Self-management and its associated factors among people living with diabetes in Blantyre, Malawi: a cross-sectional study

Adamson S Muula ,Moffat Nyirenda ,Belinda T. Gombachika ,Chimwemwe Banda

doi:10.12688/aasopenres.12992.2

Abstract

Background: Self-management is key to the control of glycaemia and prevention of complications in people with diabetes. Many people with diabetes in Malawi have poorly controlled glucose and they experience diabetes-related complications. This study aimed to assess diabetes self-management behaviours and to identify factors associated with it among people with diabetes at Queen Elizabeth Central Hospital, Blantyre, Malawi. Methods: This cross-sectional study recruited 510 adults attending a diabetes clinic at a teaching referral hospital in southern Malawi. The social cognitive theory was applied to identify factors associated with following all recommended self-management behaviours. Data on participants’ demographics, clinical history, diabetes knowledge, self-efficacy, outcome expectations, social support, environmental barriers and diabetes self-management were collected. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with following all self-management behaviours. Results: The mean age of participants was 53.6 (SD 13.3) years. The majority (82%) were females. Self-reported medication adherence within the last seven days was 88.6%; 77% reported being physically active for at least 30 minutes on more than three days in the previous seven days; 69% reported checking their feet every day and inspecting inside their shoes; 58% reported following a healthy diet regularly. Only 33% reported following all the self-management behaviours regularly. Multiple logistic regression analysis showed that self-efficacy was the only social cognitive factor associated with following all the self-management practices (p < 0.001). Conclusions: Participants in our study were not consistently achieving all self-management practices with dietary practices being the least adhered to behaviour by many. To improve self-management practices of people with diabetes, current health education programs should not only aim at improving diabetes related knowledge but also self-efficacy. Adopting interventions that promote self-efficacy in diabetes patients such as exposure to role models, peer education, providing positive feedback, and counselling is recommended.

Highlights

Diabetes mellitus significantly contributes to morbidity and mortality from non-communicable diseases in Malawi[1]
Participant questionnaire responses The median knowledge score on the diabetes knowledge questionnaire was 14 (IQR 12–16) with lowest knowledge scores being on causes of diabetes, importance of diet and exercising and recognition of hypoglycemia or hyperglycemia
The findings of this study show that people living with diabetes attending Queen Elizabeth Central Hospital (QECH) diabetes clinic were not consistently following all the recommended self-management practices

Summary

Introduction

Diabetes mellitus significantly contributes to morbidity and mortality from non-communicable diseases in Malawi[1]. A previous survey at QECH by Cohen et al, conducted 10 years before the present study found that 74% of people living with diabetes had poorly controlled sugar levels and many suffered from diabetes related complications[3]. This previous survey found that 45% of patients living with diabetes had poor dietary practices. This study aimed to assess diabetes self-management behaviours and to identify factors associated with it among people with diabetes at Queen Elizabeth Central Hospital, Blantyre, Malawi.

Objectives

Methods

Results

Discussion

Conclusion