Diabetes Self-management Practices Research Articles

Exploring type 2 diabetes self-management practices in rural Bangladesh: facilitators, barriers and expectations—a qualitative study protocol

BackgroundType 2 diabetes mellitus (T2DM) is a global public health crisis impacting low-income and middle-income countries such as Bangladesh. While self-management is encouraged for individuals with T2DM, there is a...

Diabetes self-management by Kenyan adults: Utilising the adapted Kawa River model

The outcome of diabetes management depends on diabetes self-management practices, in which factors assisting or hindering self-care play an essential role. This study identified enablers and barriers to diabetes self-management in adults diagnosed with diabetes in Kenya. The adapted Kawa River model was applied to collect data during semi-structured group discussions (n = 6). Adults (n = 32) diagnosed with diabetes at two geographically distinct county hospitals were purposively selected. The integrated model of behaviour prediction formed the theoretical platform of the study, and data were deductively analysed according to the distal variables in the model. Thematic analysis identified specific categories as enablers and barriers to diabetes self-management. The duplicated categories are economic determinants, dietary factors, support networks, and emotional influences. Health and physical status were identified as additional barriers to diabetes self-management. Findings may be more widely applicable than the context of the presented study. Self-management in diabetes care plays a crucial role, more so due to the worldwide increase in the prevalence of diabetes.

Self Management among Diabetes Patients

Background: In the management of diabetes mellitus, the role of self-care has been pivotal. Individuals with diabetes have been shown to make a dramatic impact on the progression and development of disease by participating in their care.This study aimed to assess self-management among diabetes patients.
 Materials and Methods: Analytical cross-sectional study was conducted among 232 patients with diabetes selected by convenience sampling. Diabetes Self Management Questionnaire-Revised was used to assess self-management among diabetes patients. Data were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (bivariate logistic regression).
 Results: Findings of the study revealed that out of 232 respondents, 48.7% had suboptimal diabetes self-management practices. The global score for diabetes self-management was 5.28± 1.34 The mean score for subscale cooperation with the diabetes team was highest i.e., 7.50± 1.94 followed by medication taking subscale (6.94±3.14), physical activity subscale (5.37± 3.09), eating behavior subscale (5.35±1.71) and glucose monitoring subscale (0.83± 2.19) respectively. The results further indicated a significant association between diabetes self-management and religion, type of diabetes medication, glycemic control, and diabetes complications at p<0.05.
 Conclusion: The present study showed that almost half of the respondents had suboptimal diabetes self-management. Therefore, healthcare providers should further design and implement interventions to improve self-management behavior among diabetes patients

Diabetes Self-Management Practices among Diabetic Patients Attending Chitwan Medical College Teaching Hospital

Introduction: Diabetes is a new health issue that affects many people around the world. The majority of the diabetic population lives in low-and middle-income countries. Diabetes has badly affected individuals, families, and countries. This problem can be minimized and managed through effective self-management practices. Objective: The present study aims to identify the level of self-management practices among type 2 diabetes mellitus patients. Methods: A descriptive and analytical cross-sectional study design was used to assess diabetes self-management practices. A standard ‘Summary of Diabetes Self-Care Activity’ tool was adopted with few modifications after pretesting. This study was carried out among 191 samples with diabetes type-2 patients attending the outpatient department of Chitwan Medical College Teaching Hospital. The non-probability consecutive sampling method was adopted for data collection. Ethical principles were addressed during the study. Results: Among the total participants, 51.8% had unsatisfactory diabetes self-management practices. Age, education, place of residence, religion, occupation, family history, comorbidity, duration of diagnosis, alcohol drinking, and smoking were associated with diabetes self-management practice. There were 55.5% male participants. The majority, 42.4% belonged to the age group 60 and above. The minimum age was 30, the maximum age was 94, and the mean age was 56.9 years. The majority (77%) of participants were literate. Conclusions: This study revealed an unsatisfactory level of diabetes self-management practices. This finding implies that diabetes self- management practice-related education programs should be created and implemented for people who are impacted, as well as for those who provide care at home.

Understanding Diabetes Self-Management Among Vietnamese Americans: A Focused Ethnography.

The Vietnamese American (VA) population is projected to grow to 3.9 million by 2030. This demographic shift could affect health care cost as VAs have greater susceptibility for type 2 diabetes mellitus (T2DM). Few studies have explored diabetes self-management (DSM) among VAs. The aim of this study was to explore and describe how VAs with T2DM perceive diabetes and DSM practices. A focused ethnographic design, using semi-structured interviews and participant observation, was used to understand DSM among VAs. The following four themes emerged: (a) defining diabetes and its etiology, (b) body awareness as a way of managing diabetes, (c) maintaining strength after being diagnosed with diabetes, and (d) navigating sources of information regarding diabetes. The study findings suggest that DSM is a complex and recursive process, with integrations of cultural practices and influences from the environment. These findings can help the development of culturally tailored interventions to assist with DSM.

Knowledge and Practices of Patients Regarding Diabetes Self-Management: A Mixed Method Approach

Diabetes Mellitus is a major source of death globally and has shaken middle-income and low-income countries including Pakistan. Objective: To determine diabetes knowledge, and explore the patient’s experiences of type-ii diabetes along with its self-management. Methods: A mixed-method design was used to carry out this study at a tertiary care hospital in KP Pakistan from April to September 2021. Information on patients’ demographic characteristics, diabetes knowledge, and diabetes self-practices, patients’ lived experiences of diabetes self-practices, and barriers to self-care activities were collected. Data were collected through a structured questionnaire and in-depth (IDIs) interviews for measuring diabetes knowledge, and its management. Results: Out of 215 recruited participants, the majority 90% had inadequate knowledge (score=0-4). 3.2% (n=07) had average knowledge (score=5-8) of diabetes, and its self-management. 60% of the participants were from the age group 50-59 years. 70% (n=151) of participants were from poor socioeconomic classes. The results showed an association between illiteracy, poverty, diabetes knowledge, and self-management (p-Value 0.001). The qualitative results expressed that the illiterate and low socioeconomic participants had inadequate diabetes self-management practices. Conclusions: The study inferred that the participants, who had inadequate knowledge about type-II diabetes and its management, were having poor self-care practices of diabetes.

'The solution is we need to have a centre': a study on diabetes in Liberia.

In Liberia, one of the poorest nations in sub-Saharan Africa, the burden of diabetes is a growing concern. The high mortality and morbidity associated with diabetes have significant implications for individuals, families and society at large. The aim of this critical hermeneutic study was to explore what it is like to live with diabetes in Liberia. We recruited 10 participants from Monrovia, Liberia to partake in this study. Photovoice, a well-established participatory data collection approach was used to gather images and stories that represented participants' everyday experiences of living with diabetes. Three major themes were uncovered, highlighting the strengths, challenges and solutions related to living with diabetes in Liberia: strengths-engagement in diabetes self-management practices, focused on participants' commitment to engage in diabetes self-management practices despite the socioeconomic challenges they experienced; challenges-lack of social and economic support, focused on limited access to food, diabetes medications and supplies and diabetes education; and solutions-centre for diabetes education, care and support, focused on participants' recommendations for a community-based diabetes centre, a single point of access for meeting the needs of people with diabetes. A strong commitment to prioritize diabetes on Liberia's national health agenda and increased resources for diabetes care is needed to address the challenges experienced by people living with this chronic disease in Liberia.

Peer Support Self-Management Intervention for Individuals With Type 2 Diabetes in Rural Primary Care Settings: Protocol for a Mixed Methods Study.

The increasing prevalence of diabetes is placing important demands on the Chinese health care system. Providing self-management programs to the fast-growing number of people with diabetes presents an urgent need in rural primary care settings in China. Peer support has demonstrated effectiveness in improving self-management for individuals with diabetes in urban communities in China. A priority then becomes developing and evaluating a peer support program in primary care settings in rural communities of China and determining whether it is feasible and acceptable. The aims of this study are (1) to evaluate the feasibility and acceptability of a peer support approach to type 2 diabetes self-management in rural primary care settings; (2) to identify enabler and facilitator factors likely to influence the peer support implementation; (3) to provide primary data and evidence for developing a version of the program suitable for a randomized controlled trial in rural primary care settings. Three townships will be sampled from 3 different counties of Anhui province as the study setting. Participants will be recruited based on these counties' local primary care health record system. The peer supporters will be recruited from among the participants. The peer support program will be led by peer supporters who have completed 12 hours of training. It will be guided by primary care providers. The program will include biweekly meetings over 3 months with varied peer support contacts between meetings to encourage the implementation of diabetes self-management. Mixed methods will be used for evaluation. Qualitative methods will be used to collect information from health care system professionals, individuals with diabetes, and peer supporters. Quantitative methods will be used to collect baseline data and data at the end of the 3-month intervention regarding psychosocial factors and self-management practices. The results will include (1) quantitative baseline data that will characterize type 2 diabetes self-management practices of individuals with diabetes; (2) qualitative data that will identify enablers of and barriers to self-management practices for individuals with type 2 diabetes in rural communities; (3) both qualitative and quantitative evaluation data, after the 3-month intervention, to demonstrate the feasibility and acceptability of the peer support approach for individuals with type 2 diabetes. Our findings will inform the design of a tailored intervention program to improve self-management among individuals with type 2 diabetes in rural primary care settings. If we find that the peer support approach is feasible and acceptable, we will develop a larger randomized controlled trial to evaluate effectiveness in multiple rural settings in the province. PRR1-10.2196/47822.

Self-Management of Diabetes and Associated Factors among Patients Seeking Chronic Care in Tshwane, South Africa: A Facility-Based Study.

The burden of diabetes continues to increase in South Africa and a significant number of diabetes patients present at public primary healthcare facilities with uncontrolled glucose. We conducted a facility-based cross-sectional study to determine the diabetes self-management practices and associated factors among out-patients in Tshwane, South Africa. An adapted validated questionnaire was used to collect data on sociodemography, diabetes knowledge, and summaries of diabetes self-management activities measured in the previous seven days, and over the last eight weeks. Data were analysed using STATA 17. A final sample of 402 diabetes out-patients was obtained (mean age: 43 ± 12 years) and over half of them were living in poor households. The mean total diabetes self-management of score was 41.5 ± 8.2, with a range of 21 to 71. Almost two thirds of patients had average self-management of diabetes, and 55% had average diabetes knowledge. Twenty-two percent of patients had uncontrolled glucose, hypertension (24%) was the common comorbidity, and diabetic neuropathy (22%) was the most common complication. Sex [male: AOR = 0.55, 95% CI: 0.34-0.90], race [Coloured: AOR = 2.84, 95% CI: 1.69-4.77 and White: AOR = 3.84, 95% CI: 1.46-10.1], marital status [divorced: AOR = 3.41, 95% CI: 1.13-10.29], social support [average: AOR = 2.51, 95% CI: 1.05-6.00 and good: AOR = 4.49, 95% CI: 1.61-7.57], body mass index [obesity: AOR = 0.31, 95% CI: 0.10-0.95], diabetes knowledge [average: AOR = 0.58, 95% CI: 0.33-0.10 and good: AOR = 1.86, 95% CI: 0.71-4.91], and uncontrolled glucose [AOR = 2.97, 95% CI: 1.47-5.98] were factors independently predictive of diabetes self-management. This study emphasizes that the self-management of diabetes was mostly on average among patients and was associated with the aforementioned factors. Innovative approaches are perhaps needed to make diabetes education more effective. Face-to-face sessions delivered generally during clinic visits should be better tailored to the individual circumstances of diabetes patients. Considerations should be given to the options of leveraging information technology to ensure the continuity of diabetes education beyond clinic visits. Additional effort is also needed to meet the self-care needs of all patients.

Self-Determination Theory and Quality of Life of Adults with Diabetes: A Scoping Review.

Diabetes is one of the leading causes of sickness, death, and decreased quality of life globally. The prevalence of diabetes keeps rising globally due to lifestyle changes and urbanization. Therefore, improved quality of life (QoL) and appropriate diabetes self-management practices, including treatment adherence, are crucial to improving and sustaining the health of diabetic patients. Some studies have adopted the self-determination theory (SDT) to study diabetes interventions, but less is known about its effectiveness in improving QoL, treatment adherence, and diabetes self-management. Aim/Objective. This review assessed the effectiveness of SDT in improving self-management practices, treatment adherence, and QoL among adult diabetic patients. We followed the six-stage framework by Arksey and O'Malley in conducting the review. PubMed, JSTOR, Central, and ScienceDirect databases were searched for published articles from January 2011 to October 2021 using keywords and Boolean logic. Furthermore, we screened a reference list of related articles. Also, Google Scholar, Z-library, and web-based searches were carried out to retrieve other relevant evidence that applied SDT in improving QoL, diabetes self-management, and treatment adherence. Findings. Fifteen studies met the inclusion criteria, from which data were extracted as findings. SDT effectively improved QoL, diabetes treatment adherence, and diabetes self-management among diabetic patients. Of these studies, 11 provided data on SDT and diabetes self-management and affirmed the effectiveness of the theory in improving appropriate diabetes self-management practices. Two studies confirmed the effectiveness of SDT in improving treatment adherence. SDT and QoL were assessed in 4 of the studies, which demonstrated the effectiveness of SDT in enhancing the QoL of diabetic patients. SDT effectively improved QoL, diabetes treatment adherence, and diabetes self-management. The application of SDT in diabetes management will improve the health and QoL of diabetic patients. Hence, diabetes management interventions could adopt SDT to guide treatment.

Social Support in Relation to Self-Management Behaviors Among Diabetic Individuals of Poblacion II, Tagbilaran City, Bohol

This study delves into the relationship between social support and self-management behaviors among diabetic individuals in Poblacion II, Tagbilaran City, Bohol. Employing a descriptive correlational survey design and a stratified sampling method, 48 respondents were selected, revealing that a majority were middle to older adults, married, and residing below the official poverty threshold. Hypertension emerged as the predominant comorbidity, affecting 75% of respondents. Examining social support dimensions, the study found a moderate level across most aspects, except for smoking, which displayed lower support. Remarkably, the overall self-management level among respondents was very good. Significant relationships were identified between social support and self-management practices, particularly concerning Alcoholism/Drug Addiction, Obesity, and Stroke. The study rejects the null hypothesis, establishing a significant correlation (p-value – 0.001) between social support and diabetes self-management practices. Recommendations include tailored assessments considering comorbidities, emphasizing newly adopted practices, and implementing targeted programs like teleconsultations and a "buddy system" for specific demographics. This research contributes valuable insights for healthcare professionals and policymakers, urging a holistic approach to diabetes management that integrates social support dynamics.

Barriers and facilitators in dietary and physical activity management of type 2 diabetes: Perspective of healthcare providers and patients

Background and aimsType 2 diabetes (T2DM) is a chronic disease that requires continuous management and daily self-care activities. The purpose of the study was to identify the barriers and facilitators in dietary and physical activity management of T2DM by patients. MethodTwo focus group discussions with patients with T2DM (n = 12) and interviews with healthcare providers (HCPs, n = 15) were done, to identify the barriers and facilitators experienced by patients towards lifestyle management in T2DM. Data were analyzed using qualitative data analysis software Atlas ti. version 8. ResultThree major themes were identified as barriers and facilitators viz., Personal barriers and facilitators, social barriers and facilitators, and barriers and facilitators related to the healthcare provider. Major barriers were denial of illness, low level of knowledge of the disease, excess use of gadgets, poor infrastructure, gender issues, and lack of time. Major facilitators identified were patient education and motivation, continuous counseling and regular follow-up, family and peer support, and recreational and indoor activities. ConclusionBased on the findings of the study, a multifaceted approach is required to address these barriers and facilitators. These findings will help in developing novel intervention strategies and making policy-level changes, which are required to improve diabetes self-management practices in people with T2DM.

A cross-sectional study on the association between varied social support modalities and glycemic levels amongst diabetic patients residing in Machakos County, Kenya.

diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. While there's increasing evidence that social support from caregivers improves health outcomes in chronic illness management, the potential associations of the different types of social support and glycemic control among Type II diabetes clients have largely been ignored in Kenya. This cross-sectional study sought to establish the association between tangible, emotional, and informational social support and glycemic levels among clients diagnosed with Type II diabetes in Machakos County, Kenya. semi-structured interviews were conducted with 726 randomly selected Type II diabetes clients enrolled in diabetes care and treatment programs in government-owned public health facilities in Masinga and Matungulu sub-counties, Machakos, Kenya. Descriptive statistics and multinomial logistic regression were conducted to elucidate any associations. seventy-three percent (73%) of the respondents were female, and 27% were male, with the majority (77.9%) being above 50 years and having lived with diabetes for over 3 years (61.5%). Opportunities for social support existed, with 62% of the respondents living with more than 2 persons above 18 in their households. From the Random Blood Glucose test analysis, 38.9% of the clients had high glycemic levels, partly because the majority (66.9%) of the respondents did not practice good diabetes self-management practices at the time of the study. While all three types of social support were reported as provided, only 30.6% reported receiving adequate social support. An association was found between social support and glycemic levels with respondents receiving adequate informational- P<0.05, OR 1.92, emotional -P<0.05, OR 3.7, and tangible support -P<0.05, OR 4.1 more likely to have better glycemic control than those with inadequate support. clients receiving adequate informational, emotional, and tangible social support were 2, 4, and 4 times, respectively, likely to have better glycemic control than those with inadequate support. Of the three types of social support, tangible support was most needed. Ultimately, a greater understanding of these interactions through longitudinal studies is required to identify solutions and optimize glycaemic control for diabetes clients in Kenya and beyond.

Financial, Occupational and Physical Challenges and Blood Glucose Monitoring in Type 2 Diabetes.

Blood glucose monitoring effects are changing for people living with type 2 diabetes. However, there is a lack of recent data surrounding financial, occupational, or physical stressors that affect the adherence of diabetes self-management practices. This article looks to examine specific financial, physical, and occupational challenges in adherence to blood glucose monitoring in type 2 diabetes. Data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 Pre-Pandemic data of adults 18+ were analyzed. These data were used to examine the relationships between insurance coverage, health status, occupation, and self-monitoring of blood glucose levels in the United States. This study found that respondents had a statistically significant association with five variables: prescription drug coverage (in-part or full), occupation status, gender, age, and three race subcategories (non-Hispanic White, Black, and Other-Multiracial) with blood glucose monitoring. This study may help certified health education specialists (CHES) and diabetes care and educator specialists (DCES) to better identify which groups of individuals are at highest risk for poor adherence to specific blood glucose monitoring in type 2 diabetes.

The big challenge out here is getting stuff: How the social determinants of health affect diabetes self-management education for seniors

In Canada, diabetes self-management education (DSME) programs are offered to enable individuals with diabetes to successfully implement and sustain lifestyle changes, with the goal of reducing risk of complications and morbidity. Researchers have demonstrated how older adults with diabetes often fail to achieve or maintain diabetes self-management (DSM) competencies, increasing complication risk. Further, little is known about the influence of the social determinants of health (SDH) on DSME, potentially producing additional inequalities for these adults; the WHO defines SDH as non-medical factors (e.g., education; food insecurity) that impact health outcomes. The study goal was to better understand how the SDH affect DSME for older adults living with diabetes. Methods: In our qualitative study we used participatory, art-based, and hermeneutic phenomenology research methodologies. Data collection included photovoice and semi-structured phone interviews. Fourteen older adults with diabetes participated (11 men, 3 women; aged 65 years or older). A SDH framework (Loppie-Reading and Wien) guided the thematic analysis. Results: The findings illuminate how participants live with the effects and pressures of the SDH. Proximal determinants of health revealed in participants’ stories included health behaviours (diabetes self-management practices), physical environments (rurality), socioeconomic status (income), and food insecurity (accessing healthy food). Intermediate determinants comprised health-care systems (accessing DSME in their community) and community resources and capacities (limited infrastructure due to rurality). Distal determinants involved the pandemic (isolation due to mobilization restrictions). Conclusion: Our study demonstrated how the SDH affect DSME and DSM for older adults. Participants were continuously rearranging their diabetes needs to accommodate other life priorities. Additionally, rural living is described as a barrier to DSM, as accessing diabetes education, food, medications, and gas is at a distance—a particular inconvenience during wintertime. Our findings will guide future design, planning and implementation of DSME programs for older adults in this rural setting.

Diabetes Self-Management and Health-Related Quality of Life among Primary Care Patients with Diabetes in Qatar: A Cross-Sectional Study.

Diabetes self-management (DSM) practices are an important determinant of health-related outcomes, including health-related quality of life (HRQOL). The purpose of this study is to explore DSM practices and their relationship with the HRQOL of patients with type 2 diabetes in primary health care centers (PHCCs) in Qatar. In this cross-sectional study, data were collected from PHCC patients with diabetes via interview-administered questionnaires by utilizing two instruments: the DSM questionnaire (DSMQ) and the HRQOL Short Form (SF-12). Frequencies were calculated for categorical variables and medians were calculated for continuous variables that were not normally distributed. A statistical comparison between groups was conducted using chi-square for categorical data. Binary logistic regression was utilized to examine the relationship between the significant independent factors and the dependent variables. A total of 105 patients completed the questionnaire, 51.4% of whom were male. Approximately half of the participants (48.6%) reported poor overall DSM practices, and 50.5% reported poor physical health quality of life (PC) and mental health quality of life (MC). Female participants showed significantly higher odds of reporting poor DSM than male participants (OR, 4.77; 95% CI, 1.92-11.86; p = 0.001). Participants with a secondary education (OR, 0.18; 95% CI, 0.04-0.81; p = 0.025) and university education (OR, 0.18; 95% CI, 0.04-0.84; p = 0.029) showed significantly lower odds of reporting poor DSM than participants with no/primary education. Older participants showed higher odds of reporting poor PC than younger participants (OR 11.04, 95% CI, 1.47-82.76 and OR 8.32; 95% CI, 1.10-62.86, respectively). Females also had higher odds for poor PC than males (OR 7.08; 95% CI, 2.21-22.67), while participants with a secondary (OR, 0.13; 95% CI, 0.03-0.62; p = 0.010) and university education (OR, 0.11; 95% CI, 0.02-0.57; p = 0.008) showed significantly lower odds of reporting poor MC. In conclusion, patients with diabetes reported poor overall DSM practices and poor HRQOL. Our findings suggest intensifying efforts to deliver culturally appropriate DSM education to patients and to empower patients to take charge of their health.

Knowledge of diabetes and the practice of diabetes self-management during Ramadan fasting among patients with type 2 diabetes in Malaysia

Background and aimsTo assess the level of diabetes knowledge and its association with diabetes self-management practices during Ramadan fasting among patients with type 2 diabetes (T2D). MethodsA cross-sectional study was conducted involving a sample of Malaysian patients with T2D. Patients aged 18 years and above, and attending an outpatient diabetic unit of a government hospital were recruited between February and April 2021. A self-administered questionnaire was utilized to assess diabetes knowledge and diabetes self-management practices. ResultsA total of 306 participants completed the questionnaire. Most of them were females (54.2%) and above 55 years old (75.1%). Resultantly, knowledge of diabetes was considered average among 52% of the participants. Only 9.5% of them avoided the consumption of sweet foods during iftar. Practicing late suhoor (p = 0.012) and self-monitoring of blood glucose (SMBG) (p = 0.026) during Ramadan were significantly associated with a better diabetes knowledge score. Education level (p = 0.000), working status (p = 0.030), and monthly income (p = 0.000) were significantly associated with participants’ knowledge level of diabetes. A higher proportion (72.2%) of the participants completed fasting for a month during Ramadan 2020. Meanwhile, hypoglycemia was the main reason (38.8%) for incomplete fasting. ConclusionsThese findings reflect the need to improve patients’ knowledge of diabetes and diabetes self-management practices, especially during Ramadan. Such objectives could be achieved by considering the associated factors identified in this study.

Nexus between constructs of social cognitive theory model and diabetes self-management among Ghanaian diabetic patients: A mediation modelling approach.

The promotion of Diabetes Self-Management (DSM) practices, education, and support is vital to improving the care and wellbeing of diabetic patients. Identifying factors that affect DSM behaviours may be useful to promote healthy living among these patients. The study assessed the determinants of DSM practices among Type 2 diabetes mellitus (T2DM) patients using a model-based social cognitive theory (SCT). This cross-sectional study comprised 420 (T2DM) patients who visited the Diabetic Clinic of the Komfo Anokye Teaching Hospital (KATH), Kumasi-Ghana. Data was collected using self-structured questionnaires to obtain socio-demographic characteristics, T2DM-related knowledge, DSM practices, SCT constructs; beliefs in treatment effectiveness, level of self-efficacy, perceived family support, and healthcare provider-patient communication. Path analysis was used to determine direct and indirect effects of T2DM-related knowledge, perceived family support, and healthcare provider service on DSM practices with level of self-efficacy mediating the relationships, and beliefs in treatment effectiveness as moderators. The mean age of the participants was 53.1(SD = 11.4) years and the average disease duration of T2DM was 10 years. Most of the participants (65.5%) had high (>6.1mmol/L) fasting blood glucose (FBG) with an average of 6.93(SD = 2.41). The path analysis model revealed that age (p = 0.176), gender (p = 0.901), and duration of T2DM (p = 0.119) did not confound the relationships between the SCT constructs and DSM specified in the model. A significant direct positive effect of family and friends' support (Critical ratio (CR) = 5.279, p < 0.001) on DSM was observed. Self-efficacy was a significant mediator in this relationship (CR = 4.833, p < 0.001). There were significant conditional indirect effects (CIE) for knowledge of T2DM and family and friends' support at medium and high levels of belief in treatment effectiveness (p < 0.05) via level of self-efficacy on DSM practices. However, no evidence of moderated-mediation was observed for the exogenous variables on DSM. Diabetes-related knowledge of T2DM, family and friends' support, level of self-efficacy, and belief in treatment effectiveness are crucial in DSM practices among Ghanaian T2DM patients. It is incumbent to consider these factors when designing interventions to improve DSM adherence.

Exploring the Perspective of Diabetes, Diabetes Self-Management, and Quality of Life Among Older Adults With Type 2 Diabetes: A Qualitative Study Before and During the COVID-19 Pandemic.

The purpose of the study was to explore the perspective and impact of diabetes, diabetes self-management, and quality of life (QoL) among older adults with Type 2 diabetes (T2DM) before and during the COVID-19 pandemic to better inform T2DM self-management interventions. A qualitative descriptive approach with focus group discussions (n = 5 sessions with 5-6 older adults per session) and in-depth interviews (n = 15) was conducted with community-dwelling older adults with T2DM. Five themes emerged. The definition of diabetes carries negative connotations, QoL is defined in terms of biopsychosocial health, diabetes self-management refers to the ability to adhere to medical advice and lifestyle changes, the QoL of older adults is differentially affected by COVID-19 measures, and important aspects of diabetes self-management activities are impacted by COVID-19 measures. Understanding older adults' perspectives on diabetes, diabetes self-management, and QoL provided insights into the facilitators and barriers to diabetes self-management practices before and during the COVID-19 pandemic. Findings inform the need for greater bottom-up initiatives and the need for a multipronged approach that considers the intra- and interpersonal and current policy factors to encourage diabetes self-management behaviors, especially during the COVID-19 era.

Experiences of Diabetes Self-Management: A Focus Group Study among the Middle-Aged Population of Rural Pakistan with Type 2 Diabetes

Objectives: The middle-aged population from rural areas of Pakistan is disproportionately at risk of developing and mismanaging their diabetes. The purpose of this study was to explore the self-management experiences of two focus groups in the middle-aged population with type 2 diabetes mellitus living in rural Pakistan. Methods: The study design is based on the exploratory research using a qualitative approach. Purposive sampling was used to recruit patients with diabetes from the metabolic outpatient clinics of medical centers in rural areas of Pakistan. The data were collected for two focus groups consisting of 20 persons (10 men and 10 women) with type 2 diabetes mellitus, ranging in age from 40 to 65 years, who were receiving diabetic care at a local health facility. Focus group discussions with a sample size of 10 participants each were all recorded, transcribed, and analyzed. The data were evaluated thematically. Results: Participants described diabetes management as emotionally, physically, and socially taxing. The analysis of the data indicated three major themes: (1) diabetes as a challenging disease; (2) understanding diabetes and its challenges; (3) following diabetes self-management practices. Throughout the session, participants discussed the impact of diabetes on their daily life. This study provided new insights into the experiences of the middle-aged population of Pakistan regarding their self-management of diabetes. Conclusions: Healthcare professionals should become involved in diabetes self-management education as soon as feasible to alleviate patient worry and establish better patient-centered, culturally sensitive professional abilities. Along with monitoring patients’ self-management, healthcare professionals should place a greater emphasis on patients’ understanding of the disease and its challenges and associated complications. It is recommended to establish diabetes support groups to encourage patients to share their experiences of diabetes self-management.