Three focus groups of eighteen primary care providers were performed to assess providers’ perceived barriers to educating patients about CKD during routine clinical visits.
A convenience sample of participants was recruited between April and October 2009 from Baltimore, Maryland area practices in the United States (USA). Recruitment efforts were targeted at the Maryland Chapter of the American College of Physicians and the Johns Hopkins Community Physicians practice sites to identify primary care providers working in various settings (i.e. community and academic medical center affiliated clinics) and serving adult patient populations with diverse socioeconomic and demographic backgrounds. To be included in the study, participants had to
- be in active practice (at least 50% of the time) as a licensed primary care provider (e.g. internist, family physician, physician assistant, or nurse practitioner) who provided comprehensive, longitudinal care for patients and
- provide clinical care for patients with CKD in their practice.
Oral and/or written consent was obtained from all participants. The study protocol was approved by the Johns Hopkins Medicine Institutional Review Board, the institutional ethics committee.
The focus groups were conducted in April, May, and October 2009. Each participating primary care provider completed a self-administered questionnaire at the beginning of the session, which included questions to assess their personal demographic (e.g. age, gender, race) and their clinical practice characteristics (e.g. years in practice and primary care specialty). All focus group sessions were 90 minutes and were facilitated by a trained moderator using a discussion guide. To provide primary care providers with a common context for their discussions about CKD education, focus group sessions were initiated by presenting primary care providers with a hypothetical patient scenario developed by the authors describing a 60 year-old African American man presenting as a new patient. The hypothetical patient had poorly controlled hypertension and diabetes, elevated cholesterol, obesity, and laboratory values consistent with CKD (see ).
Text Box: Hypothetical Patient Scenario
After presenting the scenario, primary care providers were asked open-ended follow-up questions to identify their perceptions regarding the importance of educating their patients about CKD and their perceived barriers to educating patients similar to the hypothetical patient about CKD. Participants were asked:
- in the context of a routine follow-up visit, what medical conditions they would educate this patient about
- do they believe that their patients, similar to the one in the scenario, would be able to list CKD as a medical problem
- what are the barriers to educating a patient about CKD, like the patient in the scenario with diabetes and hypertension
- what items could be added to their clinic setting that would be helpful in educating their patients about CKD.
Providers were encouraged to participate freely in discussions, responding either to questions posed by the moderator or to questions or ideas posed by other focus group participants. As planned prior to beginning the study, data collection was continued until thematic saturation (i.e. no new themes identified among the group members) was achieved.
The focus group discussions were audio-taped and transcribed verbatim. The grounded theory approach was used for content analysis.(Strauss and Corbin, 1990
, Glaser and Strauss, 1967
) Using the constant comparative method, transcripts were independently reviewed by two study investigators to develop a coding scheme representing the relevant concepts addressed during the discussions. These concepts were further refined and categorised to develop a list of key themes regarding perceptions of barriers and attitudes towards educating patients about CKD. The two investigators arrived at a consensus on a final list of themes, and differences in interpretation of emergent themes were adjudicated by a third investigator. ATLAS.ti version 5.0. (ATLAS.ti GmbH, Berlin, Germany) was used for data management.