Inequalities and factors associated with adherence to diabetes self-care practices amongst patients at two public hospitals in Gauteng, South Africa

Self- management is vital to the control of diabetes. This study aims to assess the diabetes self-care behaviours of patients attending two tertiary hospitals in Gauteng, South Africa. The study also seeks to estimate the inequalities in adherence to diabetes self-care practices and associated factors. A unique health-facilities based cross-sectional survey was conducted amongst diabetes patients in 2017. Our study sample included 396 people living with diabetes. Face-to-face interviews were conducted using a structured questionnaire. Diabetes self-management practices considered in this study are dietary diversity, medication adherence, physical activity, self-monitoring of blood-glucose, avoiding smoking and limited alcohol consumption. Concentration indices (CIs) were used to estimate inequalities in adherence to diabetes self-care practices. Multiple logistic regressions were fitted to determine factors associated with diabetes self-care practices. Approximately 99% of the sample did not consume alcohol or consumed alcohol moderately, 92% adhered to self-monitoring of blood-glucose, 85% did not smoke tobacco, 67% adhered to their medication, 62% had a diverse diet and 9% adhered to physical activity. Self-care practices of dietary diversity (CI = 0.1512) and exercise (CI = 0.1067) were all concentrated amongst patients with higher socio-economic status as indicated by the positive CIs, whilst not smoking (CI = 0.0994) was concentrated amongst those of lower socio-economic status as indicated by the negative CI. Dietary diversity was associated with being female, being retired and higher wealth index. Medication adherence was found to be associated with older age groups. Physical activity was found to be associated with tertiary education, being a student and those within higher wealth index. Self-monitoring of blood glucose was associated with being married. Not smoking was associated with being female and being retired. Adherence to exercising, dietary diversity and medication was found to be sub-optimal. Dietary diversity and exercise were more prevalent among patients with higher socio-economic status. Our findings suggest that efforts to improve self- management should focus on addressing socio-economic inequalities. It is critical to develop strategies that help those within low-socio-economic groups to adopt healthier diabetes self-care practices.