Enablers of and Barriers to Effective Diabetes Self-Care in Iran: A Qualitative Study

Figures & data

Table 1 Demographic Characteristics of Participants

Code	Participants	Age, years	Sex	Education	Job
1	Diabetic patients	54	Male	Bachelor’s degree	Retired
2		40	Male	Associate degree	Repair of home appliances
3		35	Female	Bachelor’s degree	Housewife
4		46	Male	Bachelor’s degree	Self-employed
5		41	Female	Bachelor’s degree	Teacher
6		54	Female	Diploma	Housewife
7		39	Male	Associate degree	Bus driver
8		45	Female	Associate degree	Housewife
9		37	Female	Bachelor’s degree	Housewife
10		50	Female	Diploma	Housewife
11		58	Male	Elementary school	Self-employed
12		43	Male	Diploma	Truck driver
13		46	Female	Associate degree	Employee
14		54	Male	Incomplete diploma	Worker
15		56	Female	Bachelor’s degree	Retired
16		35	Male	Diploma	Free
17		55	Female	Incomplete diploma	Housewife
18		56	Female	Elementary	Shopkeeper
19		40	Female	Bachelor’s degree	Employee
20		47	Male	Elementary	Worker
21		50	Male	Diploma	Worker
22	Personnel of centers and clinics	35	Male	PhD	Doctor
23		38	Female	PhD	Doctor
24		35	Male	Bachelor’s degree	Employee
25		35	Female	Bachelor’s degree	Employee
26	Patients’ family members	25	Female	Associate degree	Secretary
27		30	Female	Bachelor	Employee
28		32	Male	Diploma	Free

Table 2 Summarized Demographic Information of Participants

		n	Percentage
Sex	Male	13	46.4
	Female	15	53.6
Age, years	<30	11	39.3
	40–50	8	28.6
	≥50	9	32.1
Education	Incomplete diploma	5	17.9
	Diploma and higher	11	39.3
	Bachelor’s degree and higher	12	42.8

Table 3 Classes and Subcategories Extracted From Interviews

	Subcategories
Access	Sports facilities, healthy nutrition (ability to buy healthy food), health facilities, information
Environmental factors	Supporting authorities, challenging conditions
Behavioral habits	Physical activity, healthy diet
Individual factors	Seeking awareness, information deficits, self-indulgence, spirituality, reasoning, paying attention to illness, misconceptions, and chaos

Table 4 Subcategories and Primary Codes Extracted From the Access Class

	Subcategories
Sport facilities	Proximity to a park, proximity to the gym, exercise at home, yard, free use of gymnasiums, appropriate weather conditions
Healthy diet	Ability to buy healthy food according to the family’s economic situation
Health facilities	Proximity to the clinic, proximity to diabetes counseling centers and clinics, access to physicians and nurses in the family, having blood sugar
Information	Having a knowledgeable person at home, access to the Internet, access to books and magazines and brochures, consulting with a doctor and a nurse, joining relevant social networks

Table 5 Subcategories and Sample Primary Codes Extracted From Environmental Factors

	Subcategories
Sources of  support	Friends, relatives, family, colleagues, patients, physicians, nurses, and experts encouraging self-care behavior, being in charge of family, physician and family pressure, having athlete friends and associates, relationships with relatives and colleagues, communicating with successful patients
Specific conditions	Travel, lack of access to proper food, being forced to eat fast foods, stress, business, fatigue, mental activity

Table 6 Subcategories and Examples of Basic Codes Extracted From Behavioral Habits

	Subcategories
Behavioral habits	Physical activity: a sense of satisfaction and happiness, interest, and addiction to sports, family and coworker pressure, interest in group sports, more comfortable in group sports, and awareness of exercise results
	Healthy nutrition: interest in fruit consumption, interest in diet foods, eating light foods, making separate meals, not eating rice, avoiding oil, dislike of drinks and snacks, getting used to the diet

Table 7 Subcategories and Sample Codes Extracted From Individual Factors

	Subcategories
Seeking consciousness	Attending counseling classes, using the Internet, using magazines and books, reading brochures in class, asking questions of experts and physicians, viewing health network, learning to read, asking questions, remembering
Defective information	Using inaccurate information, imitating others, getting information from untrustworthy sites, not attending counseling classes, forgetting things, too much work
Self-induction	Observing the side effects of those affected, seeing people successful in treatment, and feeling better
Spirituality	Having strong patience and faith, a sense of trust, and hope and spirit
Unreasonable reasons for not doing the behavior	Weaknesses, being a spouse, worrying about the host being upset, being alone in the house, being embarrassed by sport in the park, being at home easier, fasting, being a hereditary illness, everyone thinking of themselves, being ignorant of others, natural desire for delicious foods, difficulty accepting illness, fatigue, insomnia, late-night sleep, old age, overwork, mental illness, and other underlying diseases (low-back pain), expense
Not important to control the disease	Importance of health, having a positive sense of behavior, sense of compulsion, not paying attention to others’ misconceptions, high level of awareness, strong will, the importance of timely medication and diet
Myths	Unbelievable disease, hereditary disease, untreatable disease, chemical medication, complicated medication, no complications, old age, industrial, medicinal, chemical
The mess	Fear of complications, observation of complications, awareness of consequences of complications, stress of daily medication use, the stress of insulin injection, hopelessness of treatment, accompanying illness for life