Ongoing education in type 2 diabetes: the attitudes of hard-to-reach participants

Background and aim: Ongoing structured patient education, for those with type 2 diabetes, is a core requirement within diabetes health policy. Although type 2 education programmes are becoming established in the UK, a recent review reveals mixed results with little evidence to suggest whether or how such programmes might be directed, to achieve maximal benefit. Black and ethnic minority peoples, and poor and socially disadvantaged groups are especially vulnerable to the effects of the disease. What are the attitudes of these hard-to-reach groups towards diabetes learning? Methods: Eight semi-structured interviews were carried out on participants from different cultural backgrounds. All were from the same primary-care setting, who had type 2 diabetes for more than 12 months. Potential participants were asked to opt in to the research process by invitation letter and in-house poster advertisement. Purposive sampling was undertaken on those who opted in. When recruitment proved difficult, targeted personal approaches were undertaken opportunistically, to increase the opt-in rate, and allow further purposive sampling. During analysis, themes and categories emerged inductively from participants’ dialogue, with no ‘a priori’ categories or themes. The themes were then linked into amap, which ultimately described the whole. The sample size was too small to be representative of the practice population and as such findings were not generalisable to a wider setting. Findings: Diabetes education was highly valued, it was needed so that people felt well and alive; it had to be a respectful experience involving listening and being listened to. It was necessary for the learning to be personal, the desire coming from within. Previous learning related to employment had involved being shown the ropes and was viewed positively. Past diabetes learning had taken place in family settings, in informal meetings and within consultations with health professionals. These were generally preferred to formal classes. The quality of the learning experience was very important to participants. Stress and depression were barriers to learning and diminished capacity to change. The hard to reach are aptly named when trying to recruit for interview studies.