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Table 3 Impact of patients’ attitudes towards diabetes on the spheres of daily life, crucial in the management of the disease

From: How to engage type-2 diabetic patients in their own health management: implications for clinical practice

   Speheres of daily life
   Diet Physical activity Therapy Doctor-patient relationship
Attitudes towards diabetes Cognitive and informative barriers in diabetes management (Cognitive dimension) The patients have difficulty understanding the rationale of the diet regimens prescribed by the doctor. This is the area in which the patients seem to have less knowledge, or at least a less elaborate understanding of medical prescriptions, that often are perceived as abstract and outside of their daily context. The patient reports an abstract knowledge of the therapeutic regime that he/she has to follow. Often he/she doesn’t understand the rationale behind the prescribed therapeutic scheme and he/she hasn’t interiorized the importance of adherence. Information given from the doctor to the patient often appears partial. Educational and informative supports are often ineffective. As a consequence, the patient reports a fragmented knowledge about his/her status and the rationale behind the doctor’s requirements.
The Behavioral Disorganization (Behavioral dimension) Even in the case of a “cognitive adhesion” to diet prescription, the patients often report difficulty in translating treatment into the concrete frame of their daily life. The majority of interviewed patients declare inconsistent physical activity. Physical activity does not often become part of patient routine and, rather, is rarely engaged in unless as a countermeasure for lack of adherence to diet. The partial understanding of therapy rationale and values lead patient to unjustified “discounts” in drug assumption as well as to occasional “reparative” changes (i.e. increase) in the drug dosage. The patient tends to “escape” the encounter with the doctor, by ignoring controls or by avoiding direct contact with the specialist.
The Emotional Burden (Emotional dimension) Food is strongly emotional and at the representational and symbolic levels, it not only allows the satisfaction of a primary need, but is also a source of gratification at the relational (conviviality) and individual levels (hedonism). At the emotive level, this sphere is poorly invested; physical activity is insufficiently gratifying for the patient, and thus it is perceived as ancillary, less important than other medical prescription in the care process. Therapy is treated with emotional ambivalence and conflict in patient experience. The reliance on drugs is s a constant reminder of the patient’s illness status, thus lack of adherence to treatment is often a sign of the patient’s reluctance to accept the awareness of his/her pathological status. The doctor is ambivalently considered to be the most important point of reference for the patient, and at the same time as far away figure, poorly attuned to patient needs and priorities. Further the patient often - at the symbolic level – blames the doctor as the “executioner” who communicated the diagnosis, and thus dramatically changed the patient’s life.
This is particularly evident in the case of insulin, lived as the “very end” of one own health status.