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

Figures & data

Table 1. Characteristics of HCWs in the in-depth interviews.

Facility name	Cadre	Gender	Years of Workexperience
Facility A	Health promoter	Male	8
Facility A	Dietician	Female	2
Facility A	Clinical nurse practitioner 1	Female	>20
Facility A	Clinical nurse practitioner 2	Female	>20
Facility A	Clinical nurse practitioner 3	Female	10
Facility B	Facility manager/ clinical nurse practitioner	Female	>20
Facility B	Clinical nurse practitioner 4	Female	>20
Facility B	Social worker	Female	11

Table 2. Composition of the FGDs.

Group number	Number of participantsper group	Facility	Gender
			Female	Male
1	13	Facility B	9	4
2	10	Facility B	10	0
3	8	Facility A	6	2
4	12	Facility A	10	2

Table 3. Summary of themes derived from the data.

Themes	Categories	Subcategories
Behavioural and medical (self-) management	Patient internal behavioural mediators	Lack of understanding, Low health literacy, Poor self-control
	External behavioural mediators	Marketing of unhealthy food, Cultural Influences, Affordability of healthy food
Role management	Interaction with health care professionals	Feeling disrespected by HCWs, Fear appeals, Dishonest behaviour
	Family support	Feeling unsupported
	Perceived stigma	Fear of disclosure, Self-isolation
Emotional management	Reactions to diagnosis	Shock/disbelief, Fear and depression
	Coping with diagnosis	Rationalization of diagnosis, Lack of acceptance, Seeking divine help, Non-adherence
Barriers to self-management	Patient-related mediators	Treatment side effects, Lack of education, Poor decision making, Entitlement mentality
	External factors	HCW attitude, Television advertising, Inadequate community services, Travel and migration, Staff shortage
Solutions for enhancing self-management	Patient-centred approaches	Individual consultations, Contextualised communication, Use of audio-visual material, Family support, Use available resources
	Community engagement	Community projects, Empowerment of street vendors, Patient advocacy
	Strengthened diabetes care services	Designated counselling services, Dedicated healthcare team, Treatment buddy, Community health worker, capacitation