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

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
• patient-derived solutions
• multidisciplinary
• chronic disease care

Responsible Editor Maria Emmelin

Responsible Editor Maria Emmelin

Acknowledgments

The authors wish to acknowledge the following persons for their contributions towards the successful implementation of this study: B. Jwili, K. Ndibaza, L. Sandile, T. Manuga, K. Mphiti, M. Hassen (data collection); D. Prozesky, University of Botswana Department of Medical Education (assigned reading critic when this manuscript was conceived during a writing workshop); and the patients and HCWs at the two Community Health Centers for their assistance and support.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics and consent

Ethics clearance was received from the University Biomedical Ethics Review Board (BMREC Nb 130416-050). Local authorities granted permission to access the study sites (permit WC_2017RP50_730). Health facilities participating in the study also granted permission to access the facilities and patients. Written informed consent was obtained from all participants in the study.

Paper context

Patients attending chronic disease clubs in South Africa are expected to practice self-management of their diseases, but they face significant challenges. We unravelled their experiences, challenges, and barriers to practising optimal self-management. They have previously not been asked to provide their voice on solutions to these. This study went a step further and solicited solutions to improve self-management from these patients and their providers experiencing self-management in one of the largest townships in South Africa.

Additional information

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.

Notes on contributors

Absetz Pilvikki

T.M., P.D., and T.P. conceived and planned the project and supervised data collection. T.M, S.O., and P.D. carried out the analysis. T.M., S.O., P.A, H.A., P.D., and T.P. contributed to the interpretation of the results. P.A. and H.A. provided critical guidance on qualitative methodology. T.M. led the writing of the manuscript. All authors reviewed several versions of the manuscript and provided critical feedback and helped shape the research, analysis, and manuscript. All authors approved the final manuscript before submission.