Barriers and Determinants of Diabetes Self-Management Among Palestinian Refugees in Jordan: A Mixed-Methods Study

Introduction: Diabetes mellitus is one of the highest causes of death around the world as one out of eleventh adults have diabetes mellitus. In Jordan, the prevalence of diabetes mellitus was projected to be around 16% in 2020. Our study aims to understand the compliance and efficacy for self-management among refugees living with diabetes mellitus in the Jordanian Nuzha health centers. Methods: Structured interviews with short questionnaires, focus group discussions (FGDs), and semi- structured interviews with healthcare providers. The study population was based on a sample of patients who visited the Nuzha health centers. Results: A total of 30 participants at UNRWA Nuzha Health Center participated in the questionnaire. Notably, most participants demonstrated high self-efficacy for controlling one’s DM (83%) and high perceived ability to find the support and medical resources for management (87%). Additionally, most participants showed robust knowledge in the importance of diet and exercise for the management of DM (93% for both variables). This study also reports that 11 participants were overweight, 9 had Class I obesity and 6 had Class II obesity. Conclusion: Limitations of this study included a low number of female patients during FGDs, limited number of Type I DM patients, and limited ages. Our main findings are that patients of Nuzha HC have high perceived self-efficacy and structural support for managing DM, level of education impacts management of diabetes, transportation is a major barrier to receiving consistent care and healthy dietary options are not affordable.