Development and evaluation of self-care intervention to improve self-care practices among people living with type 2 diabetes mellitus: a mixed-methods study protocol

Understanding the diabetes self-care behaviour in rural areas: Perspective of patients with type 2 diabetes mellitus and healthcare professionals

BACKGROUND

Diabetes self-care behaviour plays a crucial role in managing the diabetes effectively and preventing complications. Patients with type 2 diabetes mellitus (T2DM) and health care professionals (HCPs) of rural areas often face unique challenges when it comes to diabetes self-care practices (SCPs). Therefore, this study aim to explore the perspectives of patients with T2DM and HCPs on diabetes SCPs.

METHODS

Eight focus group discussions (FGDs) among individuals with T2DM and In-depth interviews (IDIs) with 15 HCPs were conducted in rural areas of Punjab, North India. Capability, Opportunity, Motivation, and Behaviour model (COM-B) was employed for thematic framework analyses.

RESULTS

The study participants perceived that a limited understanding of diabetes mellitus (DM), beliefs in alternative therapies, drug side effects, attitudes towards DM (psychological capability), comorbidities (physical capability), family support (social opportunity), financial and time constraints, and weather conditions (physical opportunity) contributed to lack of DM SCPs. Physicians' guidance and support were motivating them to adhere to SCPs, especially when aligned with their sense of self-efficacy (reflective motivation). HCPs constraints in providing patient-centred care are due to training limitations (psychological capability) and a lack of essential resources (physical opportunities). Participants expressed need for comprehensive diabetes care (automatic motivation) through structured diabetes education intervention to improve diabetes SCPs.

CONCLUSIONS

The study findings indicate that various factors influence diabetes SCPs from the perspectives of both patients with T2DM and HCPs and emphasizes the need for a multi-faceted approach to improve diabetes SCPs in rural areas. Implementing a structured diabetes self-care intervention strategy in rural areas may help for preventing and mitigating the impact of diabetes-related complications in rural areas.

Diabetes Health Literacy, Drug Adherence and Factors Associated with Them among Urban Patients in Kerala, India

Aims

The study aimed to assess diabetes health literacy, adherence to diabetes medication, and its associated factors in Kerala, India, the most advanced Indian state in epidemiological transition with the highest literacy level in India.

Materials and methods

We conducted a community-based cross-sectional study among 280 diabetes patients (mean age 62 years, male 42%) selected by multistage cluster sampling. Information on sociodemographic variables was collected using a pretested structured interview schedule. Diabetes health literacy was assessed using the revised Michigan Diabetes Knowledge test. Adherence to diabetes medication was assessed using the Hill-Bone subscale. Binary logistic regression analysis was done to find out the factors associated with diabetes health literacy and medication adherence.

Results

Good diabetes health literacy was reported by 35.7% [95% confidence interval (CI): 30.1-41.6] of the patients. Perfect adherence to diabetes medication was reported by 33.2% of patients (CI: 27.7-39.1). Patients who reported regular newspaper reading [adjusted odds ratio (AOR) 3.16; CI: 1.57-6.30], using the internet (AOR 2.23; CI: 1.11-4.50) and insulin use (AOR 2.60; CI: 1.35-5.00) were more likely to report good diabetes health literacy compared to their counterparts. Patients who reported reading health magazines (AOR 2.75; CI: 1.01-7.60) were more likely to report perfect medication adherence compared to those who did not.

Conclusion

Why diabetes health literacy and medication adherence were low among diabetes patients in the most literate state needs further investigation. Interventions to enhance diabetes health literacy and medication adherence may be undertaken among diabetes patients encouraging them to read newspapers and health magazines regularly and use the internet.

Diabetes-related distress and its impact on self-care of diabetes among people with type 2 diabetes mellitus living in a resource-limited setting: A community-based cross-sectional study

AIM

To assess the a) prevalence, b) factors associated, and c) effect on self-care practices (SCP) of diabetes related distress (DRD) among patients with Type 2 Diabetes Mellitus (T2DM) in rural Punjab, India.

METHODS

Amongst the cohort of 700 patients, the Diabetes Distress Scale-17 (DDS-17) was used to assess DRD and the Summary of Diabetes Self Care Activities scale (SDSCA) for diabetes SCP. Multivariable logistic regression identified the factors associated with DRD.

RESULTS

DRD was universal [severe or moderate in 391 (56%) and 309 (44%) patients, respectively]. Hypertension increased the odds of severe DRD [aOR 3.47; 95% CI:2.48-4.87, p-<0.01] whereas living in a joint family reduced the odds of severe DRD [aOR 0.68; 95% CI: 0.47-0.97, p- 0.03]. Patients with severe DRD were less likely to perform DM SCPs [aOR 0.53; 95% CI:0.32-0.85, p-0.01].

CONCLUSIONS

The burden of DRD was alarmingly high. There is an urgent need to screen, prevent and treat DRD to improve selfcare in T2DM.

Foot Self-Care Behaviour among People with Type 2 Diabetes mellitus Living in Rural Underserved Area of North India: A Community-Based Cross-Sectional Study

The objective of this study was to ascertain the foot self-care behaviour and its associated factors among people with type 2 diabetes mellitus (T2DM) living in the rural resource-constrained health setting of Punjab, North India. A community based cross sectional study was undertaken in the randomly selected underserved rural area of District Fatehgarh Sahib, Punjab, North India. A pre-validated Nottingham Assessment of Functional Footcare (NAFF) scale was administered to assess foot self-care behaviour, and participants were classified based on the percentage of a maximum possible score of 84 on the scale, as poor, if the score was <50%, satisfactory if score 50%-70% and >70% good foot self-care behaviour. A total of 700 participants' responses were recorded. The study results revealed that 84% (588) of the respondents had poor, 16% (112) had satisfactory, and none were following good foot self-care behaviour. An outcome of multivariable logistics regression suggested satisfactory foot self-care behaviour was significantly associated with foot self-care education, with an adjusted odds ratio (aOR) of 2.83 (95%, CI:1.62 - 4.93; p <0.01) among respondents who had received foot self-care education, literate than illiterate (aOR 2.50 95%, CI:1.31- 4.74; p <0.01) and women compared to men (aOR 1.69 95%, CI: 1.06 -2.70; p -0.26). This study revealed that foot self-care behaviours were alarmingly low among people with T2DM living in rural resource-constrained health settings of Punjab, North India, suggesting an urgent need to disseminate foot self-care education to prevent diabetes foot related complications.