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An ethnographic study of factors associated with poorly controlled Type-2 diabetes and its management among patients accessing primary care services in Jordan / Amer M. Al-Sahouri

Swansea University Author: Amer M. Al-Sahouri

DOI (Published version): 10.23889/Suthesis.50314

Abstract

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 beha...

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Published: 2019
Institution: Swansea University
Degree level: Doctoral
Degree name: Ph.D
URI: https://cronfa.swan.ac.uk/Record/cronfa50314
first_indexed 2019-05-13T13:49:35Z
last_indexed 2025-03-20T07:26:15Z
id cronfa50314
recordtype RisThesis
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spelling 2025-03-19T11:22:04.3733399 v2 50314 2019-05-10 An ethnographic study of factors associated with poorly controlled Type-2 diabetes and its management among patients accessing primary care services in Jordan acbf33146cf6fd83c371e9d3bc6c5478 0000-0002-2602-0902 Amer M. Al-Sahouri Amer M. Al-Sahouri true true 2019-05-10 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. E-Thesis Type 2 diabetes, Primary care in Jordan 31 12 2019 2019-12-31 10.23889/Suthesis.50314 A selection of third party content is redacted or is partially redacted from this thesis. COLLEGE NANME College of Human and Health Sciences COLLEGE CODE Swansea University Doctoral Ph.D 2025-03-19T11:22:04.3733399 2019-05-10T17:35:14.6350983 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health Amer M. Al-Sahouri 0000-0002-2602-0902 1 0050314-10052019173654.pdf Al-Sahouri_Amer_Moh'D_PhD_Thesis_Final_Redacted.pdf 2019-05-10T17:36:54.4170000 Output 4132909 application/pdf Redacted version - open access true 2019-05-09T00:00:00.0000000 true
title An ethnographic study of factors associated with poorly controlled Type-2 diabetes and its management among patients accessing primary care services in Jordan
spellingShingle An ethnographic study of factors associated with poorly controlled Type-2 diabetes and its management among patients accessing primary care services in Jordan
Amer M. Al-Sahouri
title_short An ethnographic study of factors associated with poorly controlled Type-2 diabetes and its management among patients accessing primary care services in Jordan
title_full An ethnographic study of factors associated with poorly controlled Type-2 diabetes and its management among patients accessing primary care services in Jordan
title_fullStr An ethnographic study of factors associated with poorly controlled Type-2 diabetes and its management among patients accessing primary care services in Jordan
title_full_unstemmed An ethnographic study of factors associated with poorly controlled Type-2 diabetes and its management among patients accessing primary care services in Jordan
title_sort An ethnographic study of factors associated with poorly controlled Type-2 diabetes and its management among patients accessing primary care services in Jordan
author_id_str_mv acbf33146cf6fd83c371e9d3bc6c5478
author_id_fullname_str_mv acbf33146cf6fd83c371e9d3bc6c5478_***_Amer M. Al-Sahouri
author Amer M. Al-Sahouri
author2 Amer M. Al-Sahouri
format E-Thesis
publishDate 2019
institution Swansea University
doi_str_mv 10.23889/Suthesis.50314
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
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description 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.
published_date 2019-12-31T04:38:44Z
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score 11.096068

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