Barriers to effective diabetes mellitus self-management (DMSM) practices among type 2 diabetic patients in Tigray region, northern Ethiopia: a qualitative study

The prevalence of diabetes in 2021 was 10.5% worldwide, 4.5% in Africa and 4.7% (3 million people) in Ethiopia. Almost all studies were from developed countries with well‐established healthcare systems for diabetic care; the generalizability of these findings to sub-Saharan Africa like Ethiopia is questionable. The aim of the study was to investigate the barriers to self-management among Type 2 diabetic patients in Tigray, Ethiopia. A qualitative study was conducted using in-depth interviews between July 10 and September 30, 2020 at three hospitals of Tigray region. The three main groups of the study population were adult patients with type 2 diabetes mellitus, caretakers (family members) and health care providers. Convenient sampling technique was employed to recruit twenty two type 2 diabetic patients, ten caretakers and ten health care providers. IDIs were conducted using an interview guide and audio tapes of all interviews were directly transcribed as true verbatim. A six-step inductive thematic analysis method was used. Five major barrier categories were identified. Educational and psychological barriers were inadequate knowledge of self-care practices, low perception and susceptibility of the illness, emotional responses and negative emotions respectively. Behavioral belief and socio-cultural barriers include difficult changing old habit, misconceptions, inadequate support, peer influence and cultural belief. Financial problem, busy work schedules, long distance to health facilities, critical shortage of medications and medical supplies, inadequate access to variety of foods and health care provider related challenges were perceived behavioral control barriers. Participants reported that educational, psychological, behavioral belief; socio-cultural and behavioral barriers affects type 2 diabetic patients’ self-care practices. Therefore, regular structured diabetes education should provide to patients, family and community; patients with mental health problems and financial burdens need to be linked to psychiatric clinic and social workers respectively.