Date of Award
2024
Document Type
Thesis
Publisher
Edith Cowan University
Degree Name
Doctor of Philosophy
School
School of Medical and Health Sciences
First Supervisor
Moira Sim
Second Supervisor
Lesley Andrew
Third Supervisor
Jacques Oosthuizen
Fourth Supervisor
Yongsong Chen
Abstract
Introduction
Treatment burden is the perceived workload of care by individuals. The treatment burden experienced by individuals with Type 2 Diabetes Mellitus (T2DM) is a major obstacle to achieving effective healthcare outcomes. The aim of this research is to facilitate better management of treatment burden in people with T2DM in primary care settings.
Methods
A systematic review, encompassing narrative analysis was used to characterise the treatment burden of T2DM and critical appraisal was used to identify the appropriate patient-reported outcome measures (PROMs) for measuring this burden. The selected instruments were employed with subsequent questionnaires, followed by patient focus groups. A convergent segregated approach was utilised to explore the T2DM treatment burden in China's primary care settings and to develop the conceptual framework of this burden, which contributed to qualitative data analysis in subsequent studies. An analysis of video recordings of consultations between general practitioners (GPs) and individuals with T2DM was conducted to identify current response approaches to the multifaceted issues related to this burden. Finally, GP focus groups involving a group decision-making process was facilitated, providing insights aimed at improving GP’s strategies for managing the T2DM treatment burdens in China's primary care settings.
Results
From the narrative review, a thematic framework for understanding the treatment burden of T2DM was developed. This framework underscores the complexity of this burden and guided the critical appraisal. The appraisal identified the treatment burden questionnaire (TBQ), the multimorbidity treatment burden questionnaire (MTBQ), and the patient experience with treatment and self-management (PETS) as the most robust PROMs. The TBQ was selected for the subsequent questionnaire, which found that treatment burden scores varied significantly according to individuals' socio[1]economic statuses. Qualitative insight was also incorporated. The patient focus groups further refined the thematic framework summarised from the narrative review into a finalised conceptual framework of T2DM treatment burden, with a specific emphasis on the overlapping theme of personal resource allocation and utilisation. The analysis of 29 video recordings revealed 12 response approaches currently utilised by China’s GPs in their practice. These findings collectively highlight the importance of personalising and identifying more effective response strategies for this burden in primary care settings to improve the management of T2DM treatment burden. In the final sub-study, an information package, integrating the above findings, was provided to the GP focus groups. The group decision-making process, involving 41 groups, determined the prioritisation of issues in T2DM treatment burden, resulting in improved strategies for GP management of T2DM treatment burden, as a visualisation tool.
Conclusions
This research contributes valuable insights into the nature of T2DM treatment burden and its impact on care management, offering practical recommendations for healthcare stakeholders, especially for GPs in clinical practice.
DOI
10.25958/68n2-c133
Access Note
Access to this thesis is embargoed until 5 July 2025
Recommended Citation
Lin, K. (2024). Exploring treatment burden in people with type 2 diabetes mellitus (T2DM) in primary care settings. Edith Cowan University. https://doi.org/10.25958/68n2-c133