Social determinants of diabetes self-management outcomes among adults with type 2 diabetes in Bolgatanga Municipality, Ghana

Abstract Introduction Diabetes mellitus requires sustained self-management, yet outcomes are strongly influenced by social determinants. In low- and middle-income settings such as Ghana, limited evidence exists on how these determinants shape diabetes self-management at the municipal level. Objective This study examined the association between social determinants of health on diabetes self-management among adults with diabetes in Bolgatanga Municipality, Ghana. Methods A cross-sectional study was conducted among 305 adults with type 2 diabetes selected through simple random sampling. Data were collected using a structured questionnaire. Diabetes self-management was assessed using a 16-item Diabetes Self-Management Questionnaire, with each participant’s mean score calculated across the 16 items. The sample mean score of 3.01 was used as a reference point; participants scoring above 3.01 were classified as having better diabetes self-management, while those scoring at or below 3.01 were classified as having poorer self-management. Descriptive statistics were used to summarize participant characteristics and self-management practices. Associations were assessed using chi-square tests, while multivariable binary logistic regression was used to examine factors associated with diabetes self-management. Statistical significance was set at p < 0.05. Results Participants were predominantly middle-aged (33.1%), female (56.4%), and married (61.0%), with 34.1% attaining tertiary education. Overall, 47.9% had better diabetes self-management, while 52.1% had poorer self-management. Multivariable logistic regression showed that widowed participants had lower odds of better self-management than single participants (AOR = 0.236, 95% CI: 0.058–0.966; p = 0.045). Participants without health insurance also had lower odds of better self-management (AOR = 0.096, 95% CI: 0.032–0.282; p < 0.001). High transportation costs (AOR = 3.522, 95% CI: 1.673–7.413; p = 0.001) and long waiting times (AOR = 2.893, 95% CI: 1.459–5.734; p = 0.002) were associated with higher odds of better self-management, while lack of staff (AOR = 0.416, 95% CI: 0.222–0.781; p = 0.006) and frequent forgetfulness due to busy schedules (AOR = 0.172, 95% CI: 0.031–0.953; p = 0.044) were associated with lower odds of better self-management. Conclusion Diabetes self-management remains suboptimal and is shaped by socioeconomic and behavioural determinants. Strengthening financial protection, service delivery efficiency, and adherence support systems is essential for improved outcomes.