We had 1082 responses from a total of 1673 diabetic patients registered with 23 general practices who received a questionnaire, giving an overall response rate of 64.7%. Altogether, 1026 (94.6%) questionnaires were completed by the patient, 42 (3.9%) were completed by the patient's spouse or carer and 17 (1.6%) were completed by the patient's parent or guardian. We found a very similar age distribution for the male responders in our sample compared with the male population with diabetes in the QRESEARCH database, however there were slightly fewer very elderly patients among the female responders; 49% of the responders to the survey were female, compared with 46% of patients with diabetes in the QRESEARCH population.
Characteristics of male and female responders
shows the characteristics of male and female responders. There were no significant differences between males and females in terms of their current age, duration of diabetes, treatment group, ethnicity or employment status. Fewer women had use of a car or a van than men (57.1 versus 77.1%; difference = −20.0%; 95% CI = −27.6 to −12.3%; P<0.001), and more women lived alone compared with men (33.5 versus 15.3%; difference = 18.2%; 95% CI = 14.1 to 22.3%; P<0.001).
Characteristics of male and female responders.
Access to health professionals
shows reported access to healthcare professionals in the previous 12 months. Overall, 76.5% of patients reported having talked to their GP about their diabetes, 75.0% to their practice nurse, 57.1% to an optician, 42.4% to a chiropodist and 26.5% to a dietician. Eighty-six per cent of patients found it easy to get through to their surgery by telephone, and 80.8% of patients were able to book routine appointments at a convenient time. Two-thirds of patients thought their surgery would fit them in for an urgent appointment on the same day.
Access to primary care health professionals.
However, compared to men, women were less likely to report that they had talked to their GP (age- and practice-adjusted OR = 0.67; 95% CI = 0.53 to 0.84) or practice nurse (age- and practice-adjusted OR = 0.67; 95% CI = 0.50 to 0.89) about their diabetes in the previous 12 months. Women were less likely to report that they were able to book a routine appointment at a time convenient for them (age- and practice-adjusted OR = 0.47; 95% CI = 0.30 to 0.74). These findings remained significant when adjusted for three sociodemographic variables (living alone, unemployment, access to a car or van) and similar ORs and 95% CIs were produced.
Women were slightly more likely to report always or sometimes having problems understanding what the doctor or nurse said to them (age- and practice-adjusted OR = 1.42; 95% CI = 1.04 to 1.93), but this was not statistically significant at P<0.01.
Getting to the GP's surgery
Overall, 39% of patients reported difficulty in visiting the doctor for diabetes care. The most common reason was the long walk to the surgery, cited by 21.0% of patients (227 of 1082). Difficulties in getting time off work, being afraid to go out alone, feeling too ill and lack of buses were cited by 5–6% of all patients.
As shows, women were more likely to report difficulties in physically getting to the GP's surgery (age- and practice-adjusted OR = 1.52; 95% CI = 1.19 to 1.94). Women were more likely to be afraid to go out alone (age- and practice-adjusted OR = 2.24. 95% CI = 1.26 to 3.99) and to report being housebound (age- and practice-adjusted OR = 3.09, 95% CI = 1.51 to 6.43). These findings remained significant when adjusted for the three sociodemographic variables (living alone, unemployment, access to a car or van).
Reasons for difficulties visiting doctor for diabetes care.
Access to routine care
In terms of routine check ups in the previous 12 months, 71.7% of all patients recalled receiving dietary advice, 51.0% recalled receiving advice about exercise, 78.4% reported that they had an eye examination, 80.9% had their feet examined, and 95.0% reported a blood pressure measurement ().
Access to diabetes checkups in the last 12 months.
There were no significant differences for these factors between men and women, although women were slightly less likely than men to report that they had had their feet examined (age-adjusted OR = 0.66; 95% CI = 0.44 to 0.99), but this was not statistically significant at P<0.01.
Diabetes health profile
The number of valid scores (that is, every question in a domain answered) was at least 89% for each domain. Assessment of Cronbach's α for the entire patient group gave satisfactory values of 0.84 for psychological distress, 0.76 for barriers to activity, and 0.81 for disinhibited eating. These compare favourably with the scores given in the validation of the DHP-18.
In terms of our main study comparison, we found that women had significantly higher scores on the DHP for eating problems (women: median = 6, interquartile range [IQR] = 3–8; men: median = 5, IQR = 3–7; P = 0.003) and barriers to physical activity (women: median 4, IQR = 2–7; men: median = 4, IQR = 1–6; P = 0.001), but no difference for psychological distress (women: median = 3, IQR = 1–5; men: median = 3, IQR = 1,6; P = 0.60). These differences remained significant in linear regression analysis adjusting for age-band and three sociodemographic variables (living alone, unemployment, access to a car or van), with allowance for clustering by practice.