Authors: Kodhek AO, Oguya F, Otieno CF, Ojwang A, Okeyo I.
Needs assessment for Chronic Diseases, and specifically Type 2 Diabetes Mellitus is usually done with the objective of identifying gaps to enable quality improvement. Quality improvement in T2DM care is heavily reliant on patient and provider behavior, and environmental factors. The aim of this study was to assess T2DM needs with a view of optimizing care. This was thus a qualitative study, which was part of a mixed method study design. It involved Focus Group Discussions (FGD), Key Informant Interviews (KII) and physical observation of care processes. Sample size was attained through the principal of saturation. Framework method was used for data analysis. The three qualitative approaches provided rich contextual data corroborated via triangulation. The study identified several needs: Knowledge, healthcare and socioeconomic needs amongst others. Simultaneously, it observed that despite much hype about factors that affect needs of T2DM, attitude is one single factor that subtly align environmental experience and knowledge to produce a particular behavior. Cognitive dissonance in attitude and how this relates to implicit and explicit attitude nuances needs assessment and consequently behavior. Paradoxical behaviors such as physical inactivity in impoverished populations that should be walking daily to work is explained by attitude. Improving knowledge and healthcare infrastructure does little to optimize care if attitude towards T2DM care is negative. Attitude is often measured in needs assessment, albeit with difficulties, but is overlooked and poorly understood when it comes to its enhancement since its impact is psychological. It is however pivotal and quintessential in translating education, culture, healthcare infrastructure and socioeconomic conditions into favorable T2DM behavior. Understanding the place of attitude and its quiddity in T2DM care spectrum provides a panoptic perspective for quality improvement.
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