Observational study about psychosocial aspects in diabetes care in Brussels (Belgium)

Background

Diabetes type 2 prevalence is increasing due to ageing populations and increase in risk factors related to diabetes. It’s a chronic condition that substantially affects daily life, as persons with type 2 diabetes must adhere to a strict healthy lifestyle. Yet the psychosocial needs of these patients are often overlooked. This study examines wether and how these needs are addressed in healthcare.

Methods

A qualitative ethnographic study based on 47 non-participatory observations of diabetes consultations at an outpatient academic diabetes specialist centre located in Brussels, a European metropolitan capital, was conducted and thematically analysed using the Making Care Fit framework.

Results

Healthcare professionals mainly focused on medical aspects, while psychosocial issues were rarely discussed. Although patients raised emotional burdens, frustrations, or shame, these concerns were rarely explored in depth. Only work-related problems were further discussed. The unique life context of patients was also rarely integrated into the care plan. Although relatives were sometimes present during healthcare, and clearly played a supportive role, their perspective was not actively taken into account. The conversation was largely provider-driven, giving patients little say in final decisions. Time constraints reinforced the focus on clinical tasks, and follow-up needs were rarely addressed.

Conclusions

By directly observing real-time interactions, this study reveals how psychosocial needs become deprioritized in routine daily healthcare practices despite current insights emphasizing person centered care.

Key messages

• Healthcare was predominantly biomedical in focus. While patients’ unique situations were acknowledged, it was rarely acted upon them, and implicit psychosocial concerns often went unnoticed.

• To address lived experiences of patients and their relatives, sufficient time, open and sincere communication, and systematic screening for psychosocial issues during care is required.