Self-Care Practice and Associated Factors Among Patients with Type 2 Diabetes Mellitus at a Referral Hospital in Northern Ethiopia – A Mixed Methods Study

Abstract

Introduction

Diabetes self-care is important to maintain optimal glycemic control and prevent debilitating and costly complications. Diabetes self-care may be improved through the identification of individual and group barriers to regimen adherence and subsequent development of specific plans to overcome these barriers. This study assessed the self-care practice and associated factors among type 2 diabetes patients attending their treatment at Dessie Referral Hospital, Dessie, North-Eastern Ethiopia.

Methods

The study employed parallel mixed methods design which followed a cross-sectional interview and in-depth interview methods, respectively, from September to October 2019. The collected data were subjected to descriptive and inferential analysis for the quantitative part and a thematic analysis for the qualitative part.

Results

A total of 328 type 2 diabetes patients participated in the study of which 50.3% reported good self-care practice. Being in the age category of 60–69 years old (AOR = 0.334, 95% CI (0.135, 0.951)), being ≥70 years old (AOR = 0.359, 95% CI (0.135, 0.951)), having complications (AOR = 1.956, 95% CI (1.172, 3.262)), having co-morbidity (AOR = 0.443, 95% CI (0.262, 0.749)) and diabetes education (AOR = 2.684, 95% CI (1.633, 4.412)) were significantly associated with good diabetes self-care. Accessibility, social support, knowledge and beliefs and diabetes-related morbidities were identified as barriers to diabetes self-care by the patients.

Conclusion

The findings from this study revealed that only half of the type 2 diabetes patients who participated in this study reported good self-care practice. Different factors, including diabetes education, were significantly associated with good diabetes self-care according to the quantitative study. This was supported by the findings from the qualitative part and thus the recommendation to strengthen diabetes health education to patients and their families.

Keywords:

• type 2 diabetes mellitus
• barriers to self-care practice
• diabetes education
• mixed methods study
• Ethiopia

Abbreviations

DM, Diabetes Mellitus; DSC, Diabetes Self-care; IDF, International Diabetes Federation; SDSCA, Summary of Diabetes Self-care Activities.

Data Sharing Statement

The tools that were used for both the quantitative and qualitative parts of the study are included as additional files. The datasets that were generated during the current study are not publicly available due to reasons of confidentiality and anonymity.

Ethical Approval and Consent to Participate

The study was done in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from Research Ethics Committee of the College of Medicine and Health Sciences, Wollo University (CMHS/013/519/12) that was followed by permissions from the administrator of the study hospital prior to starting data collection. Oral informed consents were obtained using pre-prepared information and consent form from all participants before the data collection. This consent process which used plain language and was also approved by the Research Ethics Committee of Wollo University (CMHS/013/519/12) involved information about the purpose of the study, procedures to be followed, confidentiality issues, anticipated benefits and harms/discomforts that participation in the study entails including possible publication of anonymized responses, and the voluntary nature of the participation with the full right to refuse and withdraw their participation at any time. The oral consent process is customary in the study setting for such type of observational studies where majority of the population have low educational status and tries to avoid written consents and signatures which may be considered “risky”.

Acknowledgments

The authors acknowledge the data collectors for their devotion in collecting the data. Furthermore, they wish to express their appreciation to the study participants for their keen and honest response. The authors also would like to acknowledge the Michigan Diabetes Research Center (MDRC), University of Michigan Medical School, which was supported by Grant Number P30DK020572 (MDRC) from the National Institute of Diabetes and Digestive and Kidney Diseases for permitting use of the DKT2 and the Oregon Research Institute for permitting use of the SDSCA survey instruments, respectively.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

The source of funding which was part of the graduate study of the first author was Wollo University.