Qualitative Trends in Biopsychosocial-Spiritual Treatment for Underserved Patients with Type 2 Diabetes

Abstract

Diabetes is a significant and growing concern for minority and underserved populations, especially in rural communities that have limited resources available for best managing complex biopsychosocial challenges. Thus, it is essential to understand patient-identified needs, challenges, and strengths when managing this disease. This study was completed at a community health center for underserved populations in Eastern North Carolina. A qualitative design was used to explore biopsychosocial-spiritual concerns, strengths, and goals from 294 patients with uncontrolled diabetes. Recursive frame analysis was used to analyze the results from clinician constructed progress notes following an integrated care visit with a diabetes educator, medical family therapist, and dietician. This study focused on understanding biological, psychological, social, spiritual concerns, strengths and treatment goals reported by patients. We found that the most commonly reported concern for patients included managing A1c levels, weight, other medical conditions, depressive symptoms, family and financial stressors. The goals reported were related to these concerns. Common strengths included spirituality, social supports, willingness to change, and knowledge about diabetes. This article also highlights commonly reported collaborative therapeutic interventions and recommendations for approaches to care. The use of a collaborative-care team with a holistic approach to health care may provide patients with more comprehensive care. Patients reported strengths, concerns, and goals that were related to multiple aspects of their health (i.e., biological, psychological, social, and spiritual), therefore, to promote best practices in treating diabetes, providers should focus on each of these areas of health during treatment planning.