A mixed-methods needs assessment of adult diabetes mellitus (type II) and hypertension care in Toledo, Belize

Annette M. Dekker*, Ashley E. Amick, Cecilia Scholcoff, Ashti Doobay-Persaud

*Corresponding author for this work

Research output: Contribution to journalArticle

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Abstract

Background: Non-communicable diseases, including diabetes mellitus and hypertension, continue to disproportionately burden low- and middle-income countries. However, little research has been done to establish current practices and management of chronic disease in these settings. The objective of this study was to examine current clinical management and identify potential gaps in care of patients with diabetes mellitus and hypertension in the district of Toledo, Belize. Methods: The study used a mixed methodology to assess current practices and identify gaps in diabetes mellitus and hypertension care. One hundred and twenty charts of the general clinic population were reviewed to establish disease epidemiology. One hundred and seventy-eight diabetic and hypertensive charts were reviewed to assess current practices. Twenty providers completed questionnaires regarding diabetes mellitus and hypertension management. Twenty-five individuals with diabetes mellitus and/or hypertension answered a questionnaire and in-depth interview. Results: The prevalence of diabetes mellitus and hypertension was 12%. Approximately 51% (n = 43) of patients with hypertension were at blood pressure goal and 26% (n = 21) diabetic patients were at glycemic goal based on current guidelines. Of the patients with uncontrolled diabetes, 49% (n = 29) were on two oral agents and only 10% (n = 6) were on insulin. Providers stated that barriers to appropriate management include concerns prescribing insulin and patient health literacy. Patients demonstrated a general understanding of the concept of chronic illness, however lacked specific knowledge regarding disease processes and self-management strategies. Conclusions: This study provides an initial overview of diabetes mellitus and hypertension management in a diverse patient population in rural Belize. Results indicate areas for future investigation and possible intervention, including barriers to insulin use and opportunities for lifestyle-specific disease education for patients.

Original languageEnglish (US)
Article number171
JournalBMC health services research
Volume17
Issue number1
DOIs
StatePublished - Feb 28 2017

Fingerprint

Belize
Needs Assessment
Type 2 Diabetes Mellitus
Diabetes Mellitus
Hypertension
Insulin
Chronic Disease
Health Literacy
Practice Management
Rural Population
Patient Education
Self Care
Life Style
Patient Care
Epidemiology
Guidelines
Interviews
Blood Pressure

Keywords

  • Central America
  • Hypertension
  • Mixed method
  • Needs assessment
  • Non-communicable disease
  • Type 2 diabetes

ASJC Scopus subject areas

  • Health Policy

Cite this

@article{3b563b089db14494bd8af3a637984ce2,
title = "A mixed-methods needs assessment of adult diabetes mellitus (type II) and hypertension care in Toledo, Belize",
abstract = "Background: Non-communicable diseases, including diabetes mellitus and hypertension, continue to disproportionately burden low- and middle-income countries. However, little research has been done to establish current practices and management of chronic disease in these settings. The objective of this study was to examine current clinical management and identify potential gaps in care of patients with diabetes mellitus and hypertension in the district of Toledo, Belize. Methods: The study used a mixed methodology to assess current practices and identify gaps in diabetes mellitus and hypertension care. One hundred and twenty charts of the general clinic population were reviewed to establish disease epidemiology. One hundred and seventy-eight diabetic and hypertensive charts were reviewed to assess current practices. Twenty providers completed questionnaires regarding diabetes mellitus and hypertension management. Twenty-five individuals with diabetes mellitus and/or hypertension answered a questionnaire and in-depth interview. Results: The prevalence of diabetes mellitus and hypertension was 12{\%}. Approximately 51{\%} (n = 43) of patients with hypertension were at blood pressure goal and 26{\%} (n = 21) diabetic patients were at glycemic goal based on current guidelines. Of the patients with uncontrolled diabetes, 49{\%} (n = 29) were on two oral agents and only 10{\%} (n = 6) were on insulin. Providers stated that barriers to appropriate management include concerns prescribing insulin and patient health literacy. Patients demonstrated a general understanding of the concept of chronic illness, however lacked specific knowledge regarding disease processes and self-management strategies. Conclusions: This study provides an initial overview of diabetes mellitus and hypertension management in a diverse patient population in rural Belize. Results indicate areas for future investigation and possible intervention, including barriers to insulin use and opportunities for lifestyle-specific disease education for patients.",
keywords = "Central America, Hypertension, Mixed method, Needs assessment, Non-communicable disease, Type 2 diabetes",
author = "Dekker, {Annette M.} and Amick, {Ashley E.} and Cecilia Scholcoff and Ashti Doobay-Persaud",
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A mixed-methods needs assessment of adult diabetes mellitus (type II) and hypertension care in Toledo, Belize. / Dekker, Annette M.; Amick, Ashley E.; Scholcoff, Cecilia; Doobay-Persaud, Ashti.

In: BMC health services research, Vol. 17, No. 1, 171, 28.02.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A mixed-methods needs assessment of adult diabetes mellitus (type II) and hypertension care in Toledo, Belize

AU - Dekker, Annette M.

AU - Amick, Ashley E.

AU - Scholcoff, Cecilia

AU - Doobay-Persaud, Ashti

PY - 2017/2/28

Y1 - 2017/2/28

N2 - Background: Non-communicable diseases, including diabetes mellitus and hypertension, continue to disproportionately burden low- and middle-income countries. However, little research has been done to establish current practices and management of chronic disease in these settings. The objective of this study was to examine current clinical management and identify potential gaps in care of patients with diabetes mellitus and hypertension in the district of Toledo, Belize. Methods: The study used a mixed methodology to assess current practices and identify gaps in diabetes mellitus and hypertension care. One hundred and twenty charts of the general clinic population were reviewed to establish disease epidemiology. One hundred and seventy-eight diabetic and hypertensive charts were reviewed to assess current practices. Twenty providers completed questionnaires regarding diabetes mellitus and hypertension management. Twenty-five individuals with diabetes mellitus and/or hypertension answered a questionnaire and in-depth interview. Results: The prevalence of diabetes mellitus and hypertension was 12%. Approximately 51% (n = 43) of patients with hypertension were at blood pressure goal and 26% (n = 21) diabetic patients were at glycemic goal based on current guidelines. Of the patients with uncontrolled diabetes, 49% (n = 29) were on two oral agents and only 10% (n = 6) were on insulin. Providers stated that barriers to appropriate management include concerns prescribing insulin and patient health literacy. Patients demonstrated a general understanding of the concept of chronic illness, however lacked specific knowledge regarding disease processes and self-management strategies. Conclusions: This study provides an initial overview of diabetes mellitus and hypertension management in a diverse patient population in rural Belize. Results indicate areas for future investigation and possible intervention, including barriers to insulin use and opportunities for lifestyle-specific disease education for patients.

AB - Background: Non-communicable diseases, including diabetes mellitus and hypertension, continue to disproportionately burden low- and middle-income countries. However, little research has been done to establish current practices and management of chronic disease in these settings. The objective of this study was to examine current clinical management and identify potential gaps in care of patients with diabetes mellitus and hypertension in the district of Toledo, Belize. Methods: The study used a mixed methodology to assess current practices and identify gaps in diabetes mellitus and hypertension care. One hundred and twenty charts of the general clinic population were reviewed to establish disease epidemiology. One hundred and seventy-eight diabetic and hypertensive charts were reviewed to assess current practices. Twenty providers completed questionnaires regarding diabetes mellitus and hypertension management. Twenty-five individuals with diabetes mellitus and/or hypertension answered a questionnaire and in-depth interview. Results: The prevalence of diabetes mellitus and hypertension was 12%. Approximately 51% (n = 43) of patients with hypertension were at blood pressure goal and 26% (n = 21) diabetic patients were at glycemic goal based on current guidelines. Of the patients with uncontrolled diabetes, 49% (n = 29) were on two oral agents and only 10% (n = 6) were on insulin. Providers stated that barriers to appropriate management include concerns prescribing insulin and patient health literacy. Patients demonstrated a general understanding of the concept of chronic illness, however lacked specific knowledge regarding disease processes and self-management strategies. Conclusions: This study provides an initial overview of diabetes mellitus and hypertension management in a diverse patient population in rural Belize. Results indicate areas for future investigation and possible intervention, including barriers to insulin use and opportunities for lifestyle-specific disease education for patients.

KW - Central America

KW - Hypertension

KW - Mixed method

KW - Needs assessment

KW - Non-communicable disease

KW - Type 2 diabetes

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