Structural constraints and patient agency in diabetes self-management: a critical case study in a primary healthcare center in Indonesia
Dublin Core
Title
Structural constraints and patient agency in diabetes self-management: a critical case study in a primary healthcare center in Indonesia
Subject
critical inquiry, Indonesia, patient perspectives, self-management, type 2 diabetes mellitus
Description
Introduction: Effective self-management is essential for individuals with Type 2 Diabetes Mellitus (T2DM), yet patients
in Indonesia often encounter persistent barriers. This study explores patients’ perspectives on the challenges they face
as well as the perceived supports available within the primary healthcare system.
Methods: A qualitative case study approach, based on Yin’s methodology, was employed. Guided by Habermas’s theory
of communicative action and Honneth’s theory of recognition, data were collected through in-depth interviews with 14
patients, 28 clinical observations of patient–provider encounters, and one focus group with five healthcare
professionals. Participants were recruited from a suburban primary healthcare center in Indonesia using purposive
sampling. Reflexivity and field notes were maintained throughout the data collection process. Data were analyzed using
thematic qualitative analysis. Triangulation across data sources helped enhance credibility and trustworthiness.
Results: Five key themes emerged: (1) Medical dominance in care provision, (2) Communication gaps, (3) Regulation-
centered care, (4) Care quality, and (5) Patient self-empowerment. These themes reveal systemic, structural, and
interpersonal barriers that constrain effective diabetes self-management in primary care.
Conclusions: Understanding the lived experiences of patients with T2DM is critical to informing practice and policy.
To overcome these barriers, a shift toward patient-centered care, improved communication, and more inclusive support
systems is essential within Indonesia’s healthcare system.
in Indonesia often encounter persistent barriers. This study explores patients’ perspectives on the challenges they face
as well as the perceived supports available within the primary healthcare system.
Methods: A qualitative case study approach, based on Yin’s methodology, was employed. Guided by Habermas’s theory
of communicative action and Honneth’s theory of recognition, data were collected through in-depth interviews with 14
patients, 28 clinical observations of patient–provider encounters, and one focus group with five healthcare
professionals. Participants were recruited from a suburban primary healthcare center in Indonesia using purposive
sampling. Reflexivity and field notes were maintained throughout the data collection process. Data were analyzed using
thematic qualitative analysis. Triangulation across data sources helped enhance credibility and trustworthiness.
Results: Five key themes emerged: (1) Medical dominance in care provision, (2) Communication gaps, (3) Regulation-
centered care, (4) Care quality, and (5) Patient self-empowerment. These themes reveal systemic, structural, and
interpersonal barriers that constrain effective diabetes self-management in primary care.
Conclusions: Understanding the lived experiences of patients with T2DM is critical to informing practice and policy.
To overcome these barriers, a shift toward patient-centered care, improved communication, and more inclusive support
systems is essential within Indonesia’s healthcare system.
Creator
Yulia Yulia1
* , Wendy Abigail2
, Eileen Willis2
, and Fathimath Shifaza2
* , Wendy Abigail2
, Eileen Willis2
, and Fathimath Shifaza2
Source
http://dx.doi.org/10.20473/jn.v20i3.71301
Date
18 August 2025
Contributor
peri irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Yulia Yulia1
* , Wendy Abigail2
, Eileen Willis2
, and Fathimath Shifaza2, “Structural constraints and patient agency in diabetes self-management: a critical case study in a primary healthcare center in Indonesia,” Repository Horizon University Indonesia, accessed February 22, 2026, https://repository.horizon.ac.id/items/show/11157.