“It’s got its own life, and you can’t contain it”: A qualitative study of patient and health professional experiences of diabetes care

Aims and objectives To explore the perspectives of patients and health professionals on facilitators and barriers to care in a diabetes clinic in urban South Africa. Background Although much attention has been given to the science behind diabetes management, a qualitative approach to exploring experiences, facilitators and barriers to care may have considerable value in understanding and improving diabetes care. Design We conducted a qualitative study in the context of a 3‐year collaboration at a diabetes clinic. The present study formed part of the preparatory phase to the larger project. Methods Linguistically and culturally matched research assistants collected data over a period of 18 months. Methods included interviews, focus groups, ethnographic observations and informal discussions with 38 patients and health professionals. Data from each participant group were transcribed, translated and analysed using reflexive thematic analysis principles and thereafter triangulated. The Standards for Reporting Qualitative Research checklist was followed. Results Initial findings suggest that factors can be classified into three overarching themes: relationships, health systems and the interplay between disease and the lifeworld. System resource pressures, the nuances of team interactions and a complex healthcare site may adversely affect care, even at sites where there are elements of good practice. Conclusions The collective psychosocial experience of patients appears to conflict with the biomedical approach to diabetes management. The all‐consuming nature of the disease, together with contextual and systemic factors, plays a significant role in influencing experiences of care. Relevance to clinical practice While systemic and contextual influences on experiences of diabetes care may be difficult to modify, our study suggests a need to focus on ways of enhancing relationships within the clinic and seeking to understand the lifeworld of the patient.