patients with Type- 2 diabetes in countries with similar socio-cultural norms.
Supervisor: Merrell, Joy ; Snelgrove, Sherrill Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral