Diabetes self-management strategies -
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Third, the statements were discussed with the co-authors and categorized as concerning: 1 elements of self-management e.
exercising, knowledge, being in control ; 2 characteristics of the disease and treatment e. type of medication, diet, use of blood sugar level meter ; and 3 characteristics of the attitude towards the disease e.
acceptance, consequences, role of health professional vs. role of patient. Taking into account the objective of this paper, only the results of the first category will be presented. Sixteen people applied for participation in the study. Ten people Mean HbA1c was All participants were treated for T2DM by a general practitioner GP and practice nurse specialized in diabetes care at the GP practice.
Self-management is a term which is commonly used by health professionals. Rather, they felt they dealt with their daily life as it is now, just as every other person with or without T2DM. But, apart from that, diabetes is not difficult; you just need to learn how to deal with it.
Participants did not often experience problems caused by deteriorated glycaemic control, and therefore did not consider themselves as having to actively self-manage their disease. Although self-management was generally described as diabetes in daily life , participants also mentioned that if glycaemic control was no longer stable, a need for active self-management emerged.
They described that at such times, actions were required to prevent complications. However, over time, new lifestyles became part of their routine in daily life and were no longer experienced as active self-management.
Over time, active self-management changes into routine in daily life. When problems occur, patients shift back to active self-management grey peaks. All patients mentioned that T2DM influenced their daily life.
Yet, the impact of T2DM on daily activities was greater for some patients than for others. Whether patients considered diabetes to have a large impact on their daily life also seemed to influence their acceptance of diabetes and the new lifestyle. Some patients felt that diabetes had to be taken into account at all times.
The health professional gives advice, but you have to do the work and decide what to eat and drink and what not. Since patients experienced diabetes in daily life rather than self-management , aspects which influence diabetes in daily life were investigated.
The aspects scored by the participants on a five-point scale that had the most impact 4 or 5 out of 5 on the daily life of T2DM patients were categorised and are shown in Table 2. To account for these different aspects patients felt required to be in control, and to have sufficient knowledge to keep control.
Participants mentioned very specific things that made them feel supported. For example, with regard to exercising, patients felt supported by their dog or children. However, patients were not able to mention specific causes for not feeling supported.
For example, concerning exercise, they mentioned a lack of support in motivation. Overall, patients felt supported in self-management in some ways, but mainly felt as if they had to find out everything about living with diabetes on their own.
In their view, health professionals provide medical advice, but could not explain how to deal with T2DM in daily life.
The daily care for type 2 diabetes mellitus T2DM mostly comes down to the person suffering from it. To maintain adequate glycaemic control, patients with T2DM have to make many decisions and fulfil complex care activities every day [ 25 ]. Respondents in our study mentioned a need to gain knowledge, be in control, adapt their diet, exercise, maintain a regular schedule, and adhere to complex medication regimes.
However, in fulfilling these responsibilities, they did not view themselves as actively participating in their treatment, at least not continuously. This is in line with previous research indicating that patients who perceive their illness as stable have different needs for support than patients who experience their disease as episodic or progressively deteriorating [ 26 ].
An unpredictable course of illness can cause feelings of lower self-efficacy, i. patients might experience their self-management as unsuccessful and, as a result, feel a greater need for support [ 27 , 28 ]. Although overall, respondents did not experience themselves as actively managing their diabetes, they did identify two time points of active self-management during their illness course, particularly in the period after diagnosis and when problems occurred.
With regard to support for their self-management, patients expressed that they did not feel optimally supported, which is in line with findings from previous studies [ 16 , 29 ]. However, they had difficulties in describing what is lacking, suggesting that they do not know what exactly is missing or how support could be improved.
Self-management needs to be supported in order to more successfully treat T2DM [ 30 ]. This person-centred perspective is valuable, as patients are expected to be in control of management of T2DM in daily life.
Therefore, outcomes of this research can be used to develop tools and strategies that support self-management in a way that better fits the needs of T2DM patients. The development of tools and strategies from the perspective of the user i.
It may also improve cost-effectiveness of the intervention, as costly implementation of features that patients do not want or cannot use is avoided [ 31 ].
Our findings suggest two aspects that are important to consider in developing user-centred self-management support interventions for patients with T2DM. First, it is important to provide support at the right moments, i. when patients experience a need for support due to changes in their daily routines or changes in their health.
Two such moments were identified in our study: the period directly after diagnosis and at instances when problems occur glycaemic control deteriorates.
In addition to physical limitations, such as pain and fatigue, which further complicate self-management, deterioration of health can cause feelings of loss of control, and disappointment that previous self-management strategies have failed. At such moments, patients might be more open to professional support to make sustainable behavioural change to maintain glycaemic control, and prevent — or at least postpone — the debilitating long-term complications of insufficient glycaemic control.
Second, it is important to provide support for relevant element s , i. By taking into account these specific topics when developing tools and strategies, patients will be better supported and therefore better able to successfully self-manage their disease. An important strength of this research is its focus outside medical context.
The research addressed the participant as a person with T2DM , not as a patient. This way, participants expressed they felt comfortable in sharing their experiences regarding T2DM and self-management. Participants mentioned that within the medical context, they fear being criticised on the way they cope with the disease as health professionals mostly focus on HbA1c values and less on the T2DM-related issues of the patient.
Patients were triggered to think about their personal experiences regarding management of and dealing with T2DM prior to the interview.
Therefore, the researcher could touch upon a deeper layer of information during the interviews. This study explored self-management and self-management support needs from the perspective of patients with T2DM rather than health professionals. We focused particularly on the subgroup of patients with a recent diagnosis and stable, adequate glycaemic control, for whom self-management support may be a more cost-effective- and efficient treatment approach than provider-led care.
However, patients who have not yet achieved stable, adequate glycaemic control may have different support needs, which should be explored in further detail. Furthermore, the sample size was sufficient for the current qualitative study, as the aim was to get detailed insights into the experiences of individuals.
Nevertheless, to assess the generalizability of findings, it is important to replicate the current study with a larger sample of patients. This may require different methodology as well. However, this methodology is less applicable to theory and model building [ 24 ].
To develop an overall representative theory of self-management from the patient perspective other qualitative methods such as grounded theory may be more appropriate. Moreover, 7 out of 10 participants were female. Finally, the outcomes of this research do not yet provide insight in what patients currently miss regarding support in self-management.
In order to further improve self-management support, additional research is needed on this aspect. Two moments have been indicated by this study which are most optimal for providing support; when recently diagnosed and when problems occur.
Future research can further explore the differences and similarities for providing support to people in these different moments. It is possible that different strategies for support would be best for each moment.
This research focused on the needs of a specific patient group; T2DM with stable, adequate glycaemic control. This population has not been researched before, and therefore new insights are generated for this target group specifically.
Outcomes of this study can now be further explored in a broader view, but these first insights already indicate the need for a more individualised approach to support patients with T2DM and a stable, adequate glycaemic control.
The current guidelines for treatment of T2DM are too standardised and lack personalised support in specific aspects as dietary behaviour, exercising, scheduled rhythm, medication, being in control, and knowledge. The interview records and sensitising booklets generated and analysed during the current study are not publicly available to protect participant confidentiality, but are available from the corresponding author on reasonable request.
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USA: American Diabetes Association; Standards of Medical Care in Diabetes. Download references. Authors are thankful to the study participants, note taker, District Public Health Office, Rupandehi for their support and contributions.
Thanks to my colleague Shiva Raj Mishra for his insightful comments. Institute for Social and Environmental Research-Nepal, Pokhara, Nepal. Faculty of Science, Vrije University, Amsterdam, The Netherlands.
You can also search for this author in PubMed Google Scholar. MA conceptualised the research design, conducted the research, analysed data and wrote the first draft of the manuscript. TC and HRD contributed during the research design, research proposal and ethics application, adaptation of the data collection tool and analysis of the data.
TC and HRD contributed in revising the draft manuscript. All authors revised the manuscript and agreed on the findings and views expressed. The author s read and approved the final manuscript.
Correspondence to Mandira Adhikari. Ethics committee approved both verbal and written consent. Written and verbal consent was obtained from each participant before data collection.
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Download PDF. Abstract Background Self-management of diabetes is associated with glycaemic control and adherence to medication and healthy lifestyle practices. Methods Four 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 in Rupandehi district of Western Nepal.
Results Five 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.
Conclusion Based on our findings, a multilevel approach is needed to address these barriers and facilitators. Background The increasing prevalence of Type 2 diabetes has become a major global health challenge.
Study design and participants This was a qualitative exploratory study with the inclusion of multiple stakeholders who were involved in the diabetes self-management practices in various roles: people with Type 2 diabetes, caregivers, medical doctors, district health managers and a social worker.
Data collection Data collection was carried out between April and mid-May Data analysis FGD and SSI were transcribed from the audio recordings and focus group notes. Result This study identified wide range of barriers to and facilitators of Type 2 diabetes self-management practices.
Individual level factors Knowledge of diabetes self-management strategies Knowledge about diabetes self-management practices was reported as a barrier and a facilitator of diabetes self-management practices. Discussion This qualitative study explored a wide range of barriers and facilitators to improve diabetes self-management practices from perspectives of people with Type 2 diabetes, caregivers, medical doctors, district health managers and a social worker.
Individual level Our study highlighted a lack of knowledge as an important barrier to diabetes self-management practices, in line with previous review articles [ 60 , 61 ]. Interpersonal level At the interpersonal level, family, peers and neighbour either play a supportive role or become barrier to manage diabetes at home for people with diabetes.
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.
Availability of resources Irregular supply of medicine in health facilities was a barrier to adhere to recommended medications. Policy level factors Lack of protocols and guidelines This study reported that lack of protocols and guidelines for medical doctors to provide diabetes education was a barrier, which is supported by the previous study from Nepal reporting the lack of contextual guidelines for diabetes management [ 33 ].
Economic factors The economic burden of the cost of medication, blood glucose monitoring, a healthy diet and appropriate footwear was a barrier to manage Type 2 diabetes.
Conclusion People with Type 2 diabetes experience different types of barriers and facilitators to diabetes self-management practices. Availability of data and materials The transcript can be made available for the institution or Individual with special need or request based on case by case basis.
Abbreviations FGD: Focus group discussion NCD: Non-communicable disease PHC: Primary health care centre SSI: Semi-structured interview.
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Google Scholar American Diabetes Association. Acknowledgements Authors are thankful to the study participants, note taker, District Public Health Office, Rupandehi for their support and contributions. Funding There was no funding for this study. Author information Authors and Affiliations Nepal Development Society, Bharatpur, Nepal Mandira Adhikari Institute for Social and Environmental Research-Nepal, Pokhara, Nepal Hridaya Raj Devkota Faculty of Science, Vrije University, Amsterdam, The Netherlands Tomris Cesuroglu Authors Mandira Adhikari View author publications.
View author publications. Consent for publication Not applicable. Competing interests Authors declared that we have no competing interests. Supplementary Information. Additional file 1. Focus Group Discussion guide- People with Type 2 diabetes.
Diabetes is complicated, Effective natural fat burner it takes practice to manage it Diabetes self-management strategies your everyday life. You may be Diabetes self-management strategies sttategies eating sfrategies meals, engaging in safe physical activity, checking blood sugar, or giving yourself injectable medicines. Diabetes self-management strategies stfategies help people live a healthy life with diabetes. DSMES will give you support to manage diabetes in a way that works for you and your lifestyle. DSMES can help you improve your blood sugar levels so you can prevent or delay serious diabetes complications, such as heart disease, kidney disease, and vision loss. This improvement can help you avoid emergency care, save money on health care costs, and improve your quality of life. Chronic Disease in Rural America This Self-managekent guide Diabetes self-management strategies the latest news, events, resources, and funding related Strateiges diabetes, as self-mabagement as a comprehensive overview of related issues. Diabetes self-management refers to the activities and behaviors an individual undertakes to control and treat their condition. People with diabetes must monitor their health regularly. Diabetes self-management typically occurs in the home and includes:. People with diabetes can learn self-management skills through diabetes self-management education and support DSMES programs.Diabetes self-management strategies -
I am ready to do anything to control my diabetes. I am managing my time sometimes in the morning and sometimes in the afternoon for physical exercise. Also, I think being knowledgeable on the self-management strategies also helps to manage diabetes effectively.
Sometimes the support and cooperation from the family is helpful for the patients to do right things to manage diabetes at home. Few people with Type 2 diabetes and medical doctors stated beliefs on the alternative medicines were barriers for medication initiation and adherence.
Examples of alternative medicines from the people with Type 2 diabetes side was topical use of plant leaves on foot sole and consumption of some herbs and use of ayurvedic medications. Having a belief and practicing alternative medications was influenced by neighbours and people in the community.
They believe in ayurvedic medicine and consume it. Some of the diabetes patients come to us with complications, we provide them information on the medication and other self-care strategies, but they do not listen to what we told them.
When they go to their community, neighbours and other people told them the opposite of what we said. They believe these people and keep practicing traditional medicines. There is one type of plant Calotropis gigantea ; the leaf of the plant is believed to lower blood glucose level when the leaves are kept on the sole for overnight for a few days.
I tried this for three days, and I did not take medication these days. I consumed soaked fenugreek seeks for a month with a belief to control blood glucose level. But it did not work, and I again went to a doctor. After visiting a doctor, I have started to consume medication daily.
Many participants from all groups stated that the time factor is a barrier for women to stay active and do regular blood glucose monitoring. They have limited time for themselves to stay healthy. It is due to family commitments such as looking after kids and other family members. Medical doctors stated that time management to monitor blood glucose levels is difficult for working patients.
Most of the time, people with Type 2 diabetes had to take a day off to come to the health facility for blood glucose monitoring.
People with Type 2 diabetes who were labourers had a choice to come to a health facility or go to work to feed their family. I have so many things to do at home for example, doing household works, looking after kids and many more.
They are busy doing household chores from the morning till night. They really struggle to find a suitable time for exercise and go to health facilities for blood glucose monitoring.
Also, labour workforce is affected by time constraints. If they choose to come to a health facility, they had to leave work for that day resulting loss of daily wages to run a family. Participants such as people with Type 2 diabetes and their caregivers stated that lack of family support to manage diabetes is a barrier for diabetes self-management.
They further cited that female people with Type 2 diabetes had less support from their family to maintain healthy diet and comply with physical exercise requirements. Another illustration of their difficulty to maintain healthy diet was unavailability of diabetic meal at home.
It is not possible to ask family members to eat diabetic diet every day. Several doctors mentioned that negative influence from neighbours was reported as a barrier to continue medication intake and physical exercise.
Neighbours created confusion by telling people with Type 2 diabetes that medication had negative effects and expressed concerns over their daily physical exercise. These interference from neighbours plays a barrier to comply with diabetes self-management practices. Why are you going? Patients had to answer them each time and they feel demotivated to stay active.
For example, caregiver son motivated their parents provided time and financial resources to manage diabetes at home.
apart from emotional support, my son always gives me money to buy medicines and sometimes he bought medicine from pharmacy. The support I get from my family motivates me to manage diabetes.
I feel lucky to have a caring family. This supportive role was facilitated by knowledge on diabetes management and information sharing between people with Type 2 diabetes and family members.
Such support from family members, and the sharing of experiences among people with Type 2 diabetes, informed and motivated patients to sustain diabetes self-management practices. It really helps me. Sometimes they also go with me and sometimes they help me to reach health facility.
They can tell diabetes patients not to eat unhealthy food, take your medicine daily, go to health facility for regular blood glucose monitoring, when you are going somewhere, bring your medicine with you…these kind of suggestions from family can be helpful for diabetes patients.
Some people with Type 2 diabetes stated the positive role of neighbours to arrange transportation to travel to a health facility when family members were not at home, purchase vegetables from a market when people with Type 2 diabetes could not go and prepare sugar free meals for social events.
There is much help from neighbours. The relationship between doctor and people with Type 2 diabetes influences diabetes self-management practices positively and negatively. Limited time for counselling was a barrier for doctors to provide counselling because of their high load of patients.
Doctors were also unlikely to offer advice on foot care. Patients are not provided enough information as they need. Comprehensive counselling is needed to educate patients living with diabetes as they have to care for different aspects of diabetes management such as healthy eating, concordance with medication and physical exercise recommendation and other areas.
Also, counselling to the patient is needed on all aspects of diabetes self-care in each visit to a doctor.
However, doctors cannot provide detailed counselling on all aspects of diabetes self-management strategies due to lack of time and high patient load. Doctors were regarded as an enabling source of information about key areas of diabetes self-management practices such as the importance, dosage and timing of medication; and the benefits of exercise to maintain blood glucose levels.
Many participants particularly people with Type 2 diabetes were not aware of about other forms of physical activity such as yoga and bicycle riding, and people with Type 2 diabetes believed that other forms of exercise would help them to do regular physical exercise.
Information from the doctors about foot care and healthy eating were helpful in two ways for some of the patients. First, the people with Type 2 diabetes applied the information in their diabetes self-management practices; second, they shared the information received from the doctor with family members.
Knowledge sharing with family members helped create a supportive environment for diabetes self-management practices at home. If we, doctors, can provide detailed information to diabetes patients on when to take medicine, what is the duration of medicine intake, information on continuity of medicine, it helps.
It is helpful for diabetes patients to continue taking medicine. Good communication between doctors and people with Type 2 diabetes was another reported facilitator of diabetes self-management practices.
Good relationship between patient and doctor is helpful to manage diabetes. Most participants mentioned negative and positive cultural influences on dietary practices and medication compliance. People with Type 2 diabetes and caregivers reported dietary misconceptions influenced them to eat only certain vegetables, fruits and cereals.
The other barrier to maintaining a consistent healthy diet reported by several participants were food habits, such as a preference for a carbohydrate diet and bulky meal in the evening, and a craving for sweets Also, many participants cited that food preparation method, for instance use of a lot of oil, spices and overcooked food were barriers to eat healthy food.
Doctors stressed that consuming carbohydrate-based meal limits intake of other nutrients. We have a tradition of cooking food in a lot of oil and spices which is not considered healthy these days.
Also, we have a habit of consuming bulky food in the dinner. Generally, we do not care about eating balanced and healthy diet. We give preference to carbohydrate rich food and we eat bigger portion of it in each meal.
Social events such as festivals and social gatherings were seen as an excuse to eat unhealthy food, and encouragement or pressure from family members or peers to eat unhealthy food at social events presented further barriers. At times, when healthy food was unavailable at social events, it difficult for people with Type 2 diabetes to socialise.
Some of the diabetes patients have a feeling of eating food that they are not supposed to eat. The concept of preparing different meals for people with Type 2 diabetes and other members of a family has started to change.
Knowledge about the benefits of healthy eating motivated family members to adopt a healthy cooking style with less oil and fewer spices. Participants cited the availability of suitable food helped them to enjoy festivals, religious and cultural events.
Catering for the dietary needs of people with Type 2 diabetes was facilitated by family members and peers having more knowledge about healthy diets for diabetics. We, family, are being very supportive to our father-in-law. they are aware of diabetes diet.
I have no problem to eat healthy food during social functions. Resource availability and accessibility influenced diabetes self-management practices for people with type diabetes.
For example, diabetes self-management barriers included: the unavailability of suitable food at the market, home, and restaurant; unavailability of space for physical exercise in a community; and unavailability of year-round medications in health facilities. They have no choice to eat healthy options.
We have to go to market which is far from our community. Many participants including doctors and people with Type 2 diabetes cited that availability of healthy food options relates to the purchasing capacity of people with Type 2 diabetes.
Many doctors mentioned that recommended visits to a doctor could not be made when the health facility was far away from the community. This is particularly barrier for the people with Type 2 diabetes living in rural areas. The other concern from doctors was the prescribing and dispensing medicine by a non-licenced practitioner and without proper counselling to the patients.
This practice acts as a barrier for the people with Type 2 diabetes to understand the importance of medication and respond to side effects.
The capacity to buy healthy food is the underlying factor for people to afford healthy food available in the markets. Patients from remote areas have to walk whole day to go to primary health centre just to check blood glucose level.
When resources were available, people with Type 2 diabetes were enabled to adhere to recommended diabetes self-management practices. For example, the availability of suitable food near health facilities helped people with Type 2 diabetes to enjoy healthy meals during a visit to a doctor, and private pharmacies improved year-around availability of medicines.
Similarly, shorter distances between home and health facility enabled people with Type 2 diabetes to easily see a doctor. People with Type 2 diabetes were encouraged and motivated to follow recommended diabetes self-management practices when they had access to health facilities.
Money is quite expensive but I am happy that I can eat healthy food. I found it very easy to go to doctor because of availability of diabetes-friendly food. Sometimes I bought medicines from the private pharmacy when I realise when I have no medicine left. I do not bother about the cost in this kind of emergency.
patients also feel encouraged to maintain self-management strategies. Environmental factors negatively influenced people with Type 2 diabetes management of diabetes.
Participants such as public health officers and social worker stated that increasing urbanisation has limited areas for recreation and exercise, and increased pollution, which are barriers for physical exercise in urban areas.
Medical doctors also added that bad weather such as rain, landslide and humid were the deterrents for meeting physical exercise goals and medication adherence. People with Type 2 diabetes living in hilly region cannot buy medicines during monsoon due to non-availability of transportation.
Diabetes patients do not like to walk in the streets with inhalation of dust particles every single day. During summer the temperature outside is very hot that restricts to do physical exercise.
In the rainy season, there are few transports available or sometimes there is none in case of flooding or landslide. Many doctors and public health officers highlighted the lack of guidelines and policies as barriers to diabetes self-management practices.
They discussed the difficulties of providing counselling on diabetes self-management practices because Nepali-specific diabetes self-management counselling guidelines and protocols were unavailable. Such guidelines should incorporate the types of food available in the community and physical exercise methods appropriate to the Nepalese community.
In addition, there was no policy to increase the capacity of health facilities such as availability of laboratory tests in the health post and sub-health post levels. Lack of such policies put pressure on doctors, because there was less time available to provide the required counselling.
Furthermore, the lack of policy regarding free medication and free blood glucose monitoring tests limited people with Type 2 diabetes to the medication and blood glucose monitoring tests that were recommended by doctors who, without the benefit of policy and clinical guidelines, rely on their own knowledge or experience.
Such practice only resulted in inconsistent and variable advice being given to people with Type 2 diabetes. It is the main barrier. We give emphasis on communicable diseases. Economic circumstances were cited only as a barrier to diabetes self-management by all participants.
Lack of funds to attend health facilities, buy medication and conduct regular blood monitoring tests was a barrier to people with Type 2 diabetes. In addition, people with Type 2 diabetes who struggled with low financial resources, could not buy vegetables and other foods, and appropriate footwear.
A lack of money prevented people with Type 2 diabetes from following diabetes self-management practices despite being motivated to do so. How can I arrange for healthy foods?
And how can I go to health facility, and do blood glucose monitoring? On top of that, transportation cost is a burden for patients to go to health facilities.
Those who have money issues cannot do timely visits to a doctor. For example, even patients with diabetes are aware of the benefits of healthy diet, that will not solve the issue of healthy eating. If there is lack of money how can patients afford healthy diet?
This qualitative study explored a wide range of barriers and facilitators to improve diabetes self-management practices from perspectives of people with Type 2 diabetes, caregivers, medical doctors, district health managers and a social worker.
At individual level, knowledge, motivation, responsibility, beliefs and time constrains were the influencing factors for people with Type 2 diabetes to manage diabetes at home.
Our study highlighted a lack of knowledge as an important barrier to diabetes self-management practices, in line with previous review articles [ 60 , 61 ]. A qualitative study from South Asia supports our finding that lack of knowledge hindered people with diabetes to practice foot care [ 62 ].
Further, a review article from India found people with diabetes were unable to follow recommended medication and dietary guidelines, because of low health literacy about disease and its self-management [ 63 ]. However, a review study from United States argued that knowledge is not sufficient to carry out diabetes self-management practices.
Motivation was a facilitator of diabetes self-management practices. For example, motivation to stay healthy facilitated maintenance of physical exercise, and friends and peers were the sources of motivation to continue healthy lifestyle habits.
These findings are supported by previous work from Nepal, which shows that people with diabetes feel encouraged to stay physically active when they are supported by peers [ 31 ]. Responsible people are motivated to learn in-depth information about disease and its management.
In our study feeling of responsible towards diabetes self-management was influenced by the knowledge on the diabetes management strategies, which is supported by the previous study [ 66 ]. Past studies have described the complex relationship between diabetes responsibility and motivation in relation to self-efficacy for management of the disease.
Responsible people were motivated to learn in-depth about the disease and its management. Our study further expanded this finding by showing that feeling of responsibility towards diabetes self-management was influenced by the knowledge on the diabetes self-management strategies [ 66 ].
The feeling of responsibility, confidence and the ability to manage their health were associated with diabetes self-management [ 67 , 68 ]. Particularly, being confident in their actions and having a sense of self-efficacy made people with diabetes responsible for their health [ 69 ].
To illustrate, people with diabetes who were confident in their diet plans and medication regimens had controlled glycaemic levels [ 69 ]. For instance, individuals blamed themselves for not adhering to self-management recommendations when a glycaemic level was not maintained [ 70 ].
People with diabetes who feel the responsibility were taking appropriate actions to manage diabetes. For instance, responsible people were concordant with medication recommendations [ 71 ]. 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.
Previous studies have highlighted the relationship between motivation and responsibility of own health and diabetes outcomes [ 72 , 73 ]. Motivated people are more likely to adopt healthy lifestyles and become active to and feel responsible for the outcomes that were resulted from their behaviours [ 73 ].
There is some evidence that diabetes self-efficacy is correlated with self-management of the disease e. confidence towards diet, exercise and medical treatment.
A study from Nepal showed that people with diabetes having high level of self-efficacy were also confident, and were able to initiate and maintain physical exercise activities [ 30 ].
A study from Oman further linked diabetes self-efficacy with self-management practices including following healthy diet, engaging in physical activities, and regular blood glucose monitoring [ 66 ].
Combined with diabetes self-efficacy, adequacy of diabetes medication regimen and adherence, and compliance to the regimen is crucial for diabetes self-management and needs vigilant attention in community-based settings [ 69 ].
Time constrains was emerged as the barrier to manage diabetes at home. This was particularly applicable for the women. Further, women living with diabetes in our study received less support to manage diabetes.
Lack of support from family puts burden on women to look after themselves and dependents such as children. In the patriarchal society like Nepal, women are expected to do household chores, looking after children and elderly [ 31 ].
These responsibilities limits women to manage time to do physical exercise and visit to a doctor. At the interpersonal level, family, peers and neighbour either play a supportive role or become barrier to manage diabetes at home for people with diabetes. Consistent with previous findings [ 31 ], lack of support from close social contacts including family and friends was a barrier to physical exercise.
Furthermore, unsupportive family members to follow healthy diet was a barrier; similar findings are also reported from studies conducted in Africa [ 23 ] and Portugal [ 74 ] and United States [ 75 ].
Family support is dependent on the relationship between people with diabetes and other family members, and employment status [ 63 ]. As with other studies from the Asia, Africa, United states, Europe we found an enabling factor to adhere to recommended self-management practices was support from friends and family through motivation [ 10 , 19 , 30 , 64 , 74 , 76 , 77 ], and keeping the company when practising diabetes self-management [ 31 ].
The family motivates people with diabetes through reminding them to take medicines and providing them financial assistance for medicines and visits to a doctor. Family support is needed to maintain diabetes self-management practices at home through reminders and emotional support [ 63 ].
Shared of knowledge and experience of diabetes self-management practices among people with diabetes people helped them remain physically active.
This was also reported in a previous study from Nepal [ 31 ]. Our finding that neighbours were sometimes barriers to diabetes self-management practices is consistent with previous study from the capital city of Nepal [ 30 ].
In Nepalese society, people share their issues including health problems to neighbours and in return neighbours provides their viewpoint on the treatment and management of health problems based on their knowledge and experience. This practice is fostered by a lack of sufficient counselling from physicians.
One aspect of living in harmony in a community is having trust and respect to the neighbours. This might influence people to listen on health advice and follow it without evaluating the scientific value.
Insufficient support such as the lack and continuity of counselling from doctors were barriers to diabetes self-management practices. This finding corroborates a previous study from Bangladesh. People with diabetes might not understand the message completely from the health professionals due to lack of counselling in each visit.
This, avoids concordance with diabetes self-management practices [ 79 ]. Two reviews from South Asia reported that people with diabetes rely on doctors for reliable information on diabetes management [ 60 , 80 ]. However, given the increasing burden of diabetes and a low doctor to patient ratio in Nepal [ 37 ] it is unrealistic to expect such comprehensive counselling only from doctors.
In this study, inadequate information from low-level health care providers such as auxiliary health workers and health assistants on diabetes self-management practices was reported as a barrier to the provision of diabetes education.
A possible explanation could be that only There could be an opportunity to train lower level health care providers and nurses on diabetes education. Another option could be peer support programs and community-based programs to educate people with diabetes.
Recently, female community health volunteers have seen the potential of counselling and screening for diabetes in Nepal [ 83 ]. A good relationship between people with diabetes and doctors was found to be an enabling factor for diabetes self-management practices, a finding also reported by previous studies [ 31 , 34 , 77 ].
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.
Nepalese celebrate diverse festivals throughout the year; food preparation involves ghee clarified butter , sugar, refined flours, and different sources of fat [ 30 ]. Therefore, any future interventions for management of diabetes should have both cultural and contextual understanding of major risk factors of diabetes, and factors that lead to poorer health outcomes among people with diabetes [ 84 ].
Irregular supply of medicine in health facilities was a barrier to adhere to recommended medications. A regular supply of medicines to hospitals and PHCs would resolve this barrier. Recreational facilities in the community encourage people with diabetes to engage in and sustain regular physical exercise [ 63 ].
However, a lack of recreational public space is a barrier to physical activity, especially in urban areas, which was also reported in a study from Bangladesh [ 86 ]. Our finding that a locally available, nearby health facility was helpful for people with diabetes to visit when required has been recognised previously [ 10 ].
This study reported that lack of protocols and guidelines for medical doctors to provide diabetes education was a barrier, which is supported by the previous study from Nepal reporting the lack of contextual guidelines for diabetes management [ 33 ].
In recent years, the Government of Nepal has emphasised NCDs management, though a significant process is yet to be made in the implementation [ 87 ].
For instance, in , a multi-sectoral plan was adopted and a package for essential NCDs was launched [ 33 ], however that package does not include protocols for counselling on diabetes self-management practices.
Our study found that it was essential to develop protocols that address contextual socio-cultural factors in order to improve practice.
Another finding of this study was the need of culturally specific guidelines for diabetes self-management practices, also recommended by a previous review [ 60 ]. The Nepalese health system has several challenges such as inadequate budget allocation and lack of health insurance to cover diabetes care [ 33 ].
The availability of only one type of medicine at the district hospital and PHC level makes people with diabetes to buy other medication including insulin for diabetes at highly unaffordable price [ 88 ]. In addition, the provision of free diabetes medication and blood glucose tests in government health facilities was mentioned for consistent diabetes self-management practices in Nepal [ 33 ].
The economic burden of the cost of medication, blood glucose monitoring, a healthy diet and appropriate footwear was a barrier to manage Type 2 diabetes. These findings were confirmed in a multi-national study [ 25 ] and other study conducted in Bangladeshi context [ 89 ].
Although this study did not explore socio-economic status of people with diabetes, economic issue also contributes to non-compliance of self-management practices. Additionally, there is no insurance system in place.
The public health facilities at a district level in Nepal offers free service for consultation with medical doctors but the associated costs such as laboratory tests, medicine and transportation costs are not covered. This situation adds additional economic strain on people with diabetes and their families.
Additionally, patients find it difficult to regularly purchase healthy food because of increasing prices [ 33 ].
The triangulation of multiple views helped to identify barriers and facilitators to diabetes self-management practices, which can be used to initiate strategies to overcome barriers and reinforce facilitators. In addition, information on barriers, facilitators and improvement of diabetes self-management practices can be useful when developing programs to improve diabetes self-management knowledge, skills and practices of people with diabetes [ 91 ].
Data was collected in the Nepali language by a native speaker, which facilitated the emotions and perspectives to be captured without distortion.
Finally, this study will serve as a baseline information for the future research of diabetes self-management practices in Nepal. This study was subject to certain limitations. First, it included people with Type 2 diabetes who attended public health facilities and included doctors and district health managers who all belonged to government organisations.
Like elsewhere in low and middle-income countries, public sector facilities are major gateway of health services for the management of diabetes among low socio-economic status patients in Nepal.
Therefore, the findings cannot be easily generalised to people with diabetes who receive private care. Secondly, the findings should be interpreted with caution, as this study did not explore socioeconomic status of the people with diabetes. Future studies are needed to shed light upon such factors.
People with Type 2 diabetes experience different types of barriers and facilitators to diabetes self-management practices. The important barriers were lack of knowledge of people with Type 2 diabetes about diabetes self-management practices, cultural practices related to diabetes self-management, insufficient counselling from doctors, lack of guidelines and protocols for counselling, lack of availability and accessibility of resources, and financial problems.
The major facilitators were motivation to practice diabetes self-management, self-responsibility for disease management, support from family and peers, support from doctors, and the availability of resources in the community.
Some programmatic recommendations are suggested on the basis of this study. Also, programs should be developed with an emphasis to improve self-efficacy of the people with diabetes to comply with diabetes management recommendations.
Individuals and families under economic hardship and those who lack family support should receive better attention during design of future interventions. Second, evidence based guidelines for health workers to educate or counsel people with diabetes on diabetes self-management practices is needed [ 93 ], as are and programs and guidelines for program managers public health professionals and senior medical officers to implement self-management packages.
Third, understanding of issues for managing diabetes self-management from multiple actors is paramount as well as engaging multidisciplinary team for diabetes care and management [ 92 ].
Fourth recommendation is to train low-level health workers to provide diabetes self-management education to people with diabetes. Further, community awareness programs should be developed to increase knowledge about diabetes self-management practices among general population as well as people with diabetes.
Finally, self-help support groups can be introduced to provide counselling in diabetes self-management practices and emotional support to people with diabetes. The transcript can be made available for the institution or Individual with special need or request based on case by case basis.
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Higher educational levels were also associated with better adherence to diabetes medications, medical nutrition therapy, and better interactions with doctors [ 43 , 44 ]. Similarly, patients with higher educational levels are more likley to engage in DSM education programs and practices.
Our study showed that participants following recommendations for medical nutrition therapy and physical activity had significantly higher DSMI scores than others.
Additionally, medication adherence, medical nutrition therapy and regular physical activity are the focus of the DSM education programs which provide the knowledge and skills to help optimize glucose levels and prevent diabetes complications.
Notably, this study showed that the rate of good glycemic control was While this result is in line with other studies in Vietnam and other countries [ 45 — 47 ].
Although there are now many diabetes medications available to treat people with DM, there is still a need for use of these medications to be optimized.
Clearly, engaging in DSM including adherence to DM medications helps people living with diabetes to achieve glycemic control reinforces their confidence in diabetes self-management [ 48 ].
In this study, other demographic and clinical factors were not significantly related to the total DSMI score. The multivariate linear regression model results lead to the conclusion that DSMI total score can be predicted through sex, educational status, BMI, waist circumference, medical nutrition therapy, and sufficient physical activity.
Sex plays an important role in adherence to self-management. As was the case in this study, female patients have been shown to more frequently engage in DSM, be more focused on self-care, and to search diabetes information more than males in a previous study [ 49 ].
Abdominal obesity has been shown to be a barrier to DM in self-management as those with bigger waist circumference were found to have more limitations in physical activities resulting in a obstacle to diabetes self-management [ 50 ].
Patients with DM with high BMI are generally well aware of the need to strictly follow physical activity and medical nutrition therapy regimens as well as healthy medication adherence behaviors [ 51 ].
However, there are some limitations in this study. First, a cross-sectional study at a single hospital with convenience sampling may not be generalizable to the whole picture of DSM among Vietnamese patients with DM.
The sample size was We were unable to use the shortened version of the DSMI which includes 20 items because it is currently unavailable in Vietnamese. The short version may be preferable for wider scale future administration, however, use of the full DSMI did allow us to obtain interesting insights into DSM in the present study.
Fourth, other related variables which might affect DSM status in people with diabetes, including prior participation in DSM education known to be essential to successfully acquiring DSM skills and knowledge, psychological illness including diabetes distress, depression, etc , medical insurance status, isolation status due to the COVID pandemic, and medical treatment costs were not collected in this study.
These limitations highlight the need for future research on DSM and the need for diabetes self-management education and support in adults living with DM in Vietnam.
The results of this cross-sectional study of the state of DSM among patients with diabetes at a single hospital in central Vietnam demonstrates that the status of diabetes self-management may be classified as average at this time, as reflected in the mean DSMI score of Female sex, higher educational status, higher BMI and waist circumference, following a medical nutrition therapy plan and regular sufficient physical activity were independently predictive factors of DSMI total score.
These findings demonstrate a need for improvement in diabetes self-management in the central region of Vietnam. There is clearly a need for further research into strategies to provide diabetes self-management education and support, particularly among those who are male, have a lower educational status and are not following medical nutrition therapy and regular physical activity regimens.
The authors would like to thank the patients who agreed to participate in this cohort study. Our sincere gratitude is expressed to Tiet-Hanh Dao-Tran and her colleagues for the Vietnamese version DSMI.
Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Article Authors Metrics Comments Media Coverage Reader Comments Figures. Abstract Objective Diabetes self-management DSM enables maintenance of optimal individualized glycemic control for patients with diabetes through comprehensive lifestyle, medication adherence, and self-monitoring glucose level.
Methods A cross-sectional study was conducted at a single hospital in the central Vietnam. Results The mean total DSM score based on DSMI self-administered questionnaire scores was Conclusion This study emphasizes that the DSM situation is seen to be average among DM patients with mean DSMI score Funding: The authors received no specific funding for this work.
Introduction Globally, diabetes mellitus DM is recognized as one of the four major non-communicable diseases besides cardiovascular disease, cancer, and chronic respiratory diseases. Methods Study design and sampling From March to May , we conducted a cross-sectional study among outpatients at the Center of Endocrinology and Diabetes, Da Nang Family Hospital, Da Nang, Vietnam.
Ethical approval This study was conducted in accordance with the Declaration of Helsinki. Data measurements Socio-demographic information. Clinical features.
The Diabetes Self-Management Instrument DSMI. Data analysis To perform all data analysis, SPSS software version Results A total of participants consented to join the study among whom Download: PPT.
Table 1. Socio-demographic characteristics of DM participants. Table 2. Diabetes self-management scores and internal consistency. Table 3. The mean total DSMI scores across groups by socio-demographic characteristics. Table 4. Clinical characteristics and the mean total DSMI scores by clinical characteristics.
Table 5. Factors independently predictive of total DSMI score via multiple linear regression analysis. Discussion Diabetes self-management can help achieve good individualized glycemic control to reduce the risk of diabetes microvascular and macrovascular complications [ 36 , 37 ].
Conclusion The results of this cross-sectional study of the state of DSM among patients with diabetes at a single hospital in central Vietnam demonstrates that the status of diabetes self-management may be classified as average at this time, as reflected in the mean DSMI score of Supporting information.
S1 Data. s XLSX. Acknowledgments The authors would like to thank the patients who agreed to participate in this cohort study.
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Improving Care and Promoting Health in Populations: Standards of Medical Care in Diabetes— Diabetes Care, Serrano-Gil M. and Jacob S. Advances in therapy, Powers M. The Science of Diabetes Self-Management and Care, Lin K. Diabetes research and clinical practice, Houle J.
Diabetic Medicine, Al-Khawaldeh O. Journal of Diabetes and its Complications, You can choose what, when, and how much to eat. Healthy meal planning is an important part of your diabetes treatment plan.
Decide to be physically active. This helps you keep your cholesterol, blood pressure, and blood sugar under control. Take your medications. You can all take your medications as instructed by your healthcare team, and keep track of your blood sugar levels on your own.
Keep a log book. You can learn which numbers are important for telling you how well you are doing and then watch them improve over time by keeping a log book of your A1C, blood pressure, cholesterol, and so on.
Take the book along to your appointments so you can discuss changes or new instructions with your healthcare team. Watch for symptoms or changes in your health. You can learn which symptoms or changes are important for you to watch out for and tell your doctor about.
Talk with your healthcare team if you feel overwhelmed or unable to manage one or more aspects of your diabetes management. Ask questions when you are not sure about something. Talk with others who are living well with diabetes and kidney disease. They can understand your situation in a special way and give you support.
Get tested for kidney disease.
For self-manage,ent information about PLOS Diabetes self-management strategies Areas, click here. Diabetes sslf-management DSM enables maintenance of optimal individualized Diabetes self-management strategies self-managemejt for patients with Healthy energy-boosting capsules through comprehensive Diabstes, Diabetes self-management strategies adherence, and self-monitoring glucose level. This study aimed to evaluate DSM and to find associated factors among Vietnamese diabetes patients by using the Vietnamese version of Diabetes Self-Management Instrument DSMI. A cross-sectional study was conducted at a single hospital in the central Vietnam. DSM was assessed using the DSMI. Multivariate linear regression was used to determine independent factors associated with total DSMI.
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