Exploring the decision-making experience of elderly diabetes patients regarding their health-seeking behaviour: a descriptive qualitative study

Abstract

Background

Diabetes has emerged as a critical global public health issue. The burden of diabetes is escalating in developing countries, including China. For individuals with diabetes, making informed and rational decisions regarding health-seeking behaviour is crucial to prevent or delay the occurrence of complications. However, prevalent irrational health-seeking behaviours among Chinese patients with diabetes have led to a low treatment rate of only 32.2%. In this study, we explore the subjective experiences of elderly patients with diabetes related to their decision-making experience for seeking healthcare, providing valuable insights for targeted intervention, and provide theoretical basis for establishing an efficient medical and health service system.

Methods

A qualitative study using descriptive phenomenology research methodology was adopted to explore the decision-making experience of elderly diabetes patients in seeking healthcare services. A purposive sampling approach, specifically maximum variation sampling, was employed to conduct semistructured in-depth interviews with 11 eligible participants between January and February 2023. Data analysis was carried out using QSR Nvivo 12.0 software and Colaizzi’s seven-step analysis method.

Results

Four themes emerged: ‘lack of disease risk perception and negative coping styles’, ‘ huge medical and economic burden’, ‘lack of family and social support’ and ‘Dissatisfaction with medical services’.

Conclusion

The health-seeking behavioural decision-making level of elderly diabetic patients is relatively low. Medical and healthcare professionals should formulate targeted intervention measures aimed at improving their disease cognition level, changing their coping styles and enhancing their health-seeking behavioural decision-making level to improve their health outcomes. Meanwhile, policymakers should plan and allocate medical resources in a targeted manner based on the needs and expectations of patients.

Correspondence to Hong Hong Jia; [email protected]

STRENGTHS AND LIMITATIONS OF THIS STUDY

• This study is the first qualitative research that uses the phenomenological research method to describe the health-seeking behavioural decision-making experiences of diabetic patients.

• Due to the limitations of regional selection and research conditions, all participants were recruited only from the same city in China, which may introduce a certain degree of bias.

• Due to the limitation of the sample size, the results of this study may not be applicable to all diabetic patients.

• Because the participants were asked about their past experiences of health-seeking behaviour decision-making, it may be affected by recall bias.

• Due to the cultural differences between Chinese and English, translating the interviews from Chinese to English is another limitation of this study.

Background

Diabetes is the most prevalent metabolic disorder, characterised by long-term hyperglycaemia that leads to significant damage to vital organs and various complications, imposing a substantial mental and economic burden on patients, severely impacting their physical and mental health, and even posing a threat to their lives.¹ With the ageing of society, diabetes incidence rates in China are increasing annually. According to the International Diabetes Federation’s (IDF) 10th edition of the Global Diabetes Map released in 2021,² there are approximately 140 million adult diabetes patients in China—ranking first globally. Additionally, over half (50.5%) of Chinese adults with diabetes remain undiagnosed², while only 32.2% receive treatment for this condition.² These findings suggest that although diabetes prevalence is high in China, awareness rates, diagnosis rates and treatment rates remain low; consequently, resulting in poor blood sugar control.

Unreasonable medical treatment of diabetes patients often leads to various complications, including cardiovascular disease, neuropathy, nephropathy and retinopathy.³ In 2015, Hu⁴ and other researchers demonstrated that over two-thirds of Chinese diabetes patients experienced at least one complication. These complications have been proven to be the primary cause of mortality in diabetic patients. A systematic evaluation on the identification, causes and outcomes of delayed treatment for chronic threat limb ischaemia and diabetes foot ulcers⁵ revealed a significant positive correlation between treatment delay and amputation rate. Poor health-seeking behaviour further increases the likelihood of amputation in diabetic patients. Chen⁶ suggests that continuous blood glucose fluctuations may accelerate atherosclerosis formation in elderly type 2 diabetes patients and increase cardiovascular disease mortality rates. Health-seeking decision-making behaviour is influenced by external factors such as social environment, policy systems and national health service systems as well as individual needs. It provides a novel perspective for understanding the occurrence, progression and changes in health-seeking behaviour from diverse angles.

Most of the existing studies on the health-seeking behaviour of diabetes patients are quantitative, mainly concentrating on the complications and influencing factors arising from poor health-seeking behaviour. Nevertheless, there is a shortage of research that explores the actual decision-making experience underlying such behaviour. Hence, this study adopts phenomenology as the research method to explore the lived experiences of elderly diabetes patients when making health-seeking decisions. By scrutinising their health-seeking experiences, we aim to identify the challenges related to health-seeking behaviour and develop targeted interventions aimed at enhancing the overall health outcomes for elderly diabetes patients. This study provides a theoretical foundation for establishing an efficient medical and healthcare service system.

Methods

Study design

This qualitative study employed a descriptive phenomenological approach via personal semistructured interviews to offer an in-depth comprehension of the health-seeking behavioural decision-making among elderly patients with diabetes mellitus. The study intended to identify the motivators and barriers associated with such behaviour. From January to February 2023, the research was carried out in a community in Nanchong City, Sichuan Province, China.

Recruitment and participants

Purposive sampling with maximum variation was employed in this study, and 11 participants were selected from a community in Nanchong City, Sichuan Province, China by this method. The inclusion criteria for elderly patients with diabetes mellitus were as follows: (1) meeting the diagnostic criteria for diabetes according to the American Diabetes Association Medical Diagnosis and Treatment Standards for Diabetes in 2022; (2) age ≥60 years old⁷; (3) conscious, with stable vital signs, and the ability to communicate normally; (4) willingness to participate and able to provide informed consent. Exclusion criteria: (1) cognitive impairment, as judged by the attending physician; (2) mental disorder, as judged by the attending physician.

Data collection

Based on an extensive literature review, the research team developed an interview outline. In an effort to guarantee the scientificity and effectiveness of the research, we invited five experts in relevant fields to modify the interview outline of this study. Among the five experts, two are experts in diabetes nursing management with profound academic background and professional knowledge, one is a diabetes clinical nursing expert with rich clinical work experience and two are experts with rich experience in qualitative research methods. Pilot interviews also have been employed to guarantee scientific nature and effectiveness of the research.

Before conducting in-depth interviews, the researcher presented the purpose of the interview to the participants and sought permission for recording, ensuring that all the content would be used solely for scientific research purposes. The researcher obtained informed consent from each participant and scheduled a convenient time and place for the interview, while selecting an environment that was quiet, comfortable and free from distractions. Both interviewers of this study are masters of nursing research and have received systematic qualitative research training before conducting this study. During the interview process, close attention was paid to the emotional changes exhibited by the participants, and they were encouraged to express their genuine feelings. Flexibility was maintained in both the procedure and the content based on individual circumstances, with the interviews lasting between 20 and 40 min and being recorded in their entirety. After the conclusion of each interview, transcript copies were returned to the participants who were requested to verify the accuracy, thereby enhancing the credibility of the results.

Saturation was deemed to have been achieved when no new themes emerged from the sample size. All elderly diabetes patients were Chinese-speaking and interviewed in accordance with the interview guidelines outlined in box 1.

Box 1

Outline of the interview

• What about your feelings and thoughts when you had symptoms of diabetes？

• What are your plans after determining that you may be ill?

• What are the difficulties you encountered during the decision-making process?

• What have you experienced and felt during your past medical treatment?

• What are your medical habits?

• What did you do when you hesitated?

Data analysis

Transcribe the recording within 24 hours of the interview. The interview content was analysed using the Colaizzi analysis method by two nursing master’s researchers simultaneously. The data were sorted and analysed using QSR Nvivo 12.0 software, in conjunction with manual work. The opinions expressed were carefully coded, classified according to diabetes treatment behaviour decisions and further refined into themes and subthemes for a comprehensive description. Any discrepancies during the encoding process were solved by joint discussion with another researcher. Finally, the results obtained will be returned to respondents for verification of theme extraction accuracy and authenticity.

Patient and public involvement statement

We did not incorporate the participants (interviewees) into the design, implementation, reporting and dissemination plans of the study.

Results

In this study, there were 11 participants, consisting of four males and seven females, all diagnosed with type 2 diabetes. The age ranged from 64 to 79 years old, with a mean age of 73 years old. The duration of the disease ranged from 0 to 30 years, with a mean duration of 12 years. Among them, five were illiterate while two had primary school education, two had junior high school education and two had senior high school education. Ten patients experienced complications related to diabetes; among them, one suffered from diabetic foot while five suffered from diabetic macular oedema and eight presented cardiovascular symptoms associated with their condition; only one participant had no complication related to diabetes. All participants were married and five have lost their spouses. Regarding monthly family income levels: five people earned less than $419 per month; three earned between $419 and $698 per month; two earned between $698 and $1116 per month while one participant’s monthly family income exceeded $1116 per month (table 1).

Table 1

Characteristics of participants

Characteristic	Number
Gender
Male	4
Female	7
Age
60–69	2
70–79	9
Educational level
Illiterate	5
Primary school	2
Junior high school	2
Senior high school	2
Marital status
Married	6
Death of spouse	5
Confirmed time (years)
<1	1
1–9	5
10–19	3
20–30	2
Monthly family income
<$423	5
$423–$705	3
$705–$1128	2
≥$1128	1

Data analysis gave rise to four themes and 10 subthemes. The themes were ‘lack of disease risk perception and negative coping styles’, ‘ huge medical and economic burden’, ‘lack of family and social support’ and ‘Dissatisfaction with medical services’ (table 2).

Table 2

Themes and subthemes

Theme	Subthemes
Lack of disease risk perception and negative coping styles	Lack of disease risk perception
	Negative coping styles
Huge medical and economic burden	Serious disease economic burden
	Meagre family economic income
	Previous medical history and disease course
Lack of family and social support	Lack of support from family and friends
	Lack of medical insurance support
	Have the support of national policies
Dissatisfaction with medical services	Unsatisfactory quality of health services
	Inaccessible medical service

Theme 1 Lack of disease risk perception and negative coping styles

Lack of disease risk perception

The vast majority of the participants explicitly manifested a pronounced deficiency in their comprehensive knowledge regarding diabetes, an utter incapacity to accurately identify the diverse symptoms associated with the disease and a severely limited comprehension of the potential and intricate complications ensuing from delayed diagnosis and treatment. Notably and significantly, a substantial proportion of the patients prematurely discontinued their ongoing treatment either due to perceiving a certain degree of improvement or mistakenly holding the erroneous belief that they themselves had been completely cured.

N5 ‘I possess rather limited knowledge about diabetes and have never engaged in any discussions about the disease with others. Personally, I have been taking medication, and fortunately, I haven’t encountered any major issues related to this disease so far.’

N7 ‘Lacking knowledge about diabetes, I overlooked the symptoms (such as dry mouth, frequent urination and weight loss) and underestimated their significance.’

N8 ‘There are many elderly diabetes patients around me. Both my wife and I have diabetes. I think diabetes is both hereditary and contagious. My wife’s diabetes is not serious. When she manages to control her blood sugar to the normal level, she believes her diabetes has been completely cured.’

Negative coping styles

Most participants display a pessimistic stance towards health-seeking behaviour, characterised by the belief that ‘fate determines one’s destiny.’ The absence of pain is frequently misinterpreted as the absence of severe disease symptoms, resulting in a tendency to overlook such symptoms. Eight interviewees stated that the treatment suggestions from the hospital were in line with their own treatments, so there was no necessity to go to the hospital. The participants have a pronounced sense of conformity. The diabetes patients around them always self-medicate by buying medicine in drugstores, so they do the same.

N3 ‘When I was young, I hoped to control my blood sugar within the normal range. But now, I think I’ll just live until whenever.’

N9 ‘I typically purchase medicine at the drugstore. I don’t go to the hospital for my diabetes.’

N11 ‘Many people around me suffer from diabetes, but I don’t think it is very serious. Diabetes doesn’t have a significant impact on my own life. If I hadn’t found out about it, I wouldn’t have known anything and would have always lived like this.’

Theme 2 Huge medical and economic burden

Serious disease economic burden

Among the respondents, seven patients indicated that the economic burden related to the disease constitutes a primary determinant in their decision-making process when seeking healthcare. Due to economic hardships, some patients only inform the doctor of the symptoms they consider serious when seeking medical assistance, while neglecting to mention certain symptoms that they believe can be endured. This is because they are afraid that doctors will prescribe an excessive amount of medication.

N6 ‘In rural areas, people who have a minor physical problem won’t go to see a doctor. We all procrastinate. Only when the condition becomes very serious will we consider going to the hospital. Going to the hospital costs a lot!’

N7 ‘My diabetes isn’t a big deal. Being old, I just live each day as it comes. Currently, I have numbness in my hands and feet, but it doesn’t affect me much. When I went to the hospital to see a doctor, I didn’t mention this condition because that would lead to being prescribed a lot of medications.’

N10 ‘I haven’t been to a major hospital for nearly 3 years. Going to the hospital is extremely costly! A check-up alone costs over 1000 yuan, and I have several diseases such as cerebral infarction, myocardial infarction and osteoporosis. I need to spend more than 1000 yuan on medication every month.’

Meager family economic income

Among the respondents, seven patients had no income. Six elderly patients relied on their children for living expenses, and one patient relied on her husband working outside to earn money. Due to financial constraints, patients might be more hindered by economic conditions when seeking medical assistance. Some patients might feel guilty and self-blaming for their medical expenses.

N4 ‘Because I rely entirely on my son for money. If I spend too much on diseases, then I will run out of living expenses. So, I can’t buy expensive medication for treatment.’

N6 ‘My children are also under considerable pressure. They have to provide for their children’s college education, which costs 10 000 to 20 000 yuan per year. They are also responsible for my living expenses. I don’t want to burden my children too much, so I need to manage my money appropriately.’

N7 ‘We used to be involved in agricultural activities, but due to our advanced age, we are no longer able to work outside (migrate). Our livelihood solely relies on crop production, which unfortunately has little economic value. Regrettably, the pigs we raised this year have also died, and my wife and I have been relying on medication all year round. As a result, due to financial difficulties, we have stopped taking medication recently.’

Previous medical history and disease course

Respondents who have a history of multiple medical conditions and a longer duration of illness might encounter greater challenges and experience higher pressure when seeking healthcare, potentially resulting in insufficient confidence in managing their condition.

N3 ‘I have been diagnosed with multiple medical conditions, such as diabetes, hypertension, hyperlipidaemia, cerebral infarction, myocardial infarction, coronary heart disease and osteoporosis (expressing discomfort). Currently, I am experiencing blurred vision in my eyes and have undergone previous surgeries. I have little hope for the treatment of diabetes.’

N10 ‘I am afflicted with multiple conditions, including cerebral infarction, myocardial infarction and osteoporosis, requiring the administration of more than 1000-yuan worth of medications each month.’

Theme 3 Lack of family and social support

Lack of support from family and friends

The decision-making of diabetic patients in seeking health behaviours is influenced by their families, friends and people around them. Some patients seek health services under the urging of their families, but some patients lacking support from their families and friends often fail to seek health services.

N3 ‘Owing to multiple illnesses, I am incapable of walking. My son is occupied with business and has no time. I won’t seek health services unless my condition is serious.’

N4 ‘A few years ago, I was employed in a factory. As my family was not nearby, I had to tolerate minor health issues by myself as long as they weren’t overly serious.’

N10 ‘Once, I suddenly fainted to the ground due to hypoglycaemia. I was alone at home and I don’t know how long it took before I woke up.’

Lack of medical insurance support

Medical insurance has changed the price of medical services, playing an important role in patients’ health-seeking behavioural decision-making. Three respondents with employee medical insurance stated that due to a 90% reimbursement rate, they would not consider economic factors when seeking medical treatment. Due to China’s prominent agricultural status, the majority of patients rely solely on the New Rural Cooperative Medical Insurance for healthcare coverage. Given the high threshold for medical insurance reimbursement or the significant proportion of out-of-pocket expenses borne by patients themselves, certain individuals, especially those reluctant to allocate excessive funds for medical treatment, may choose to stop purchasing medical insurance due to the escalating costs year after year.

N7 ‘I didn’t purchase medical insurance. Now the rural medical insurance is 380 yuan per year and it is increasing year by year. Currently, I pay for the medical expenses by myself.’

N11 ‘Generally, mild symptoms are noticed, while those with obvious symptoms should seek medical treatment. Our company’s employee medical insurance has a 90% reimbursement rate, so if there is any illness, we go to see a doctor.’

Have the support of national policies

The majority of respondents mentioned the significance of national policies in dealing with chronic diseases, and such policies play a crucial role in shaping their health-seeking behaviour.

N7 ‘Annually, village cadres inform us to have medical examinations such as electrocardiograms, B-ultrasounds, and liver and kidney function tests at the town hospital. With the implementation of favourable policies and competent healthcare professionals, we, as ordinary individuals, have become increasingly active in seeking regular check-ups at the hospital.’

N8 ‘Our family lives in a state of economic deprivation, and the nation offers us assistance policies. Hospitalisation expenses are eligible for reimbursement at a rate of 90%, thereby resulting in a relatively small financial burden after reimbursement.’

N9 ‘The area I come from is rural, and our country has carried out supportive policies for chronic diseases. I have registered in the community’s chronic disease registration system, which enables me to receive a yearly drug subsidy of 135 yuan.’

Theme 4 Dissatisfaction with medical service satisfaction

Unsatisfactory quality of health services

The quality of medical and healthcare services plays a pivotal role in patient decision-making, particularly when it comes to selecting medical institutions. A positive medical experience contributes to fostering a harmonious doctor-patient relationship and alleviating patients’ concerns during the process of making medical decisions. Additionally, our research indicates that having familiar or trusted physicians can significantly enhance patients’ inclination towards seeking healthcare.

N1 ‘I went to a small hospital for treatment and felt particularly dissatisfied. The hospital gave me too many tests, but the treatment effect was not good. Since then, I have been going to a tertiary hospital for medical treatment.’

N4 ‘For some time, I always felt dry mouth and bitter taste. I went to the township health centre for treatment, and the doctor diagnosed it as a kidney disease. But after taking medicine for a long time, it didn’t get better. Later, I was diagnosed with diabetes in a big hospital. Since then, I no longer trust the medical skills of the doctors in the township health centre.’

N11 ‘I always ask the director of the endocrinology department at a certain hospital to prescribe medication for me. Because he is very familiar with my condition, if I have any discomfort or want to ask anything, I can communicate with him.’

Inaccessible medical service

The quality of medical and healthcare services plays a crucial role in patients’ decision-making, particularly when it comes to the selection of medical institutions. A positive medical experience contributes to fostering a harmonious doctor-patient relationship and alleviating patients’ anxieties during the process of making medical decisions. Additionally, our research indicates that having familiar or trusted physicians can significantly enhance patients’ propensity to seek healthcare.

N1 ‘At that time, I was also very busy with work, so I didn’t attach much importance to this matter. I just used metformin to control my blood sugar and didn’t eat anything overly sweet. Later, I took the treatment seriously after retirement.’

N6 ‘When I was hospitalised for other diseases, I felt that the registration fee was rather expensive and I didn’t know which department to apply to, which was still quite troublesome. Therefore, now I usually go to some small clinics to see a doctor.’

Discussion

Consistent with a cross-sectional survey involving 630 participants in Ghana,⁸ a majority of respondents reported a lack of knowledge regarding diabetes, resulting in an inability to identify symptoms and incorrect attribution of risk, ultimately leading to delayed medical treatment. Despite some patients having received information on diabetes knowledge, due to the uneven quality of the obtained information and the uncertainty of information, they often have cognitive biases.⁹ Diabetes patients require professional guidance to establish effective self-management and alleviate concerns regarding their health. According to research conducted by the US Centres for Disease Control and Prevention, up to 60%~75% of diabetes patients have successfully prevented complications through education on healthcare knowledge.¹⁰ Educational interventions should play a pivotal role in promoting symptom recognition. Additionally, this study reveals that negative attitudes and coping style towards seeking healthcare are prevalent. Scholars, such as Jia et al,¹¹ Nada et al ¹² and so on, argue that negative attitudes and coping style towards healthcare-seeking behaviours are the primary cause of treatment delays. Consequently, medical staff should carry out personalised health education according to the actual situation of elderly patients with diabetes so that patients have a scientific understanding of diabetes. In addition, medical workers should assist diagnosed diabetes patients in developing positive health beliefs, changing their negative perceptions towards healthcare and empowering them to make informed decisions regarding their healthcare behaviours.

Most respondents pointed out that the economic burden related to diabetes treatment is considerable, which is in line with the research results of Zhu et al ¹³ on the financial stress experienced by elderly diabetic patients in China. When determining whether to seek healthcare and which healthcare facility to choose, it is essential to give priority to economic factors. Similar to the research findings of action logic of the older adults about health-seeking in South Rural China,¹⁴ this study found that over half of the participants emphasised that ageing and poor physical condition, which result in limited financial resources, are the key disturbances influencing their tendency towards delayed medical treatment. Additionally, due to the specific characteristics of diabetes management, outpatient expenses notably exceed inpatient costs within its healthcare expenditure structure, consistent with the calculations made by Ding et al ¹⁵ based on national health service surveys. In recent years, there has been a continuous rise in healthcare demand in China; nevertheless, the majority of the increased expenses are borne by individuals themselves, leading to an augmented economic burden for many.¹⁶ Multiple studies confirm that an overly heavy economic burden of diseases remains one of the primary causes for discontinuation or delay in receiving necessary medical care.^{17 18} Based on this, the majority of rural respondents, especially elderly individuals and marginalised populations lacking financial resources and education, rely heavily on national medical and health service policies for treatment.¹⁹ It is recommended that policymakers in healthcare formulate targeted policies to allocate and use health resources effectively, thereby enhancing the ability of marginalised groups affected by diabetes to cope with treatment costs while reducing their economic burden.

Provide positive and effective family and social support

Many studies^{20 21} have demonstrated that the provision of information support, emotional support and financial support by families and society, such as the companionship of family members, care from friends, encouragement from fellow patients and assistance from community medical staff, can enhance their confidence and ability in managing their condition.²² A majority of respondents indicated that they acquired knowledge about diabetes through indirect experiences shared by family members, friends and people around them. The information and emotional support provided by loved ones can motivate patients to actively engage in health-seeking behaviour.²³ Furthermore, the implementation of national policies for chronic diseases enables respondents to access more medical resources and somewhat mitigates negative emotions associated with the illness. Consequently, it enhances the sense of benefit during the course of seeking health services.²⁴

Respondents who have urban employee medical insurance clearly stated that 90% of the expenses are reimbursable. Furthermore, they indicated that economic factors would not be a consideration when seeking treatment, and they tend to choose tertiary hospitals. On the contrary, respondents without medical insurance support or only covered by the New Rural Cooperative Medical Insurance tend to purchase their own medication from pharmacies or seek healthcare services at grassroots medical institutions. These individuals prioritise their health-seeking decisions based on the cost of medical expenses. Feng et al ²⁵ also discovered that patients from low-income and middle-income families exhibit higher sensitivity to healthcare costs. Therefore, it is crucial for healthcare professionals to pay attention to the patient’s family and social support system, provide targeted assistance and guidance and encourage active engagement in managing diabetes. National policymakers should also propose strategies aimed at mitigating financial risks associated with chronic disease expenses.²⁶ Combined with the research results of a study on the hospitalisation expenses and burden of the elderly in China^{21, 27 27}, this study suggests that the reimbursement proportion for diabetes outpatient services should be appropriately increased, allowing low-income diabetic patients to choose the appropriate medical institutions based on their individual disease needs and make wise health-seeking behaviour decisions.

Improving patient satisfaction with Healthcare services

During the interview, when asked about their previous medical experiences and sentiments, several respondents with medical experience in provincial and municipal hospitals expressed dissatisfaction regarding inconvenient transportation, cumbersome medical procedures and exorbitant healthcare expenses. A study conducted in Bosnia and Herzegovina^{28 29} also suggests that patients’ contentment with healthcare not only impacts their communication with healthcare providers and adherence to medical advice but also influences their healthcare-seeking behaviour. In light of this observation, it is recommended that provincial and municipal hospitals streamline the process of receiving treatment by encouraging patients to be familiar with using medical service to reduce waiting times. Strong evidence suggests that providing professional medical consultation services can enhance the overall patient experience while they seek health services,³⁰ ultimately leading to an improvement in patient satisfaction levels.

With the implementation of the first visit policy at the grassroots level in China, the management of chronic diseases is being decentralised to grassroots healthcare institutions.³¹ Elderly individuals with conditions like diabetes are increasingly inclined towards seeking medical treatment at these primary care facilities.³² However, respondents with grassroots hospital experience express dissatisfaction with limited tech capabilities, lack of advanced equipment, incomplete medication range and poor hospital environment. Grassroots medical and health institutions, as a vital part of urban community service systems, are the frontline defence for public health.³³ This study suggests that grassroots hospitals should enhance their learning of advanced medical technologies and strengthen cooperation with provincial and municipal hospitals, thereby improving the capabilities and standards of grassroots medical and health services. Moreover, strengthening communication and exchanges with patients, understanding their diseases and psychological needs, can enhance the soft power of grassroots hospitals.

Strengths and Limitations

This study is the first one to explore the health-seeking behaviour of diabetic patients from the perspective of their decision-making experience. It has identified the significant challenges and facilitating factors that elderly diabetic patients encounter in dealing with the threats brought by diabetes and its complications. Although this study employed purposive sampling method to capture the diversity of viewpoints as much as possible, our sample size is rather small and thus not representative. Additionally, participants in this study were asked to recall past experiences in making decisions on health-seeking behaviour, which may be subject to recall bias.

Conclusion

This study adopted the phenomenological research method to deeply explore the inner experience of health-seeking behavioural decision-making of elderly diabetic patients. Through in-depth analysis and refinement of the data, four themes emerged: ‘lack of disease risk perception and negative coping styles’, ‘huge medical and economic burden’, ‘lack of family and social support’ and ‘Dissatisfaction with medical services’. Therefore, medical staff should actively formulate and implement targeted intervention measures to improve the health-seeking behavioural decision-making ability level of diabetic patients. Meanwhile, policymakers should also formulate targeted medical and health service policies based on the needs and expectations of patients.

We would like to thank the participants diagnosed with diabetes for sharing their experience in health-seeking behavioural decision-making.

Data availability statement

Data are available upon reasonable request. No data are available.

Ethics statements

Patient consent for publication

Not applicable.

Ethics approval

This study involves human participants. This study obtained the consent of the ethics committee of Daqing campus of Harbin Medical University (Number: HMUDQ20230418001), and written informed consent was obtained from each participant. Participants gave informed consent to participate in the study before taking part.

Footnote

X @[email protected]

QHD and JHY contributed equally.

Contributors QHD and JHY contributed to the study design, conducted the interviews, analysed the data and led the drafting of the manuscript. ZCZ and SBL contributed to the study design, data analysis and drafting of the manuscript. YQL, YML and YY contributed to the production of the interview outline and forms. HHJ accepts full responsibility for the conduct of the study, had access to the data and controlled the decision to publish. All authors discussed the results and contributed to the final manuscript. Guarantor: HHJ is the guarantor.

Funding This work was financially sponsored by the 2022 Humanities and Social Science Research Planning Fund of the Ministry of Education (Nos: 22YJAZH035).

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

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