A Mixed Methods Study of Self-Care Behavior in Patients of Type 2 Diabetes Mellitus Availing Out-Patient Services in A Hilly Tribal Area of Ahmednagar District of Maharashtra in India

Abstract

Background: Management of Diabetes in tribal populations who have lower access to education and health care services poses unique challenges. Understanding patterns at local level will help implement comprehensive primary care services better. Objectives: To record self-care behaviors and identify barriers to self-care among tribal diabetics. Material and Methods: A triangulation (Quant + Qual) mixed-methods study was undertaken in 124 patients with type 2 Diabetes mellitus attending tribal health clinics in Bhandardara and Rajur in Akole taluka between April 2019 to April 2020. Socio-demographic profile, clinical history, Diabetes Self-Management Questionnaire (DSMQ) scores, and themes from Focus group discussion with patients were analyzed. Results: There was negative correlation between all domains of self-care with age. Being married correlated with better diet management (ρ= 0.344, p=0.001), physical activity (ρ= 0.184, p=0.04), and health service utilization (ρ= 0.274, p=0.002). Tobacco consumption was reported by 66.9% of patients and 74.49% of patients reported alcohol consumption. Presence of addictions showed negative correlation with all domains of self-care behaviors. Conclusion: Patients have led a relatively active lifestyle and are willing to comply with advice. Areas that need special attention are high prevalence of addictions, lack of foot care, lack of knowledge, depression & lack of supportive care. Family circumstances and socio-cultural factors need to be taken into account. Supportive care, family involvement in diet planning, improving health service utilization by addressing health beliefs, availability of time and money, competing priorities, perceived quality of care, and patient’s expectations from care providers. Efforts to improve community participation and inclusive care will foster confidence among patients to avail of services.