Patient and provider dilemmas of type 2 diabetes self-management: a qualitative study in socioeconomically disadvantaged communities in Stockholm

Juliet Aweko, Jeroen De Man, Pilvikki Absetz, Claes-Goran Ostenson, Stefan Swartling Peterson, Helle Moelsted Alvesson, Meena Daivadanam

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Studies comparing provider and patient views and experiences of self-management within primary healthcare are particularly scarce in disadvantaged settings. In this qualitative study, patient and provider perceptions of self-management were investigated in five socio-economically disadvantaged communities in Stockholm. Twelve individual interviews and four group interviews were conducted. Semi-structured interview guides included questions on perceptions of diabetes diagnosis, diabetes care services available at primary health care centers, patient and provider interactions, and self-management support. Data was analyzed using thematic analysis. Two overarching themes were identified: adopting and maintaining new routines through practical and appropriate lifestyle choices (patients), and balancing expectations and pre-conceptions of self-management (providers). The themes were characterized by inherent dilemmas representing confusions and conflicts that patients and providers experienced in their daily life or practice. Patients found it difficult to tailor information and lifestyle advice to fit their daily life. Healthcare providers recognized that patients needed support to change behavior, but saw themselves as inadequately equipped to deal with the different cultural and social aspects of self-management. This study highlights patient and provider dilemmas that influence the interaction and collaboration between patients and providers and hinder uptake of self-management advice.

Original languageEnglish
Article number1810
JournalInternational Journal of Environmental Research and Public Health
Issue number9
Number of pages18
Publication statusPublished - 2018


  • Self-management
  • type 2 diabetes
  • immigrants
  • health systems
  • chronic diseases
  • qualitative study
  • lifestyle change
  • thematic analysis
  • socioeconomically disadvantaged
  • Sweden
  • RISK


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