Health expectations : an international journal of public participation in health care and health policy · 2025
'Why, Can I Not Have Control of My Own Insulin?': Qualitative Exploration Amongst Older Adults With Diabetes With Lived Experience of Surgical Hospital Admission.
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Lange Ferreira Christina, Habte-Asres Hellena, Forbes Angus, Winkley Kirsty
Аннотация
AIM: To explore the experiences and perspectives of older adults living with diabetes, in relation to insulin management during a surgical hospital admission and identify factors that appear to be associated with insulin safety in these older people. To identify key messages that address people with diabetes priorities, to be used in staff education.
METHODS: Qualitative study, conducted in a single, rural NHS hospital. Ten semi-structured phone interviews were held with older adults with diabetes, with or without frailty, treated with insulin while undergoing surgical hospital admission. Framework analysis was employed in data analysis.
RESULTS: Six people with type 2 diabetes and four people with type 1 diabetes, aged 68 to 91 years old (mean age 77.2 years [SD = 6.2]) participated in the study. Four themes identified specific to hospital insulin management and safety: (1) preparedness for hospital admission; (2) feeling disempowered in hospital; (3) staff knowledge, confidence, attitudes and behaviours; (4) diabetes and insulin management as a balancing act. In addition, participants co-designed an infographic to help hospital staff understand what matters most to older adults in terms of managing their insulin safely in the hospital.
CONCLUSION: Lack of joined-up care, staff knowledge gaps and lack of empowerment ethos hinder hospital insulin safety. This study identified that having a self-management policy in a hospital does not necessarily mean it is implemented for older adults with diabetes. Using a co-design approach to engage with older adults helped to identify components critical to hospital insulin safety interventions.
PATIENT OR PUBLIC CONTRIBUTION: Patients and members of the public are involved in study design and interpretation of findings. Before the study, a diabetes peer-support group reviewed and contributed to the interview topic guide and study recruitment documentation. Study participants co-designed the infographic developed.
METHODS: Qualitative study, conducted in a single, rural NHS hospital. Ten semi-structured phone interviews were held with older adults with diabetes, with or without frailty, treated with insulin while undergoing surgical hospital admission. Framework analysis was employed in data analysis.
RESULTS: Six people with type 2 diabetes and four people with type 1 diabetes, aged 68 to 91 years old (mean age 77.2 years [SD = 6.2]) participated in the study. Four themes identified specific to hospital insulin management and safety: (1) preparedness for hospital admission; (2) feeling disempowered in hospital; (3) staff knowledge, confidence, attitudes and behaviours; (4) diabetes and insulin management as a balancing act. In addition, participants co-designed an infographic to help hospital staff understand what matters most to older adults in terms of managing their insulin safely in the hospital.
CONCLUSION: Lack of joined-up care, staff knowledge gaps and lack of empowerment ethos hinder hospital insulin safety. This study identified that having a self-management policy in a hospital does not necessarily mean it is implemented for older adults with diabetes. Using a co-design approach to engage with older adults helped to identify components critical to hospital insulin safety interventions.
PATIENT OR PUBLIC CONTRIBUTION: Patients and members of the public are involved in study design and interpretation of findings. Before the study, a diabetes peer-support group reviewed and contributed to the interview topic guide and study recruitment documentation. Study participants co-designed the infographic developed.