Method: The study took place in the capital city Yerevan and Shirak province to understand diabetes care at national and regional levels. The study utilized qualitative research methods. There were six groups of participants: primary health care (PHC) physicians and nurses; PHC endocrinologists; hospital endocrinologists; other specialists dealing with diabetes complications care; policy makers/experts; and adult diabetes patients (both type 1 and 2). Ninety one study participants included 80 women and 11 men. The study team used advanced analytical qualitative research methods to analyze the transcripts from focus group discussions and in-depth interviews utilizing conventional directed content analysis technique.
Result: The main obstacles to appropriate care were associated with shortage of hypoglycaemic drugs that placed a heavy financial burden on most diabetes patients. Moreover, changes in types and brands of hypoglycaemic drugs were leading to destabilization of patients’ blood glucose levels and increasing the risk of complications. There was a poor coordination of efforts between diabetes care at primary and secondary levels.
Diabetes treatment compliance among patients was poor due to several reasons including lack of knowledge about the disease and its management, low priority for personal health, lack of concern about complications, and high cost of medication and instruments of self-management. The high price of diabetic dietary food, unaffordable for many diabetes patients, increased the chance of non-compliance with diabetes dietary plan. Moreover, social stigma and fear associated with particularly diabetes type I among young diabetes patients and fear of insulin-use among diabetes type II patients were also important barriers to compliance with proper diet and treatment.
Conclusion: Patients with diabetes often have limited knowledge about how to control their disease and prevent complications since they do not receive proper counseling about the disease and its management. Physicians, and not patients, are seen as being primarily responsible for diabetes management and decision making.
This was a collaborative Research between AUA School of Public Health, London School of Hygiene and Tropical Medicine, & Curatio International as part of the European Uunion-funded Health in Times of Transition project.