The Challenges and Needs in Developing a Healthcare Service Model for People with Uncontrolled Type 2 Diabetes Mellitus in the New Normal Era
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Abstract
This qualitative study aimed to explore the challenges and needs in developing a healthcare service model for people with uncontrolled type 2 diabetes in the new normal era. Purposive sampling was used to select 16 registered nurses working in diabetes clinics and 30 people with uncontrolled type 2 diabetes receiving care at diabetes clinics across eight hospitals affiliated with the Ministry of Public Health in central Thailand. Data were collected through in-depth interviews and analyzed using content analysis.
The results revealed key service-related problems during the COVID -19 pandemic in diabetes clinics included shortages of equipment, inadequate staffing in terms of both expertise and quantity, temporary clinic closures, patients reported delays, overcrowding, and inaccurate information. Contributing factors to uncontrolled blood glucose levels included insufficient knowledge about appropriate dietary choices, excessive consumption of high-sugar foods, low commitment to dietary control, insufficient physical activities, work-related constraints affecting meal schedules, inconsistent and incomplete medication intake, and limited access to appropriate food.
The needs for improving healthcare service models included continuous self-management support, risk-reducing and time-efficient services, increase qualified healthcare providers, sufficient and ready-to-use equipment, clear and accessible learning materials, courteous and friendly service, and telenursing monitoring and consultation system.
This study provides insights into the context and deepens understanding of the challenges and needs of people with uncontrolled type 2 diabetes, offering guidance for developing responsive and effective health service systems in the new normal era. It emphasizes continuous self-management support, convenience, timeliness, and responsiveness to the evolving needs of people with type 2 diabetes.
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References
World Health Organization. Global report on diabetes. World Health Organization; 2022.
Non-Communicable Diseases Division, Department of Disease Control, Ministry of Public Health. Annual report 2024, Non-Communicable Diseases Division. Bangkok: Printing and Graphic Design Office; 2024. (in Thai).
Berwick DM. Choices for the “new normal”. JAMA 2020;323(21):2125-6.
Olesen K, Joensen LE, Madsen KP, Willaing I. How has the COVID-19 pandemic affected diabetes self-management in people with diabetes? A one-year follow-up study. Front Clin Diabetes Healthc 2022;3:867025.
Mahlare SS, Rasweswe MM, Ramavhoya TI. Self-management challenges of adults with type 2 diabetes mellitus in Ekurhuleni district primary health care facilities amid COVID-19 lockdown. Afr J Prim Health Care Fam Med 2024;16(1):e1-e7.
Ministry of Public Health. Report on ministry indicators, year 2024. Nonthaburi: Ministry of Public Health; 2024. (in Thai).
Galindo RJ, Trujillo JM, Low Wang CC, McCoy RG. Advances in the management of type 2 diabetes in adults. BMJ Med 2023;2(1):e000372
Lorig KR, Holman HR. Self-management education: History, definition, outcomes, and mechanisms. Ann Behav Med 2003;26(1):1-7.
Pikun P, Navicharern R. The effect of coaching program for lifestyle modification on HbA1c level in newly diagnosed type 2 diabetic persons. RTN Med J 2016;43(2):55-73. (in Thai).
Vibulchai N, Sridech R. Development of a program to enhance the motivation for self-management in delaying the diabetic nephropathy progression of type 2 diabetic patients with hypertension. RTN Med J 2020;47(2):373-93. (in Thai).
Simon J, Eggleston A, Bright D, Driscoll P, Morrison J, Yang T-Y, et al. The role of telehealth in improving care connections and outcomes for community health center patients with diabetes. J Am Board Fam Med 2024;37(2):206-14.
Ohannessian R, Duong TA, Odone, A. Global telemedicine implementation and integration within health systems to fight the COVID-19 pandemic: a call to action. JMIR Public Health Surveill 2020;6(2):e18810.
Ahmed SK. The pillars of trustworthiness in qualitative research. J Med Surg Public Health 2024;2:100051.
Rungnoei N, Kruttakart S, Dechpoonyachit P, Duangchan C, Phianthanyakam N. Effectiveness of a self-management support program on self-care behaviors and diabetic control among adults with uncontrolled type 2 diabetes: a quasi-experimental study. Pacific Rim Int J Nurs Res 2026:30(1):7-24.
Felix HC, Andersen JA, Willis DE, Malhis JR, Selig JP, McElfish PA. Control of type 2 diabetes mellitus during the COVID-19 pandemic. Prim Care Diabetes 2021;15(5):786-92.
Leite NJC, Raimundo AMM, Mendes RDC, Marmeleira JFF. Impact of COVID-19 pandemic on daily life, physical exercise, and general health among older people with type 2 diabetes: a qualitative interview study. Int J Environ Res Public Health 2022;19(7):3986.
Numsang P, Oumtanee A, Kurat S, Sananok R, Kraichan S, Sarapoke P. Failure to control blood sugar experiences of persons with type 2 diabetes mellitus. Int J Nurs Sci 2023;10(4):527-32.
Siddiqui FJ, Avan BI, Mahmud S, Nanan DJ, Jabbar A, Assam PN. Uncontrolled diabetes mellitus: pprevalence and risk factors among people with type 2 diabetes mellitus in an Urban District of Karachi, Pakistan. Diabetes Res Clin Pract 2015;107(1):148-56.
Alsuliman MA, Alotaibi SA, Zhang Q, Durgampudi PK. A systematic review of factors associated with uncontrolled diabetes and meta-analysis of its prevalence in Saudi Arabia since 2006. Diabetes Metab Res Rev 2021;37(3):e3395.
American Diabetes Association. Standards of medical care in diabetes—2021 abridged for primary care providers. Clin Diabetes 2021;39(1):14-43.
Colling C, Atlas SJ, Wexler DJ. Application of 2021 American diabetes association glycemic treatment clinical practice recommendations in primary care. Diabetes Care 2021;44(6):1443-6.
International Diabetes Federation. IDF Diabetes Atlas. 10th ed. [Internet]. [cited 2024 Aug 15]. Available from: https://diabetesatlas.org/idfawp/resourcefiles/2021/07/IDF_Atlas_10th_Edition_2021.pdf.
Luciani M, Bigoni C, Canesi M, Masotto M, Fabrizi D, Di Mauro S, et al. Self-care of adults with type 2 diabetes during the COVID-19 pandemic: a qualitative interpretive description study. Clin Nurs Res 2023;32(1):73-83.
Gregg EW, Sophiea MK, Weldegiorgis M. Diabetes and COVID-19: population impact 18 months into the pandemic. Diabetes Care 2021;44(9):1916-23.
Peric S, Stulnig TM. Diabetes and COVID-19: disease-management-people. Wien Klin Wochenschr 2020;132(13-14):356-61.
