Methods
Type 2 diabetes, diabetes-specific distress, diabetes regimen, Puskesmas, hypertension, diabetes-related distress, diabetes distress, diabetes
TYPE 2 DIABETES, POOR GLYCEMIC CONTROL, SEMI, HYPERTENSION, TYPE 2 DIABETES, COMPLICATIONS, DIABETES
To identify the current health status of people with diabetes in Aceh province, we explore baseline data from a randomized controlled trial (RCT) conducted in early 2019. The sample was drawn from people who had a diagnosis of Type 2 diabetes at primary health posts in Banda Aceh and Aceh Besar [521 participants had non-missing data on age, education, and relevant biomarkers. The statistical analysis is limited to the calculation of averages, standard deviations, and frequencies. Poor glycemic control is defined as a HbA1c level greater than or equal to 64 mmol/l; high cholesterol is defined as a total cholesterol level greater than or equal to 6.2 mmol, and hypertension is defined as systolic blood pressure above 130 and diastolic blood pressure above 80. In addition to providing estimates of lab-based measures of HbA1c, cholesterol and BMI (based on measured waist and height) to assess the metabolic profile of type 2 diabetes patients in Aceh and self-reported information on prevalent diabetes complications, we also use information on diabetes-related distress, based on the two-item diabetes distress scale (DDS2) [Feeling overwhelmed by the demands of living with diabetes.Feeling that I am often failing with my diabetes regimen.An average score of ≥ 3 was considered to be indicative of diabetes-specific distress, following the recommendations of Fisher et al. (2008) [We conducted semi structured individual interviews with eight health officers from the Aceh Provincial Health Office. The interviews were conducted in eight Puskemas with a high share of type 2 diabetes patients. Two Puskesmas were located in Banda Aceh and six in Aceh Besar. The interviews were designed to ascertain the level of engagement with the current NCD programs and activities conducted in Puskesmas.Following the interviews, diabetes patients from these Puskesmas were invited to participate in focus group discussions (FGDs). Three FGDs were conducted with 24 patients in two Puskesmas in Aceh Besar and one Puskesmas in Banda Aceh. The FGDs sought information on patients’ understanding of diabetes and their motivation for, and feelings about, participating in the Posbindu PTM and Prolanis programs, and explored their experiences of receiving diabetes treatment in Puskesmas.The sampling strategy for interviews and FGDs was purposive sampling. The inclusion criteria for interviews were: health officer of Puskesmas in Banda Aceh or Aceh Besar, who is responsible for Prolanis and Posbindu, and had at least one year of work experience. The inclusion criteria for FGDs were: patients diagnosed with diabetes from Banda Aceh or Aceh Besar, who actively participated in the Posbindu and Prolanis activities, and who were at least 18 years old. We obtained the contact details of diabetes patients from Prolanis and Posbindu staff. The interviews and FGDs were conducted face-to-face by study authors FD and SSS, and lasted approximately one hour. With participants’ permission, the interviews and FGDs were recorded on an encrypted laptop or audio recording device and then transcribed verbatim by the research team. The interviews and the FGDs were conducted in Bahasa Indonesia and later translated to English after transcripts were anonymized and all names were replaced by identifier numbers. We then conducted line by line analysis and utilized inductive thematic analysis to code the transcripts and cluster them into themes, along with anonymized quotes to support the themes, for presentation in the final report.