Abstract
BackgroundThe burden of non-communicable diseases is growing rapidly in low- and middle-income countries. Research suggests that health interventions that aim to improve patient self-management and empower patients to care actively for their disease will improve health outcomes over the long-term. There is, however, a gap in the literature about the potential role of the inpatient setting in supporting chronic care. This is particularly important in low-and-middle income countries where hospitals may be a rare prolonged point of contact between patient and health provider. The aim of this small scale, exploratory study was to understand what factors within the inpatient setting may affect patients’ feelings of empowerment in relation to their chronic disease care and provides recommendations for future inpatient-based interventions to support self-management of disease.MethodsThis study was based in a public, academic hospital in South Africa. Eighteen qualitative, semi-structured interviews were conducted with multiple participants with experience of diabetes care: inpatients and health professionals such as nurses, endocrinologists, and dieticians. Findings were analysed using a broad, exploratory, thematic approach, guided by self-management and chronic care literature.ResultsInterviews with both patients and providers suggest that patients living in low socio-economic contexts are likely to struggle to access appropriate healthcare information and services, and may often have financial and emotional priorities that take precedence over their chronic illness. Younger people may also be more dependent on their family and community, giving them less ability to take control of their disease care and lifestyle. In addition, hospital care remains bound by an acute care model; and the inpatient setting of focus is characterised by perceived staff shortages and ineffective communication that undermine the implementation of patient empowerment-focused interventions.ConclusionsPatient and provider contexts are likely to make supporting patient engagement in long-term chronic care difficult in lower income settings. However, knowledge of these factors can be harnessed to improve chronic care interventions in South Africa and other similar countries.
Highlights
The burden of non-communicable diseases is growing rapidly in low- and middle-income countries
The experiences of participants were categorised into three broad themes: patient context, the inpatient setting, and the patient-provider relationship
The participants had a mix of Type 1 and Type 2 diabetes and were hospitalised for a variety of reasons
Summary
The burden of non-communicable diseases is growing rapidly in low- and middle-income countries. There is, a gap in the literature about the potential role of the inpatient setting in supporting chronic care This is important in low-and-middle income countries where hospitals may be a rare prolonged point of contact between patient and health provider. Beyond reduced quality of life, families face long-term medical expenses and loss of income earners, employers experience increased staff turnover and absenteeism, and it is estimated that between 2006 and 2015 diabetes, stroke, and coronary heart disease alone cost SA nearly two million US dollars in gross domestic product losses [1] All of this is occurring in a country characterised by a quadruple burden of disease including NCDs, infectious diseases, injuries, HIV/AIDS, and a demographic shift resulting in people living for longer [4]. An empowered patient would be more able to adapt, question, challenge, and change their daily practices in an attempt to maximise their physical, emotional, and social wellbeing [12]
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