Sosyal Bilimler ve Sağlık Bülteni

Özgün Makale

No. 17 (2026)

Living with Diabetes and Cardiovascular Diseases: A Qualitative Study on Unmet Needs and the Phenomenon of “Doctor Shopping”

Submitted
February 23, 2026
Published
2026-03-11

Abstract

Objective: The aim of this study is to understand the experiences of patients with Cardiovascular Disease (CVD) and Diabetes Mellitus (DM) in Turkey when receiving healthcare services.

Method: This phenomenological and qualitative study is based was a part of a larger European Commission (EC)-funded project, Mediterranean Studies of Cardiovascular disease and Hyperglycaemia: Analytical Modelling of Population Socio-economic transitions (MedCHAMPS, 2009-13). Data were collected in four clinics selected in Istanbul and Izmir. During the data collection process, in-depth interviews were conducted with 20 patients, 11 relatives of patients, and 8 healthcare providers.

Findings: Two interrelated main themes emerged in this study. The first concerns expectations regarding the quality of services. The second is the phenomenon of “doctor shopping,” expressing a continuous search for higher-quality care. Additionally, perceptions about the causes of the diseases were identified as a prominent theme.

Conclusion: At the level of healthcare delivery, the system in Türkiye does not sufficiently meet the multidimensional needs of individuals with CVD-DM. In terms of continuity of care, there is a need for initiatives that strengthen primary care and support it with a referral chain.

References

  1. Abel T, Tadesse L, Frahsa A, Sakarya S. (2023) Integrating Patient-reported Experience (PRE) in a multistage approach to study access to health services for women with chronic illness and migration experience. Health Expect. 2023 Feb;26(1):237-244. doi: 10.1111/hex.13649. Epub 2022 Nov 23. PMID: 36416363; PMCID: PMC9854289.
  2. Akman M, Sakarya S, Sargın M, Ünlüoğlu İ, Eğici MT, Boerma WG, Schäfer WL. (2017) Changes in primary care provision in Turkey: A comparison of 1993 and 2012. Health Policy. 2017;121:197-206
  3. Arakelyan S, Jailobaeva K, Dakessian A, Diaconu K, Caperon L, et al. (2021) The role of trust in health-seeking for non-communicable disease services in fragile contexts: A cross-country comparative study. Soc Sci Med. 2021 Dec:291:114473. doi: 10.1016/j.socscimed.2021.114473. Epub 2021 Oct 9.
  4. Bowman S, Unwin N, Critchley J, Capewell S, Husseini A, Maziak W, et al. (2012) Use of evidence to support healthy public policy: a policy effectiveness–feasibility loop. Bull World Health Organ. 2012; 90:847-53.
  5. Campbell R, Pound P, Pope C, Britten N, Pill R, Morgan M, et al. (2003) Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care. Soc Sci Med. 2003;56: 671-84.
  6. Curry LA, Nembhard IM, Bradley EH. (2009) Qualitative and Mixed Methods Provide Unique Contributions to Outcomes Research. Circulation. 2009; 119:1442-52.
  7. De-Graft Aikins A. (2005) Healer-shopping in Africa: new evidence from a rural-urban qualitative study of Ghanaian diabetes experiences. BMJ. 2005; 331:737-43.
  8. Ebrahim S, Pearce N, Smeeth L, Casas JP, Jaffar S, Piot P. (2013) Tackling Non-Communicable Diseases In Low- and Middle-Income Countries: Is the Evidence from High-Income Countries All We Need? PLoS Med. 2013; 10: e1001377.
  9. EPF (2017) The need for patients’ perspective to face chronic diseases. European Patients Forum (EPF). http://www.eu-patient.eu/News/News-Archive/The-need-for-patients-perspective-to-face-chronic-diseases/. (ulaşılma tarihi 09.02.2017)
  10. Eser S. (2025) Türkiye’de Bulaşıcı Olmayan Hastalıklar Alanında Geleceğe Yönelik Değerlendirme. Türkiye Sağlık Raporu 2025 içinde (ed:Kılıç, Ayoğlu, Çamur). Cilt:2, s:703-704. HASUDER, Ankara 2025.
  11. Faxelid E, Ahlberg BM, Ndulo J, Krantz I. (1998) Health-seeking behaviour of patients with sexually transmitted diseases in Zambia. East Afr Med J. 1998 Apr;75(4):232-6.
  12. Health Quality Ontario (2013). An Evidence-Based Analysis. Continuity of Care to Optimize Chronic Disease Management in the Community Setting. Ont Health Technol Assess Ser. 2013; 13: 1–41.
  13. Kılıç B. (2025) Türkiye’de 2020-25 Döneminde Uygulanan Sağlık Politikalarının Analizi. Kılıç, Çamur, Ayoğlu (Ed.) Türkiye Sağlık Raporu 2025 içinde (s:3-24). HASUDER Yayınları, 1180 Sayfa, Nobel Yayınevi, e-ISBN: 978-625-93709-1-0. Ankara, 2025.
  14. Kilic B, Kalaca S, Unal B, Phillimore P, Zaman S. (2015) Health policy analysis for prevention and control of cardiovascular diseases and diabetes mellitus in Turkey. Int J Public Health. 2015; 60 Suppl 1:47-53.
  15. Maziak W, Critchley J, Zaman S, Unwin N, Capewell S, Bennett K, et al. (2013) Mediterranean studies of cardiovascular disease and hyperglycaemia: analytical modelling of population socio-economic transitions (MedCHAMPS): rationale and methods. Int J Public Health 2013; 58:547-53.
  16. Phillimore P, Zaman S, Ahmad B, Shoaibi A, Khatib R, Husseini A, et al. (2013) Health system challenges of cardiovascular disease and diabetes in four Eastern Mediterranean countries. Glob Public Health. 2013; 8: 875-89.
  17. Renedo A, Marston C. (2015) Developing patient-centred care: an ethnographic study of patient perceptions and influence on quality improvement. BMC Health Serv Res. 2015. 15:122
  18. Röing M, Sanner M. (2015) A meta-ethnographic synthesis on phenomenographic studies of patients’ experiences of chronic illness. Int J Qualitative Stud Health Well-being. 2015; 10: 262-79.
  19. Şimşek MNÜ, Ünal B. (2025) Türkiye’de Kalp Damar Hastalıkları. Türkiye Sağlık Raporu 2025 içinde (ed:Kılıç, Ayoğlu, Çamur). Cilt:2, s:621-628. HASUDER, Ankara 2025.
  20. The Ministry of Health of Türkiye (2025) Health Statistics Yearbook 2024. Republic of Türkiye Ministry of Health General Directorate of Health Information Systems, 2025
  21. Uddin F, Molyneux S, Murava K, Jemutai J, Berkley JA, Wallson JL et al. (2022) Treatment-seeking and recovery among young undernourished children post-hospital discharge in Bangladesh: A qualitative study. PLoS One, 2022 Sep 23;17(9):e0274996.
  22. Unal B, Ergor G. eds. (2017) Chronic Diseases and Risk Factors Survey in Turkey. Ministry of Health, Turkey, Publication No: 909. http://sbu.saglik.gov.tr/Ekutuphane/kitaplar/khrfai.pdf (ulaşılma tarihi 09.02.2017).
  23. Yardim N, Erkoc Y. eds. (2011) Policies for Tackling Non-Communicable Diseases and Risk Factors in Turkey. Republic of Turkey Ministry of Health, Directorate General Primary Health Care. Ministry of Health Publication No: 809. Ankara, 2011. http://halksagligiokulu.org/anasayfa/components/com_booklibrary/ebooks/1.pdf (ulaşılma tarihi 09.02.2017)
  24. WHO (2006) Quality of care. A process for making strategic choices in health systems. World Health Organization (WHO), 2006. http://www.who.int/management/quality/assurance/QualityCare_B.Def.pdf?ua=1 (ulaşılma tarihi 09.02.2017)