Patients and healthcare providers needs and challenges in diabetes self-management and support in Ethiopian primary healthcare context

Abstract

BACKGROUND: It’s crucial for individuals with diabetes to practice effective self-management to reach their treatment goals and to prevent complications. AIM: This study aimed to explore needs and challenges in diabetes self-management for patients with type 2 diabetes (T2D) and healthcare providers in Addis Ababa, Ethiopia, between February and April 2023. METHODS: This study employed a mixed method approach, with an exploratory qualitative study, including in-depth interviews with 22 patients with diabetes and key informant interviews with 25 healthcare providers. Additionally, we conducted a quantitative assessment of 26 primary health care facilities to understand facility-related factors that impact diabetes self-management practices. Thematic analysis was performed using a deductive coding approach following the socioecological model, with the help of Open Code software. FINDINGS: This study revealed that poor diabetes self-management practices are a major risk factor for blood glucose control among patients with type 2 diabetes. Patients struggled with misconceptions, low health literacy, dietary preferences, a lack of glucometers, financial constraints, age-related issues, and comorbidities. Healthcare system factors included insufficient trained staff, the absence of health insurance coverage, inadequate diabetes education, the scarcity of educational resources, and limited access to affordable diagnostic facilities. At the community level, a lack of social support, self-stigma, religious fasting practices, and restricted access to diverse food options were prominent obstacles. Patients expressed preferences for accessible educational materials such as pamphlets, mobile messages, and localized TV programs. Healthcare providers emphasized the necessity for culturally appropriate guidelines tailored to local contexts, emphasizing patient understanding and personalized care. CONCLUSIONS: This study found that inadequate diabetes self-management practices are the risk behaviours for poor blood glucose control in patients with T2D and these issues are associated with challenges at the patient, organizational, and community levels. This study highlights the need for tailored diabetes self-management programs in Ethiopian primary healthcare, considering local contexts, diabetes health literacy, participant demographics, and evolving patient needs.

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