Diabetes self-management: a qualitative study on challenges and solutions from the perspective of South African patients and health care providers

Tiny Masupe; Sunday Onagbiye; Thandi Puoane; Absetz Pilvikki; Helle Mölsted Alvesson; Peter Delobelle

doi:10.1080/16549716.2022.2090098

Diabetes self-management: a qualitative study on challenges and solutions from the perspective of South African patients and health care providers

Glob Health Action. 2022 Dec 31;15(1):2090098. doi: 10.1080/16549716.2022.2090098.

Authors

Tiny Masupe^{1

2}, Sunday Onagbiye³, Thandi Puoane², Absetz Pilvikki⁴, Helle Mölsted Alvesson⁵, Peter Delobelle^{2

6

7}

Affiliations

¹ Department of Family Medicine & Public Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
² School of Public Health, University of the Western Cape, Bellville, South Africa.
³ The Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom Campus, Potchefstroom, South Africa.
⁴ Collaborative Care Systems Finland, Helsinki, Finland.
⁵ Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
⁶ Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa.
⁷ Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium.

Abstract

Background: Health education and self-management are among key strategies for managing diabetes and hypertension to reduce morbidity and mortality. Inappropriate self-management support can potentially worsen chronic diseases outcomes if relevant barriers are not identified and self-management solutions are not contextualised. Few studies deliberately solicit suggestions for enhancing self-management from patients and their providers.

Objective: This qualitative study aimed to unravel experiences, identify self-management barriers, and solicit solutions for enhancing self-management from patients and their healthcare providers.

Methods: Eight in-depth interviews were conducted with healthcare providers. These were followed by four focus group discussions among patients with type-2- diabetes and or hypertension receiving chronic disease care from two health facilities in a peri-urban township in Cape Town, South Africa. The Self-Management framework described by Lorig and Holman, based on work done by Corbin and Strauss was used to analyse the data.

Results: Patients experienced challenges across all three self-management tasks of behavioural/medical management, role management, and emotional management. Main challenges included poor patient self-control towards lifestyle modification, sub-optimal patient-provider and family partnerships, and post-diagnosis grief-reactions by patients. Barriers experienced were stigma, socio-economic and cultural influences, provider-patient communication gaps, disconnect between facility-based services and patients' lived experiences, and inadequate community care services. Patients suggested empowering community-based solutions to strengthen their disease self-management, including dedicated multidisciplinary diabetes services, counselling services; strengthened family support; patient buddies; patient-led community projects, and advocacy. Providers suggested contextualised communication using audio-visual technologies and patient-centred provider consultations.

Conclusions: Community-based dedicated multidisciplinary chronic disease healthcare teams, chronic disease counselling services, patient-driven projects and advocacy are needed to improve patient self-management.

Keywords: Self-management; Type-2-diabetes; barriers; chronic disease care; multidisciplinary; patient-derived solutions.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Diabetes Mellitus, Type 2* / psychology
Diabetes Mellitus, Type 2* / therapy
Health Personnel / psychology
Humans
Hypertension*
Qualitative Research
South Africa

Grants and funding

This work was funded by the European Commission Horizon2020 Health Coordination Activities [Grant Number 643692] under call ‘HCO-05-2014: Global Alliance for Chronic Diseases: prevention and treatment of type 2 diabetes’. The SMART2D consortium includes Karolinska Institutet and Uppsala University, Sweden; the Institute of Tropical Medicine, Belgium; Collaborative Care Systems, Finland; Makerere University, School of Public Health, Uganda; and the University of the Western Cape, School of Public Health, South Africa. The contents of this article are solely the responsibility of the authors and do not reflect the views of the EU.