Abstract
BackgroundSelf-management of diabetes is associated with glycaemic control and adherence to medication and healthy lifestyle practices. There is lack of information on the barriers to and facilitators of diabetes self-management practices in low income country, Nepal. This study aimed to explore the barriers to and facilitators of Type 2 diabetes self-management practices taking multiple stakeholders’ perspectives in Nepal.MethodsFour focus group discussions and 16 semi-structured interviews with people with Type 2 diabetes, caregivers, health care providers and health managers were conducted from April to May 2018 in Rupandehi district of Western Nepal. They were audio-recorded, transcribed, and analysed using a thematic approach.ResultsFive main themes emerged that influenced diabetes self-management practices: individual factors, socio-cultural and economic factors, health system and policy factors, availability and accessibility of resources, and environmental factors. The important barriers were: lack of knowledge about diabetes self-management practices, cultural practices, insufficient counselling, lack of guidelines and protocols for counselling, and financial problems. The major facilitators were: motivation; support from family, peers, and doctors; and availability of resources in the community.ConclusionBased on our findings, a multilevel approach is needed to address these barriers and facilitators. These findings will help guide strategies to develop programs that impart knowledge and skills to improve the diabetes self-management practices of people with Type 2 diabetes.
Highlights
Self-management of diabetes is associated with glycaemic control and adherence to medication and healthy lifestyle practices
Our study only shows that people with diabetes feel responsible for self-management of the diabetes in daily basis; further studies should explore the complex relationship between diabetes responsibility and self-efficacy in relation to management of the diabetes in community-based settings
Community level factors Cultural values In line with existing literature [30, 60, 74] this study found that cultural practices that are a barrier to healthy dietary regimes include unhealthy food preparation styles, preferences for a carbohydrate diet, and festivals and social events at which food plays a significant cultural and social role, putting pressure on people with diabetes to abandon their healthy diet
Summary
Self-management of diabetes is associated with glycaemic control and adherence to medication and healthy lifestyle practices. There is lack of information on the barriers to and facilitators of diabetes selfmanagement practices in low income country, Nepal. This study aimed to explore the barriers to and facilitators of Type 2 diabetes self-management practices taking multiple stakeholders’ perspectives in Nepal. Diabetes prevalence has been increasing steadily over the past decades in the low and middle-income countries. 86.4 million people are living with Type 2 diabetes in South Asia alone in 2014 [2]. Despite the magnitude of the burden in Nepal, knowledge, attitude and practice of patients with Type 2 diabetes on the management of diabetes is poor [9, 10].
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