Self-monitoring of blood glucose: The perception of physicians who care for older adults in a health service in Mexico

This paper presents the perception of the process of glucose self-monitoring by older adults diagnosed with type 2 diabetes mellitus. The study was conducted in a health service in Mexico using semi-structured interviews to physicians and it was based on the behavioural model. Diabetes mellitus type 2 (DM2) is one of the 3 main causes of death in Mexico. The self-monitoring of blood glucose (SMBG) behaviour is one of the most valuable tools in controlling of diabetes. In health care, it is common for interventions to be developed, implemented or evaluated to promote healthier lifestyle behaviours for patients; however, these interventions are often designed without an analysis or diagnosis to determine what needs to be changed to change the behaviour. This work focuses on the perception of people working in Mexican health services that provide medical care to the older adult population diagnosed with T2DM. The objectives of this research were: (1) Identify the organizational aspects that influence or affect the use of the blood glucose meter (BGM) in elderly patients with T2DM; (2) define the barriers and enablers for older adults to use the BGM detected by clinician in patients with T2DM and whether these characteristics differ with the rest of the population diagnosed with T2DM and; (3) understand the importance of the BGM for the treatment of T2DM in an elderly patient. Six semi-structured interviews with clinicians with specialization in Family Medicine (FM) of the first level of the Mexican Social Security Institute (IMSS) were undertaken. The interviews were divided into five aspects: (a) Clinicians’ background, (b) context and support by IMSS, (c) glucose meter in home and use, (d) information that patients receive, and (e) barriers and enablers to use the BGM. A thematic analysis of the qualitative data collected in the interviews with the clinicians was carried out to identify, analyze and report the patterns. The coding of the themes was based on the theory of the COM-B model. As a result of the interviews, it was identified that SMBG is composed of three different behaviours and that each behaviour requires different capabilities, motivations and opportunities. In order to perform the SMBG behaviour, clinicians considered 12 physical capacities necessary, 22 psychological capabilities, seven physical opportunities, three social opportunities, five reflective motivations and two automatic motivations. Physicians consider that older people have barriers to achieving the behaviour. The study further demonstrated that the target behaviour of SMBG use is not only the interaction with a single medical device; rather the older adult is required to interact with four medical devices to achieve SMBG.