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A Journey Map of Health Behaviour Decision-Making Among Patients with Type 2 Diabetes Mellitus Who are Repeatedly Hospitalized: A Longitudinal Qualitative Study

Year: 2026

Type: article

Abstract: Background: Health behaviour decision-making is central to type 2 diabetes mellitus management, but remains complex and context dependent after repeated hospitalisations. Research has focused on health behaviours and associated factors, overlooking patient-centred decision-making across care stages and limiting stage-specific decision support and continuity-of-care strategies. Methods: A longitudinal qualitative study was conducted in mainland China, with data collected from October 2025 to March 2026. 16 patients with type 2 diabetes mellitus who had experienced repeated hospitalisations were included and participated in repeated semi-structured interviews across three stages: pre-admission (T1), hospitalisation (T2), and home management (T3). Interviews were conducted on the second day of hospitalisation, one day before discharge, and three months after discharge. The interviews explored decision-making behaviours, support needs, emotional experiences, and pain points. Longitudinal analysis involved within-participant comparison across the three care stages, followed by cross-case synthesis to identify recurrent and divergent patterns of change. The findings were then integrated into a time-based visual journey map of health behaviour decision-making. Results: Four stage-specific trajectories were synthesised from the longitudinal interview data within four dimensions initially identified through preliminary patient observations: (1) behavioural transition from preference-driven care-seeking decisions to structured treatment adherence and fragile self-management; (2) evolving support needs from seeking trusted decision anchors to seeking structured empowerment and transition preparation, and finally to seeking continuous and accessible out-of-hospital support; (3) emotional evolution from self-blame after initially neglecting the illness, to fragile stability, and ultimately to acceptance and coexistence with the disease under long-term burden; and (4) phase-specifc pain points, including decision-making impeded by multiple information dilemmas before admission, insufficient motivation for sustained self-management during hospitalisation, and support discontinuity with practical burdens during home management. Conclusion: This study extends the application of patient journey mapping to understanding health behaviour decision-making among patients with T2DM who experience repeated hospitalisations. By identifying critical disruptions in decision-making, unmet needs, and barriers to sustained management, the journey map offers actionable insights for designing stage-specific, patient-centred decision-support and continuity-of-care interventions, with particular relevance to nurse-led clinical practice.

Source: Journal of Multidisciplinary Healthcare

DOI: 10.2147/jmdh.s646999