Table 1
Interview questions for needs assessment of a new integrated nutrition module.
I. Based on your experience in management glycaemic control/periodontitis (choose one):
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II. In your routine management of patients, do you:
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Table 2
Themes for challenges in managing patients with diabetes and/or periodontitis.
| THEMES | SUBTHEMES | QUOTES |
|---|---|---|
| Patient’s attitude and behaviour towards own health care | Refusal to make lifestyle changes | “Some of the patients came here because of request by the doctor. In reality, they do not want to change or accept making changes. They just don’t have that yet – the willingness to make changes. For me, that’s difficult. We can educate, we have (can provide) information and knowledge, but they just do not (want to) accept.” (HP 6) |
| Refusal to undergo advanced treatment | “Another obstacle in (getting a) successful outcome, sometimes when the patients hear: “(dental) surgery? No need, doctor. The non-surgical procedure is sufficient, I don’t want to undergo surgery.” (HP 14) | |
| Relying too much on healthcare professional | “Some of the patients would just leave everything to the doctors and depend on whatever the doctor wants to do.” (HP 12) | |
| Listening more toward family members and peers | “The common problem is they listen more to their peers and family members, rather than the doctors.” (HP 12) | |
| Preference for alternative medicine | “There are a lot of challenges, especially their preference to alternative medicine such as supplements and traditional medicine. When they buy these kinds of things (i.e., medicine), there is a tendency wherein they will not use hospital medication. That is the biggest challenge.” (HP 13) | |
| Language barrier | Patients only speak their mother tongue | “Usually (patients) some of them do not understand English, so they prefer (their own mother tongue) other language. It’s difficult. So, there’s a barrier.” (HP 2) “… especially among patients, we do not have that communication skill (i.e., to converse in their ethnic language). So, there’s a language barrier.” (HP 10) |
| Prioritising time for counselling sessions | Patients in a hurry | “Usually when the patients come to the hospital, they are in a rush. They don’t want to wait. When you talk to them, they try to push you to talk as fast as possible so that they can go back as early as possible. They don’t want to wait for long. That is the main barrier.” (HP 13) |
Table 3
Common issues related to management of diabetes and/or periodontitis.
| THEMES | SUBTHEMES | QUOTES |
|---|---|---|
| Health professionals’ knowledge and competency | Limited number of health professionals with multi-language skills | “We will refer to other pharmacists for different (non-Malay or English speaking) patients. … we have other diabetic educators also (who speak different languages)” (HP 4) |
| Low awareness of the relationship between diabetes and periodontitis | “So far, people (i.e., healthcare professionals) just reinforce the microvascular complications such as the kidney, eyes and macrovascular complications like nerves and heart. Therefore, they don’t realize that there is another thing (i.e. oral health) that is also important. It is a small thing, but important.” (HP 3) | |
| “If you read everywhere, they talked about the macrovascular and microvascular complications. They don’t include this issue (i.e., periodontitis in their talks).” (HP 11) | ||
| “Periodontitis… I’m not aware of it. Because periodontitis is not, I think at this moment, part of the assessment that the pharmacist needs to do.” (HP 13) | ||
| “I think maybe dental students also should be taught to refer to the dietitian. Let say for example, the student noticed that the patient has some severe nutritional problems, maybe can be referred to the dietitian for counselling because the knowledge that the dental students or the dental professions have on nutrition is quite limited.” (HP 7) | ||
| Lack integration in multi-disciplinary care | Conflicting messages in a multidisciplinary team | “In terms of the multidisciplinary team, among the doctors, nurses, (and) dietitians, when they talk to the patient most of the time, they are not providing the same messages.” (HP 11) |
| Lack of referral and inter-professional collaboration | “From my experience in handling patients, we don’t get any referral from the dentist. Also never get those with the periodontitis problems before. I can say that none of the patients will discuss that (i.e. periodontitis problems) and (how that can relate) to the diabetes management.” (HP 1) | |
| “We only have (referral) for the medical department. We don’t actually refer to the dietitian.” (HP 7) | ||
| “Never. So far no (referrals from dental team). We only refer to other clinics. Dental has never referred to us (either).” (HP3) | ||
| “When there’s a patient who complained to the doctor that he had a problem, only (then) we will make a referral to the dental department.” (HP 3) | ||
| “I think maybe dental students should also be taught to refer to the dietitian. Let’s say, for example, the student notices that the patient has severe nutritional problems or maybe they can actually be referred to the dietitian for (dietary) counselling.” (HP 7) | ||
| “And I also hope that medical practitioners, when conducting medical check-ups, will refer the patient for a dental check-up or treatment.” (HP 7) | ||
| Limited available educational materials | Limited number and access to educational materials | “Previously, I went to KKM (Ministry of Health) to collect (educational) materials. However, there is no more now. So, I just give advice verbally.” (HP 3) |
| “I don’t have any specific module to give to the patients.” (HP 14) | ||
| “We have pamphlets from … (industry). We give these for them (patients) to read.” (HP7) | ||
| “I don’t have any specific module to give to patients.” (HP14) | ||
| Unattractive materials | “So far, we only have black and white factsheets as coloured printing is costly.” (HP 10) | |
| “.. due to the cost, it’s better to be colourful… if in black and white, you cannot visualize (the diagrams or photos).” (HP 3) | ||
| Limited cultural-based module | Diversity of culture and practices among the multi-ethic population | “I think the component of culture, we need to put in something. …there are a lot of cultural things that need to be put in.” (HP13) |
| “In Malaysia, we need to mix everything. But if you form (develop) a (new) module, you need to find the most common (eating) practice).” (HP11) | ||
| “…must include the common local food.” (HP6) | ||
| Multi languages for multi-ethics | “English and Malay could be better actually…” (HP3) | |
| “I think all these modules must be made with multiple languages. You must also consider other ethnic groups.” (HP14) | ||
| “… the official language is Bahasa Malaysia (Malay language), so therefore, by right, everyone (is) supposed to understand it.” (HP1) | ||
| Time constraint | Limited time for education and counselling session | “Because our clinic has a lot of patients and we have limited time.” (HP 12) |
| “I think that’s one of the reasons why sometimes the messages do not get across to the patients; because of the time factor; periodontists wouldn’t have much time to repeat these messages over and over again.” (HP 14) | ||
| Patients in a hurry to get home | “Usually when the patients come to the hospital, they are in a rush. They don’t want to wait. When you talk to them, they try to push you to talk as fast as possible so that they can go home as early as possible. They don’t want to wait for long.” (HP 13) | |
| Costly therapy | Expensive treatment for complex and severe cases | “Cost is again another barrier. To be able to get a good result in treatment, we need to up notch it to a more complex surgical phase. This may need more (incur a higher cost), which patients need to commit to in terms of financial and it is a lot. … don’t see that they should be committing (to) that amount of money just to retain one or two teeth.” (HP 14) |
| Cost for long term monitoring | “it is not easy to tell patients to monitor their blood sugar level every day because of the cost involved.” (HP 12) |