Stage of change | Barriers to patients’ self-management | Factors that facilitate patients’ self-management |
---|---|---|
Pre-contemplation | • Does not accept the diagnosis or hopes it will go away. | • Inclusive, horizontal communication. |
I haven’t suffered from it, but it appears that I am going to suffer from high blood pressure, when they take me in to check my blood pressure, yes it is high… (Chiapas, Female) | • Lack of information about the disease. | • The primary health care institution is accessible (frequency of appointments, timing, publicly-funded). |
“I battled a long time with my husband about hypertension, and so we argued about him taking his pills, and he said “-ay! What for? if we all have to die from something…” (San José, CR, Female) | • Does not feel any symptoms. | |
• Vertical communication between the provider and the patient. | ||
• Poor eating habits and limited funds for healthy food. | ||
Contemplation | • Previous negative family health care experiences with hypertension or diabetes. | • Previous positive relative’s care experience with hypertension or diabetes. |
The doctor tells us that we should take care of ourselves, what we should do, she gives us appointments and she helps us. (Chiapas, Mexico Female) | • Difficulties negotiating between work, family, and health care commitments. | • Guidance from the primary care provider that allows patients to express how they feel about their disease. |
Preparation | • Negative perception of healthy food as being expensive or does not fill you up. | • Feeling of urgency to begin to take care of oneself. |
Having “sugar” is sad, I have high blood pressure, I have a warning, now it is up to me. (Chiapas, Mexico, Female) | • Difficulty adhering to treatment (lack of medicines, lack of or infrequent follow-up). | • Community educational sessions. |
• Green spaces are not accessible. | • Family support. | |
Action | • Difficulty losing weight. | • Accessibility of the medical care system. |
Now I love myself, I am going to stick to my diet, and my medications, I have to lose 8 kilograms. (Chiapas, Mexico, Female) | • Medication stock-outs. | • Humane, compassionate care is encouraging. |
• Difficulty controlling what food to eat/compulsive eating. | • Organized walking groups. | |
• Additional health conditions. | ||
• Not seeing progress/not having a record of change. | ||
• Taking care of other family members. | ||
Maintenance | • Difficulty keeping track of multiple medications. | • High self esteem, self efficacy. |
Yes, every three months my doctor sees me in the clinic, weighs me, tells me you take this and that and gives me a prescription, it keeps me in control. (San José, Costa Rica, Male) | • Health care appointment becomes routine without new information or educational processes. | • Strict health center attendance is a requirement for national insurance. |
• Staying calm and limiting stress. |