Influence Diabetes Self-management Research Articles

Contribution of Disease-Specific Distress, Social Support, and Self-Efficacy to Diabetes Self-Management Behaviors in Saudi Adults: A Path Analysis.

Disease-specific distress, social support, and self-efficacy have noticeable impacts on diabetes self-management. Although these three concepts are connected, their interplay and subsequent influence on diabetes self-management warrants further research. A total of 154 individuals with type 2 diabetes mellitus were recruited to complete a survey, which included questions related to social support, diabetes self-efficacy, diabetes self-management behaviors, and disease-specific stress. The variables were examined with path analysis using Analysis of Moment Structures (AMOS) software. In the final model, diabetes self-efficacy was a significant predictor of increased diabetes self-management behaviors. Lower levels of disease-specific distress were associated with higher levels of self-efficacy. Path analysis indicated that the direct effect of social support on diabetes self-management behaviors was significant, and social support indirectly affected diabetes self-management behaviors through the mediating effect of diabetes self-efficacy. Overall, the study findings indicate that social support can exert an impact on diabetes self-management behaviors through the mediating effect of diabetes self-efficacy. The study's findings support the use of Individual and Family Self-Management Theory to improve diabetes self-management. Further research is needed to better understand how factors related to the family support system influence diabetes self-management behaviors.

Lived experiences of diabetes self-management among persons with disabilities in rural Tamil Nadu – a case study approach

BackgroundPeople with disabilities have numerous challenges in diabetes self-management. Poor self-management leads to the worsening of disability and secondary complications of diabetes. This study was conducted to explore the challenges in diabetes self-management and the factors influencing diabetes self-management among people with disabilities.MethodsWe conducted 16 case studies among people with physical, neurological, visual, hearing, and multiple disabilities who were affected by diabetes. We adopted a thematic content analysis approach to analyse the data.ResultsPeople with disabilities have challenges in adopting healthy diets as they are unable to purchase and consume fruits and vegetables which are costly, unavailable, and inaccessible. They have difficulty in doing physical activity due to lack of inclusive public spaces which are inaccessible, lack of motivation, and dependence on others for their mobility. Irregular drug supply in the public health system and unaffordable cost of drugs hamper adherence to medications. Laboratories are inaccessible to people with disabilities thus preventing monitoring of blood sugars. They have poor quality of life, life with pain and mental health issues, which prevent adoption of self-management behaviors. The intersectionality of age and gender with disability worsens self-management behaviors. Inaccessible health system, poor quality of health care and insensitive health care providers further complicate self-management.ConclusionThis study documents the challenges faced by persons with disabilities in practicing diabetes self management. There is a need for public health policy and planning that is inclusive of persons with disabilities to make access to diabetes care universal.

The relationship between self-efficacy in blood sugar management and self-management in type 2 diabetes patients at Subang General Hospital

Background: Type 2 diabetes mellitus requires effective self-management to prevent complications and maintain a healthy quality of life. Self-efficacy, or a patient’s belief in their ability to manage their condition, is recognized as a key factor influencing diabetes self-management. However, the strength and nature of this relationship remain understudied in the local context of patients receiving care at Subang General Hospital. Purpose: This study aims to investigate the relationship between self-efficacy in blood sugar management and self-management in type 2 diabetes patients at Subang General Hospital. Methods: A quantitative correlational study with a cross-sectional design was conducted. Consecutive sampling was used to recruit 40 respondents. Data were collected using two standardized tools: the Diabetes Management Self-Efficacy Scale (DMSES) and the Diabetes Self-Management Questionnaire (DSMQ). The relationship between self-efficacy and self-management was analyzed using the Spearman-Rho statistical test. Results: Among the respondents, 80% (n=32) demonstrated high levels of self-efficacy, while 67.5% (n=27) exhibited good self-management practices. The statistical analysis revealed a significant positive correlation between self-efficacy and self-management (p=0.003). Conclusion: The findings indicate a significant relationship between self-efficacy and self-management in patients with type 2 diabetes mellitus. These results underscore the importance of enhancing self-efficacy as part of diabetes education and management strategies to improve patient outcomes. Future research should explore interventions that specifically target improving self-efficacy to optimize self-management behaviors.

Social connectedness and diabetes self-management across the COVID-19 pandemic: A mixed methods study.

Structural social connectedness is the structure and size of a person's social network, including whether persons live with or have regular contact with others. The COVID-19 pandemic disrupted structures that facilitate social connectedness. This study investigated how a person's structural social connectedness influenced diabetes self-management strategies through the COVID-19 pandemic. The study followed an explanatory sequential mixed methods design. First, quantitative data were collected via surveys of 54 patients living with diabetes (67% female, Mage of 60 [12] years) in 2021. Then in 2022, we interviewed 25 patients (64% female, Mage of 62 [9] years) as a follow-up to the survey to help explain quantitative findings. Longitudinal mixed methods analysis integrated both phases to offer a holistic view of the factors influencing diabetes self-management. A full-factorial analysis of covariance tested home and workplace social connectedness effects onto glycemic control and four self-management measures. In integrated analysis, researchers categorized patients into four groups by level of home and workplace social connectedness. Individuals with home social connectedness were more likely to overcome pandemic-related self-management challenges than those without home social connectedness. Although the workplace provided social connectedness, it imposed structural barriers to self-management. Structural social connectedness influenced how patients navigated diabetes self-management challenges through the COVID-19 pandemic. Results suggest clinicians should consider how home and workplace connectedness interact to facilitate or impede patient self-management. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Theory of Transitions Influencing Diabetes Self-management Among Emerging Adults With Type 1 Diabetes.

Emerging adults with type 1 diabetes are experiencing numerous transitions, potentially affecting diabetes self-management. For example, when transitioning to college, these emerging adults may experience changes in their daily routines and usual reminders or triggers for habitual behavior such as checking blood glucose levels. In turn, these emerging adults may omit checking glucose levels, impacting decisional and adaptational diabetes self-management behavior associated with their insulin dose or bolus. Thus, we propose a theory on transitions influencing daily routines, diabetes self-management habitual behavior triggers, and, in turn, diabetes self-management habitual and decisional/adaptational behaviors for emerging adults with type 1 diabetes.

Comparative Study of Diabetes Knowledge, Attitudes, Family Support, Self-efficacy, and Self-management Behaviors Between Cancer Survivors With Diabetes and Diabetes Patients Without Cancer

Background Studies have compared diabetes management quality indicators, focusing on physiological markers such as hemoglobin A1c, between cancer survivors with diabetes and general diabetes patients. However, research comparing differences in diabetes self-management behaviors and the factors influencing them between these groups is lacking. Objectives This study aimed to compare self-management behaviors, guided by the information-motivation-behavior model, between cancer survivors with diabetes and general diabetes patients. In addition, we aimed to identify differences in factors such as diabetes knowledge, attitudes, family support, and self-efficacy that may influence diabetes self-management behaviors in both groups. Methods A total of 125 cancer survivors with diabetes and 126 general diabetes patients participated in this cross-sectional study. A structured questionnaire assessed demographics, diabetes knowledge, attitudes, self-efficacy, and self-management behaviors. Results Regarding diabetes education, 47.0% of cancer survivors and 61.6% of general diabetes patients received education. The cancer survivors had lower diabetes knowledge scores (10.30 ± 4.15, P < .001), a lower perceived value of strict blood glucose control (4.10 ± 0.56, P < .001), and less family support (15.50 ± 7.50, P = .019) than the patients without cancer (13.51 ± 3.84, 4.25 ± 0.65, and 17.57 ± 6.40, respectively). Conclusion This study reveals significant differences in diabetes self-management between cancer survivors and general diabetes patients. Cancer survivors showed lower diabetes knowledge, glucose control perception, and family support. These findings highlight the need for tailored self-management programs for cancer survivors. Implications for Practice This study offers insights for developing tailored diabetes self-management programs and educational interventions for cancer survivors.

Analysis of Psychosocial Factors Affecting Dietary Behavior among People with Type 2 Diabetes Mellitus in Indonesia

Dietary behavior is essential to diabetes self-management in people with type 2 diabetes mellitus. Understanding factors influencing diabetes self-management will help in designing appropriate intervention. The study aims to determine the effect of psychosocial on dietary behavior. This study was an analytical observational with a cross-sectional design. The sample size was 138 respondents recruited with multistage random sampling. Psychosocial factors were identified using; 1) Spoken Knowledge in Low Literacy patients with Diabetes Scale, 2) The Coping Scale, 3) Diabetes Distress Scale, 4) Hensarling Diabetes Family Support Scale, 5) Perceived nurse support questionnaire, while dietery behaviour was measured by Self-Management Dietary Behaviors Questionnaire. Data analysis used multiple linear regression. Among five psychosocial factors only two factors influenced dietary behaviour, such as; distress and perceived family support (p=0.004; p=0.001 < α=0.05). Meanwhile, knowledge, coping, and perceived nurse support did not affect diabetes diet (p=0.133; p=0.527; p=0.535 > α=0.05) with R2 = 0.275 (F=11.148; p=0.001 <α=0.05). Distress and perceived family support are two psychosocial factors that can affect dietary behavior. Preventing the occurrence of distress and increasing family support are important to improve dietary behavior adherence in people with type 2 diabetes mellitus.

Underlying mechanisms of diabetes knowledge influencing diabetes self-management behaviors among patients with type II diabetes in rural China: Based on health belief model

To investigate the association between diabetes knowledge and diabetes self-management (DSM) behaviors and to explore the influence mechanism between them among patients with type 2 diabetes mellitus (T2DM) based on health belief model in rural China. This cross-sectional study included 483 participants with T2DM from 8 villages of 3 townships in Jiangsu Province. All participants completed a structured questionnaire, including demographic information, diabetes knowledge, DSM behaviors, health beliefs, and cognitive function. Multiple linear regression and mediation analysis were performed to analyze the association between diabetes knowledge and DSM behaviors, furthermore the mechanism between them. Diabetes knowledge and self-efficacy positively influenced DSM behaviors. Health beliefs multiply mediated the association between diabetes knowledge and DSM behaviors. Perceived behavioral barriers mediated the relationship between diabetes knowledge and DSM behaviors, where a suppression effect existed. A chain-mediated effect was found: diabetes knowledge affected perceived benefits, followed by self-efficacy, and finally DSM behaviors. Diabetes knowledge acquisition played an important role in improving DSM behaviors, and health beliefs multiply mediated the relationship between them. When designing interventions, health systems and health providers should refocus on diabetes knowledge, emphasize the benefits of self-management, and consider the barriers that patients may encounter.

Factors influencing diabetes self-management among adults with type 2 diabetes mellitus in China.

In China, the prevalence of Type 2 Diabetes Mellitus (T2DM) continues to rise, and Diabetes Self-Management (DSM) is generally suboptimal. Thus, identifying the factors influencing DSM in adults with T2DM is crucial for healthcare providers. This study aimed to 1) describe DSM among adults with T2DM in Wenzhou, China, 2) examine the correlations between diabetes knowledge, perceived self-efficacy, fatalism, social support, and DSM, and 3) determine how much power of the correlated independent variables could predict DSM. This study adopted the cross-sectional design and included 108 adults with T2DM who were randomly selected from the outpatient clinic of a hospital in Wenzhou, China. Data were recruited using a demographic questionnaire, and standardized tools were utilized to determine the correlation between DSM, diabetes knowledge, perceived self-efficacy, fatalism, and social support. Data were analyzed using descriptive statistics, Pearson correlation, and multiple regression analysis. 62% of participants had poor blood glucose control (HbA1c ≥8.0%) and suboptimal DSM. Significant factors related to DSM were diabetes knowledge (r = 0.594, p <0.001), perceived self-efficacy (r = 0.447, p <0.001), and social support (r = 0.312, p = 0.001). The regression analysis revealed that all variables significantly explained 38.2% of the variance in DSM among adults with T2DM. However, only diabetes knowledge and perceived self-efficacy significantly predicted DSM (β = 0.468, p <0.001; β = 0.184, p = <0.05, respectively). The findings indicated that increasing diabetes knowledge and perceived self-efficacy could help improve DSM in T2DM to ascertain the ultimate treatment outcomes. Nurses and healthcare providers should improve the ability of patients and their families to think critically and act autonomously.

Healthcare Professionals' Views of Factors Influencing Diabetes Self-Management and the Utility of a mHealth Application and Its Features to Support Self-Care.

IntroductionThe perspectives of healthcare professionals (HCPs) are pivotal to co-development of self-management strategies for patients with diabetes. However, literature has been largely limited to perspectives of patients within the context of a Western healthcare setting. This study aims to explore factors influencing diabetes self-management in adult patients with diabetes from the perspectives of HCPs and their views of the value of mHealth application for diabetes self-management.Materials and MethodsWe conducted focus group discussions (FGD) with purposively selected HCPs in Singapore. All FGDs were audio-recorded and transcribed verbatim. Thematic analysis was conducted using NVivo 12.ResultsA total of 56 HCPs participated in the study. Barriers to self-management included limited patient commitment to lifestyle changes, suboptimal adherence to medication and treatment, patient resistance to insulin initiation and insufficient rapport between patients and HCPs. Patients’ perceived susceptibility to complications, social support from family and community, multidisciplinary team care and patient’s understanding of the benefits of self-care were viewed as facilitating self-management. HCPs saw mHealth apps as a vital opportunity to engage patients in the self-management of conditions and empower them to foster behavior changes. Yet, there were concerns regarding patient’s limited digital literacy, lack of integration into routine electronic system and reluctance.DiscussionWe identified a set of factors influencing self-management in adult patients with diabetes and useful app features that can empower patients to manage their conditions. Findings will inform the development of a mHealth application, and its features designed to improve self-care.

The "Ups and Downs" of Living With Type 2 Diabetes Among Working Adults in the Rural South.

The purpose of this qualitative study was to gain a better understanding of the spheres of influence on engagement in recommended diabetes preventive health services among rural, working adults. Additionally, this study sought to understand the unique factors that influence diabetes self-management among rural, working adult populations. The sample included mostly African-American, low-income females with self-reported diabetes, who scored low on the Patient Activation Measure (PAM-10). Semi-structured interviews (N = 20) revealed that most participants struggled with the "ups and downs" of living with diabetes. Four major themes emerged from the data: "the struggle," "doing things together," "diabetes is not the priority," and "we're lucky to have what we have." Most participants were developing individual responsibility and motivation for a healthy future, but were overwhelmed by inconsistency in self-management, diabetes distress, lack of effective coping strategies, and lack of social and economic capital. The findings of this study indicate the need to further address psychological well-being among rural, working adults, yet rural populations often lack sufficient access to mental health care and formalized psychological support. Psychological support and resources are essential to facilitate engagement in diabetes self-management and preventive health services for rural, working adults.

An Interpretive Description of Sociocultural Influences on Diabetes Self-Management Support in Nigeria

The purpose of this study is to explore how Nigeria’s social and cultural environment influences professional diabetes self-management support practices. This interpretive descriptive study is based on two diabetes clinics in southeastern Nigeria. Nineteen healthcare providers, including nurses, were purposely selected and engaged in participant observation and interviews. Concurrent data generation and analysis facilitated iterative constant comparative analysis. Findings show significant factors influencing diabetes self-management support include belief in the supernatural origin of diabetes, individual–family interdependence, myths and limited understanding of diabetes, lack of health insurance, poverty, and the rigidity of a hierarchical acute care model of diabetes services. Thus, there is an urgent need to adapt diabetes self-management support strategies to fit people’s contexts. By doing so, specific challenges in the healthcare system can directly be addressed while capitalizing on identified strengths and adapting select strategies that constructively foster person-centered and culturally appropriate care.

The Role of Religion, Spirituality and Fasting in Coping with Diabetes among Indian Migrants in Australia: A Qualitative Exploratory Study.

Australia has a high proportion of migrants, with an increasing migration rate from India. While many factors influence diabetes self-management among Indian migrants, very little is known about the influence of religious beliefs and spirituality. This study explored the religious beliefs of Indian migrants in Australia and the influence of those beliefs on their diabetes self-management. Semi-structured interviews were conducted with a convenience sample of 23 Indian migrants. All interviews were audio-recorded, transcribed verbatim and thematically analysed. Most participants believed that prayers helped them alleviate stress and improve diabetes management participants also believed that receiving blessings/prayers from religious leaders prevent or cure diseases including diabetes. There were mixed views on beliefs about using insulin obtained from animal sources. Some participants were concerned about the use of animal-based insulin as it was against their religious beliefs and teachings. Some participants believed that religious fasting does not have any impact on their diabetes while others believed that it can be detrimental to their health. Religious beliefs therefore played an important role in how Indian migrants managed their diabetes. Healthcare professionals should consider their patients' religious beliefs during consultations, enlist support, such as religious scholars, to better address people's misconceptions, and identify strategies for effective diabetes management that consider religious beliefs.

Factors influencing diabetes self-management in adults: an umbrella review of systematic reviews.

The objective of this review was to identify and describe the factors influencing diabetes self-management in adults by summarizing the available evidence concerning their types, categories, and relative importance. A wide range of factors, acting simultaneously, influence diabetes self-management and interfere with its actual application by patients. There is a variety of systematic reviews of these factors; however, a more thorough examination of their influences was lacking. Systematic reviews of qualitative or quantitative literature focusing on factors influencing adult diabetes self-management in general or on individual behaviors (ie, management of oral antidiabetic medication and insulin injections, self-monitoring of blood glucose, foot care, healthy eating, regular exercise, and smoking cessation) will be included. We performed an extensive search of 11 bibliographic databases, including gray literature, up to June 2019. Quantitative and qualitative findings were summarized separately and labeled according to their types (eg, facilitator/barrier, strength and direction of association), categories (eg, demographic, social), and frequency of occurrence. We identified 51 types of factors within 114 systematic reviews, which mostly addressed medication-taking behavior. Thirty-two (62.7%) factors were reported in both qualitative and quantitative literature. The predominant influences were psychological factors and behavioral attributes/skills factors. The most frequently reported facilitators of diabetes self-management were motivation to diabetes self-management, a favorable attitude to diabetes self-management, knowledge about the disease, medication and behaviors associated with diabetes self-management, skills, and self-efficacy/perceived behavioral control. The predominant barriers were the presence of depression, and polypharmacy or drug regimen complexity. The demographic factor of female sex was frequently reported for its negative influence on diabetes self-management, whereas older age was a positive factor. The social/cultural and physical environment were the least-studied categories. Other factors such as social support from family, friends, or networks; interventions led by health professionals; and a strong community environment with good social services favoring diabetes self-management were reported as major facilitators of diabetes self-management. Essential components of interventions to promote effective diabetes self-management should aim to help adults manage the effects of specific factors related to their psychological and practical self-management experience. Screening for depression, in particular, should become an integral part of the support for adult diabetes self-management, as depression is a particular obstacle to the effectiveness of diabetes self-management. Future studies should more deeply examine the influence of factors identified in the sociocultural and physical environment categories. Research should properly consider and invest efforts in strengthening social support and innovative community care approaches, including pharmacist- and nurse-led care models for encouraging and improving adult diabetes self-management. Finally, researchers should examine non-modifiable factors - age, sex, or socioeconomic status - in the light of factors from other categories in order to deepen understanding of their real-world patterns of action on adult diabetes self-management. PROSPERO CRD42018084665.

Religious Faith and Diabetes Health Beliefs in a Homeless Population: A Qualitative Study.

This participatory action research project explored the perspectives and challenges of homeless persons living with, or at risk for, type 2 diabetes. Because these persons were sheltered in and served by a church, their perspectives provide understanding about how religious faith may influence diabetes self-management.

Challenges to diabetes self-management for adults with type 2 diabetes in low-resource settings in Mexico City: a qualitative descriptive study

BackgroundThe prevalence of type 2 diabetes (T2D) in Mexico is one of the highest in the world, with high morbidity and mortality, and difficulty meeting glycemic targets. The purpose of this study was to identify the challenges for T2D self-management as perceived by both adults with T2D and health care providers in primary health clinics from Seguro Popular in Mexico City.MethodsThis was a qualitative descriptive study conducted in three Seguro Popular primary care clinics in Mexico City using convenience sampling. Semi-structured interviews were conducted with participants and data were analyzed using a content analysis approach.ResultsThe sample included 20 adults with T2D [52.5 years old (SD = 9.9), diagnosed with T2D for 12.3 years (SD = 6.3), mean A1C of 9.8% (SD = 2.4), 80% female, 90% with financial insecurity] and 19 providers [primarily female (78.9%), mean age of 41.6 years old (SD = 11.4), 12.3 mean years in practice (SD = 8.50)]. Personal challenges included cultural beliefs, lack of resources, challenges to lifestyle modification, lack of family support/competing demands, and mental health issues. System level challenges included lack of resources, perceived quality of care, and patient engagement barriers.ConclusionsEvidence-based diabetes self-management programs need to become more accessible, taking into consideration the social determinants of health and building upon current initiatives to improve early diagnosis and treatment of T2D. Cultural beliefs, personal control, and low health literacy influence diabetes self-management in adults with T2D with limited resources. Mental health and financial challenges of adults with T2D will require multidisciplinary team-based care. Future research on best practices to implement and scale-up evidence-based patient-centered T2D prevention and DSME programs for the poor and underserved is warranted in Mexico and world-wide.

Pilot of Community-Based Diabetes Self-Management Support for Patients at an Urban Primary Care Clinic.

Diabetes is the seventh leading cause of death in the United States (1). Furthermore, diabetes prevalence, diabetes-related hospital admissions and re-admissions, and risk factors are disproportionately higher in racial and ethnic minorities, indicating the need to focus efforts on reducing these disparities while also improving outcomes for all (2–4). Diabetes care and management vary significantly by race/ethnicity and insurance status and are less likely to be optimal in certain minority groups and the uninsured (5,6). Because most resources and barriers to diabetes management are present within the broader context in which patients carry out their daily lives, the ability to support self-management from within health care delivery systems is limited. Conversely, the capacity for health care systems to partner with community-based programs to manage diabetes is almost limitless. For example, an expert synthesis of strategies to reduce diabetes disparities concluded that community-based efforts and health information technology are the “new frontier” for eliminating diabetes disparities (7). Health care is shifting from volume to value, from treatment to prevention, from patients to populations, and from discrete clinical encounters to whole-person care. In this new model, collaborative partnerships to promote health and well-being within communities are increasingly relevant. Evidence suggests that chronic disease self-management support provided in the community setting improves outcomes in patients with complex chronic conditions (8–10). Previous studies on peer-led support have shown improvements in participant self-care (i.e., nutrition, physical activity, and glucose monitoring), psychosocial outcomes (i.e., quality of life, self-efficacy, and depression), and treatment and appointment engagement (8,11). Positive social support has been shown to influence diabetes self-management practices such as eating a healthy diet, exercising, and monitoring blood glucose (8). Peer-led diabetes social support in a community setting is gaining traction among people with diabetes (12). Pairing …

Cross-Validating a Structural Model of Factors Influencing Diabetes Self-Management in Chinese Americans with Type 2 Diabetes

The purpose of this study was to cross-validate a structural model depicting the effects of individual and environmental factors on diabetes self-management in Chinese Americans with type 2 diabetes. A cross-sectional survey was administered to a convenience sample of 209 Chinese Americans with type 2 diabetes in the Midwest of the United States. Structural equation modeling was used to cross-validate the model fit. Provider-patient communication indirectly influenced self-management via belief in treatment. Knowledge indirectly influenced self-management via belief in treatment and self-efficacy. Social support indirectly influenced self-management via belief in treatment and knowledge. This study demonstrated that the structural model, previously tested with Chinese diabetes patients in China, also fits Chinese Americans in the United States with few modifications. The cross-validated model provides a theoretical basis for developing culturally relevant diabetes self-management interventions for Chinese Americans, which may lead to health improvements in this ethnic population.

Health-Related Stigma in Young Adults With Type 1 Diabetes Mellitus

Young adults with type 1 diabetes mellitus (T1DM) often exhibit poor treatment adherence and suboptimal glucose control. Health-related stigma may adversely influence diabetes self-management behavior. The aim of the current study was to explore health-related stigma among young adults with T1DM using qualitative descriptive methods in focus groups. Data were collected from a purposive sample of 14 young adults ages 20 to 34 with T1DM. Using content analysis, transcripts from two focus groups were analyzed, and five main themes were identified: (a) Desire to be Seen as a Person, Not a Disease; (b) Wanting to be "Normal"; (c) Feeling Ashamed Managing Diabetes in Public; (d) Struggling to Overcome Anger and Distress; and (e) Feeling Distrusted by Others to Manage Their Condition. Young adults with T1DM reported experiencing a high degree of stigma in their daily lives, which negatively influenced their self-management and psychological well-being. Stigma led to delaying blood glucose monitoring and insulin dosing and feelings of anger and distress. Young adults with T1DM require strategies to help cope with stigma and the anger and distress they experience. [Journal of Psychosocial Nursing and Mental Health Services, 56(10), 44-51.].

The barriers and challenges toward addressing the social and cultural factors influencing diabetes self-management in Indian populations

AbstractPatient adherence to recommended diabetes self-care practices reduces the risk of diabetic complications. However, most clinic-based approaches have proved inadequate in maintaining optimal diabetic self-management and the prevention of undesirable health outcomes at the population level among disadvantaged populations. Several sociocultural factors influence patient adherence to diabetic self-care practices which should be recognized and addressed by the health-care provider, especially in lower socioeconomic status and women patients. The lack of physician empathy and tendency to assign blame upon diabetic patients for the failure of adherence without recognizing the complex sociocultural factors influencing patient behavior can undermine the possibilities for better management. The enlistment of familial support when available is valuable for improving medical adherence and health outcomes in vulnerable diabetic patients with low health literacy. Young unmarried women with diabetes are particularly at risk of diabetes stigma eroding familial support and marital prospects require need effective health communication along with their family. Moreover, women with diabetes have a greater likelihood of compromising their dietary needs for the sake of their familial dietary preferences. The inability of patients to comply with recommended exercise regimen may be derived from environmental factors; primarily unsafe neighborhoods, lack of availability of nearby recreational facilities such as public parks, and cultural resistance in patriarchal social environments. Policy approaches for improving diabetes management in disadvantaged diabetic populations should consider mandatory registration, assured diabetic medication, and follow-up in case of missed appointments. Community mobilization for overcoming societal stigma against women with diabetes also persists as a formidable challenge.