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Open Access Research article

Type 2 diabetes patients’ perspectives on lifestyle counselling and weight management in general practice: a qualitative study

Matthias Wermeling1*, Ulrike Thiele-Manjali1, Janka Koschack1, Gabriele Lucius-Hoene2 and Wolfgang Himmel1

Author Affiliations

1 Department of General Practice/Family Medicine, University Medical Center Göttingen, Göttingen, Germany

2 Freiburg Institute for Advanced Studies (FRIAS) and Institute of Psychology, University of Freiburg, Freiburg, Germany

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BMC Family Practice 2014, 15:97  doi:10.1186/1471-2296-15-97

Published: 15 May 2014

Abstract

Background

Lifestyle counselling is a pivotal aspect of diabetes care. But general practitioners (GPs) often have problems in finding their role in patients’ weight management. The aims of this study were to investigate the experiences of type 2 diabetes patients with lifestyle counselling from their GPs and to explore how patients’ preferences regarding counselling are embedded in the context of self-management and wider cultural aspects of nutrition.

Methods

Narrative interviews were conducted with 35 people with type 2 diabetes aged between 35 and 77 years. The interviews were transcribed verbatim and analysed using the thematic framework method.

Results

Many patients had a strong feeling of personal responsibility for weight reduction as integral to diabetes self-management but found it difficult to integrate the changes their disease requires into their self-management activities. They attached great importance to their GPs’ advice on diet. While some patients appreciated direct communication, others regarded dramatic pictures as either unhelpful or offending. A serious problem was the incompatibility of the dietary recommendations with daily life resulting in a reluctance to adjust the whole diet to the needs of diabetes care.

Conclusions

Ambivalence towards patient self-management and tensions between the necessary changes to patients’ lifestyles and their culture, makes the GP’s role difficult and full of conflict. Instead of focusing exclusively on the guidelines of diabetes management and provision of information, GPs should explore the patients’ capabilities of self-management through open communication and accept their patients’ wishes to protect nutrition as part of their culture.

Keywords:
Type 2 diabetes; Physician-patient relations; Obesity; Eating; Patient education; Family practice; Qualitative research