Determinants of adherence to home management of type 1 diabetes mellitus among children in Kenya: A hospital-based cross-sectional study

Objectives: Type 1 diabetes mellitus (T1DM) is a chronic condition and the most common endocrine disorder in children. Effective home management of T1DM requires adherence to insulin therapy, blood glucose (BG) monitoring, dietary regulation, and physical activity. However, adherence to these practices is often suboptimal. This study aimed to assess the level of adherence and identify family psychosocial and facility-related factors influencing adherence to T1DM home management among children in a hospital. Material and Methods: A cross-sectional study was conducted among 91 caregivers of children with T1DM, selected through simple random sampling. Data were collected through structured interviewer-administered questionnaires [Supplementary Material], with informed consent obtained from caregivers and assent from children above 8 years. Descriptive statistics and binary logistic regression were used to identify factors associated with adherence. Results: The study observed that only 39.6% of the children adhered to the full home management regimen for T1DM. Family psychosocial factors that significantly influenced adherence included support from family members and siblings (adjusted OR = 1.45, P = 0.041), good communication and reminders to the child (adjusted OR = 1.72, P = 0.028), perceived helpfulness of treatment (adjusted OR = 1.89, P = 0.014), and the affordability of resources and treatment (adjusted OR = 2.05, P = 0.002). Facility-related factors positively associated with adherence included support from healthcare workers (adjusted OR = 1.60, P = 0.008), necessary follow-up by healthcare workers (adjusted OR = 1.50, P = 0.01), treatment availability in health facilities (adjusted OR = 2.13, P < 0.001), healthcare providers’ positive attitude and willingness to help (adjusted OR = 1.56, P = 0.011), appropriate health education offered to caregivers (adjusted OR = 1.84, P < 0.001), and offering adequate time by healthcare providers (adjusted OR = 1.62, P = 0.001). Conclusion: Adherence to T1DM home management is suboptimal, particularly in diet, physical exercise, and BG monitoring. The study highlights that family psychosocial factors, such as support and communication, along with facility-related factors such as healthcare worker support, treatment availability, and health education, significantly influence adherence. Interventions should focus on improving family support systems, enhancing healthcare provider engagement, ensuring the availability and affordability of treatment, and providing adequate health education to caregivers. These findings are essential for informing policy and practice aimed at improving diabetes management and health outcomes for children with T1DM.