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. 2017 Feb 28;17(1):171.
doi: 10.1186/s12913-017-2075-9.

A mixed-methods needs assessment of adult diabetes mellitus (type II) and hypertension care in Toledo, Belize

Annette M Dekker  1 , Ashley E Amick  2 , Cecilia Scholcoff  3 , Ashti Doobay-Persaud  2
Affiliations

A mixed-methods needs assessment of adult diabetes mellitus (type II) and hypertension care in Toledo, Belize

Annette M Dekker et al. BMC Health Serv Res. .

Abstract

Background: Non-communicable diseases, including diabetes mellitus and hypertension, continue to disproportionately burden low- and middle-income countries. However, little research has been done to establish current practices and management of chronic disease in these settings. The objective of this study was to examine current clinical management and identify potential gaps in care of patients with diabetes mellitus and hypertension in the district of Toledo, Belize.

Methods: The study used a mixed methodology to assess current practices and identify gaps in diabetes mellitus and hypertension care. One hundred and twenty charts of the general clinic population were reviewed to establish disease epidemiology. One hundred and seventy-eight diabetic and hypertensive charts were reviewed to assess current practices. Twenty providers completed questionnaires regarding diabetes mellitus and hypertension management. Twenty-five individuals with diabetes mellitus and/or hypertension answered a questionnaire and in-depth interview.

Results: The prevalence of diabetes mellitus and hypertension was 12%. Approximately 51% (n = 43) of patients with hypertension were at blood pressure goal and 26% (n = 21) diabetic patients were at glycemic goal based on current guidelines. Of the patients with uncontrolled diabetes, 49% (n = 29) were on two oral agents and only 10% (n = 6) were on insulin. Providers stated that barriers to appropriate management include concerns prescribing insulin and patient health literacy. Patients demonstrated a general understanding of the concept of chronic illness, however lacked specific knowledge regarding disease processes and self-management strategies.

Conclusions: This study provides an initial overview of diabetes mellitus and hypertension management in a diverse patient population in rural Belize. Results indicate areas for future investigation and possible intervention, including barriers to insulin use and opportunities for lifestyle-specific disease education for patients.

Keywords: Central America; Hypertension; Mixed method; Needs assessment; Non-communicable disease; Type 2 diabetes.

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Figures

Fig. 1
Fig. 1
Hillside Clinic and Mobile Sites in Toledo District
Fig. 2
Fig. 2
Overview of Methodology
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