In search of patient-centred care in middle income countries: The experience of diabetes care in the former Soviet Union

Charlotte Kühlbrandt, Dina Balabanova, Ivdity Chikovani, Varduhi Petrosyan, Kseniya Kizilova, Oksana Ivaniuto, Olga Danii, Noune Makarova, Martin McKee

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

10 Citations (Scopus)


In this study we apply the principles of patient-centred care to assess how health systems in middle income countries shape the experiences of patients with a common chronic disease and their care providers. We conducted semi-structured interviews with patients with diabetes, health professionals and key informants. We selected interviewees by purposive and snowball sampling. In total 340 respondents were interviewed in five countries: Armenia, Belarus, Moldova, Russia and Ukraine. Data were analysed according to a coding framework that was developed by three researchers, who then uncovered salient themes, similarities and differences between the five countries. Access to and consistent use of services was hampered by the lack of coordination and the financial weaknesses in the health systems. In many cases, lack of external support for individual patients left friends and family as the main providers of support. Patients were not expected to have a say or challenge the decisions concerning their treatment. Our study suggests the need for a radically different way of delivering care for people with diabetes and, by extension, other chronic diseases. Reforms should focus on improving self-management, the coordination of care, involving patients in decisions about their care, and providing emotional and practical support for patients.
Original languageEnglish
Title of host publicationHealth Policy
PublisherElsevier Ireland Ltd
Number of pages8
ISBN (Print)0168-8510
Publication statusPublished - 1 Nov 2014

Publication series

NameHealth Policy


  • Access to care
  • Chronic illness
  • Diabetes
  • Former Soviet Union
  • Health system research
  • Patient-centred care
  • Quality of care


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