Patients’ conceptions of opting out of group-based education for type 2 diabetes in Swedish primary care – a phenomenographic interview study

PURPOSE: Type 2 diabetes affects everyday life, requiring patients to learn to live with the illness. Although group-based education can improve clinical outcomes and support self-care, it remains underutilised in Sweden. Only about a fifth of healthcare centres offer group-based education, and many patients opt out of participation. Understanding the various reasons patients opt out is crucial for designing group-based education that meets individual needs and promotes long-term disease management. This study aims to describe variations in the conceptions of patients with type 2 diabetes who opted out of group-based education. METHODS: A phenomenographic approach was applied based on 18 individual interviews with patients in primary care who opted out of group-based education for type 2 diabetes. RESULTS: Three conceptions emerged regarding group-based education for type 2 diabetes, reflecting patients' varied views and understanding. Some patients saw no need for group-based education and preferred individual learning. Others recognised the benefits and barriers of group-based education, such as inflexible schedules. Others appreciated the reflective and supportive environment, shared experiences, and greater self-insight. CONCLUSIONS: Patients who declined group-based education held varied conceptions, from preferring individual counselling to recognising benefits. Understanding these variations supports more personalised education and better long-term self-management. These insights may inform clinical and assistive practices by promoting more flexible and person-centered approaches to diabetes education within primary care.