Journal of Education and Health Promotion

Self‑care practices and factors influencing self‑care among type 2 diabetes mellitus patients in a rural health center in South India

Document Type : Original Article

Authors

. Vanitha Durai
. V. Samya
. G. V. Akila
. Vanishree Shriraam
. Aliya Jasmine
. Anitha Rani Muthuthandavan
. T. Gayathri
. Shriraam Mahadevan

Department of Endocrinology and Metabolism, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Abstract
BACKGROUND: Self-care for diabetes is very important in preventing complications of diabetes
and also improving quality of life. This study aims to find the various self‑care practices of type 2
diabetes patients who are being treated at a rural health center of a medical college and the factors
influencing self‑care.
MATERIALS AND METHODS: This is a hospital‑based cross‑sectional study. Type 2 diabetes
patients registered and receiving treatment from the noncommunicable disease clinic of a rural health
center were administered a pretested questionnaire, developed based on different diabetes self-care
questionnaires making changes as appropriate and including most aspects of self-care practices. The
proportion of compliant was then cross-tabulated with background characteristics and their glycated
hemoglobin (HbA1c) levels. SPSS version 16.0 was used for the analysis.
RESULTS: Among 390 patients with a mean age 56 years, 25.5% adhered to at least four dietary
modifications, 46% were physically active, and 57% had good compliance to drugs; hypoglycemia
prevention practices ranged from 21% to 51%. Except for avoiding barefoot walking (90%), other
foot‑care practices were followed by only a quarter of them. Among ever users, 69.2%, 64.3%, and
29.4% have quit smoking, alcohol, and tobacco use, respectively. Adherence to dietary modifications
and drug compliance were associated with a lower HbA1c level of ≤7 g% (P < 0.05).
CONCLUSION: In this study, the compliance to physical activity or medications is much better
than dietary changes and foot-care practices. Focused education programs and monitoring during
follow-up visits will improve self-care in the less adhered to aspects. Those who are adherent to
dietary modifications and drugs have better glycemic control.

Keywords

Dietary modifications
drug compliance
rural center
self‑care practices
type 2 diabetes
1. Nanditha A, Snehalatha C, Satheesh K, Priscilla S, Mary S,
Lakshminarayanan V, et al. Secular trends in diabetes in
India (STRiDE‑I): Change in prevalence in 10 years among
urban and rural populations in Tamil Nadu. Diabetes Care
2019;42:476‑85.
2. Little M, Humphries S, Patel K, Dewey C. Decoding the Type 2
diabetes epidemic in Rural India. Med Anthropol 2017;36:96‑110.
3. Misra P, Upadhyay RP, Misra A, Anand K. A review of the
epidemiology of diabetes in Rural India. Diabetes Res Clin Pract
2011;92:303‑11.
4. Tripathy JP, Sagili KD, Kathirvel S, Trivedi A, Nagaraja SB,
Bera OP, et al. Diabetes care in public health facilities in India:A situational analysis using a mixed methods approach. Diabetes
Metab Syndr Obes 2019;12:1189‑99.
5. Rao MB, Manja P, Željko M. Organization of diabetes health care
in Indian rural areas. Diabetol Croat 2002;31:161‑71.
6. Lall D, Engel N, Devadasan N, Horstman K, Criel B. Challenges
in primary care for diabetes and hypertension: An observational
study of the Kolar district in rural India. BMC Health Serv Res
2019;19:44.
7. McGill M, Blonde L, Chan JC, Khunti K, Lavalle FJ, Bailey CJ
et al. The interdisciplinary team in Type 2 diabetes management:
Challenges and best practice solutions from real‑world scenarios.
Clin Transl Endocrinol 2016;7:21‑7.
8. Linda S. Team Care the preferred approach to diabetes treatment.
US Endocrinol 2015;11:75‑6.
9. Zhao FF, Suhonen R, Katajisto J, Stolt M, Leino‑Kilpi H.
Association between diabetes‑related self‑care activities and
positive health: A cross sectional study. BMJ Open 2019;9:e023878.
10. Shrivastava SR, Shrivastava PS, Jegadeesh R. Role of self‑care
in management of diabetes mellitus. J Diabetes Metab Disord
2013;12:14.
11. Yesudian CA, Grepstad M, Visintin E, Ferrario A. The economic
burden of diabetes in India: A review of the literature. Global
Health 2014;10:80.
12. Shriraam V, Mahadevan S, Anitharani M, Jagadeesh NS,
Kurup SB, Vidya TA, et al. Knowledge of hypoglycemia and its
associated factors among Type 2 diabetes mellitus patients in a
Tertiary Care Hospital in South India. Indian J Endocrinol Metab
2015;19:37882.
13. ShriraamV, MahadevanS, AnitharaniM, Jagadeesh NS, KurupSB,
Vidya TA, et al. Reported hypoglycemia in type 2 diabetes mellitus
patients: Prevalence and practices‑a hospital‑based study. Indian
J Endocrinol Metab 2017;21:148‑53.
14. Hood KK, Hilliard M, Piatt G, Ievers‑Landis CE. Effective
strategies for encouraging behavior change in people with
diabetes. Diabetes Manag (Lond) 2015;5:499‑510.
15. Rani MA, Shriraam V. Are patients with Type 2 diabetes not
aware or are they unable to practice self‑care? A qualitative
study in rural South India. J Prim Care Community Health
2019;10:2150132719865820.
16. Glasgow RE, Toobert DJ, Gillette CD. Psychosocial barriers to
diabetes self‑management and quality of life. Diabetes Spectr
2001;14:33‑41.
17. Adu MD, Malabu UH, Malau‑Aduli AE, Malau‑Aduli BS.
Enablers and barriers to effective diabetes self‑management:
A multi‑national investigation. PLoS One 2019;14:e0217771.
18. Ayele AA, Emiru YK, Tiruneh SA, Ayele BA, Gebremariam AD,
Tegegn HG. Level of adherence to dietary recommendations and
barriers among Type 2 diabetic patients: A cross‑sectional study
in an Ethiopian hospital. Clin Diabetes Endocrinol 2018;4:21.
19. Jannoo Z, Khan NM. Summary of diabetes self‑care activities:
A confirmatory factor analytic approach. Prim Care Diabetes
2018;12:425‑31.
20. Schmitt A, Gahr A, Hermanns N, Kulzer B, Huber J, Haak T. The
diabetes self management questionnaire (DSMQ): Development
and evaluation of an instrument to assess diabetes selfcare
activities associated with glycaemic control. Health Qual Life
Outcomes 2013;11:138.
21. Shrivastava SR, Shrivastava PS, Ramasamy J. Role of self-care
in management of diabetes mellitus. J Diabetes Metab Disord
2013;12:14. doi: 10.1186/2251-6581-12-14.
22. García‑Pérez LE, AlvarezM, Dilla T, Gil‑Guillén V, Orozco‑Beltrán
D. Adherence to therapies in patients with Type 2 diabetes.
Diabetes Ther 2013;4:175‑94.
23. Culig J, Leppée M. From Morisky to Hill‑bone; self‑reports
scales for measuring adherence to medication. Coll Antropol
2014;38:55‑62.
24. Tewahido D, Berhane Y. Self‑care practices among diabetes
patients in Addis Ababa: A qualitative study. PLoS One
2017;12:e0169062.
25. Alhariri A, Daud F, Almaiman A, Saghir SA. Factors associated
with adherence to diet and exercise among Type 2 diabetes
patients in Hodeidah city, Yemen. Diabetes Manag 2017;7:264‑71.
26. Marinho FS, Moram CB, Rodrigues PC, Leite NC, Salles GF,
Cardoso CR. Treatment Adherence and its associated factors in
patients with Type 2 diabetes: Results from the Rio de Janeiro
Type 2 diabetes cohort study. J Diabetes Res 2018;2018:8970196.
27. Sohal T, Sohal P, King‑Shier KM, Khan NA. Barriers and
facilitators for Type‑2 diabetes management in South Asians:
A systematic review. PLoS One 2015;10:e0136202.
28. Pati S, Lobo E, Pati S, Desaraju S, Mahapatra P. Type 2 diabetes
and physical activity: Barriers and enablers to diabetes control in
Eastern India ERRATUM. Prim Health Care Res Dev 2019;20:e126.
29. Srinath KM, Basavegowda M, Tharuni NS. Diabetic self care
practices in rural Mysuru, Southern Karnataka, India a need for
diabetes self management educational (DSME) program. Diabetes
Metab Syndr 2016;11:S181‑6.
30. Venkatesan M, Dongre AR, Ganapathy K. A community‑based
study on diabetes medication nonadherence and its risk factors
in rural Tamil Nadu. Indian J Community Med. 2018;43:72‑76.
31. Dinesh PV, Kulkarni AG, Gangadhar NK. Knowledge and
self‑care practices regarding diabetes among patients with
Type 2 diabetes in Rural Sullia, Karnataka: A community‑based,
cross‑sectional study. J Family Med Prim Care 2016;5:847‑52.
32. Huang YM, Shiyanbola OO, Smith PD. Association of health
literacy and medication self‑efficacy with medication adherence
and diabetes control. Patient Prefer Adherence 2018;12:793‑802.
33. Mohandas A, Bhasin S, Upadhyay M, Madhu S. Diabetes self
care activities among adults 20 years and above residing in
a resettlement colony in East Delhi. Indian J Public Health
2018;62:104.
34. Shrivastava PS, Shrivastava SR, Ramasamy J. An epidemiological
study to assess the knowledge and self care practices among
Type 2 diabetes mellitus patients residing in rural areas of Tamil
Nadu. Biol Med 2015;S3:2‑4.
35. Raithatha SJ, Shankar SU, Dinesh K. Self‑care practices among
diabetic patients in Anand district of Gujarat. ISRN Family Med
2014;2014:743791.
36. Deepa LN, Murty P, Reddy M, Muninarayan C, Shetty S.
Assessment of awareness and practice of foot care and physical
activity among people with Type 2 diabetes attending a tertiary
care teaching hospital. Int J Community Med Public Health
2017;4:3218‑23.
37. Samya V, Shriraam V, Jasmine A, Akila GV, Rani MA, Durai V,
et al. Prevalence of hypoglycemia among patients with Type 2
diabetes mellitus in a rural health center in South India. J Prim
Care Community Health 2019;10:2150132719880638.
38. Kushwaha AS, Kumari S, Kushwaha N. Self care in diabetes:
A study amongst diabetics in an urban community. Int J
Community Med Public Health 2016;3:293‑8.
39. Gopichandran V, Lyndon S, Angel MK, Manayalil BP, Blessy KR,
Alex RG, et al. Diabetes self‑care activities: A community‑based
survey in urban Southern India. Natl Med J India 2012;25:14‑8.
Journal of Education and Health Promotion
Volume 11, Issue 4
May 2021
Pages 1-7

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