Self-Management of Diabetes and Associated Factors among Patients Seeking Chronic Care in Tshwane, South Africa: A Facility-Based Study

Abstract

The burden of diabetes continues to increase in South Africa and a significant number of diabetes patients present at public primary healthcare facilities with uncontrolled glucose. We conducted a facility-based cross-sectional study to determine the diabetes self-management practices and associated factors among out-patients in Tshwane, South Africa. An adapted validated questionnaire was used to collect data on sociodemography, diabetes knowledge, and summaries of diabetes self-management activities measured in the previous seven days, and over the last eight weeks. Data were analysed using STATA 17. A final sample of 402 diabetes out-patients was obtained (mean age: 43 ± 12 years) and over half of them were living in poor households. The mean total diabetes self-management of score was 41.5 ± 8.2, with a range of 21 to 71. Almost two thirds of patients had average self-management of diabetes, and 55% had average diabetes knowledge. Twenty-two percent of patients had uncontrolled glucose, hypertension (24%) was the common comorbidity, and diabetic neuropathy (22%) was the most common complication. Sex [male: AOR = 0.55, 95% CI: 0.34–0.90], race [Coloured: AOR = 2.84, 95% CI: 1.69–4.77 and White: AOR = 3.84, 95% CI: 1.46–10.1], marital status [divorced: AOR = 3.41, 95% CI: 1.13–10.29], social support [average: AOR = 2.51, 95% CI: 1.05–6.00 and good: AOR = 4.49, 95% CI: 1.61–7.57], body mass index [obesity: AOR = 0.31, 95% CI: 0.10–0.95], diabetes knowledge [average: AOR = 0.58, 95% CI: 0.33–0.10 and good: AOR = 1.86, 95% CI: 0.71–4.91], and uncontrolled glucose [AOR = 2.97, 95% CI: 1.47–5.98] were factors independently predictive of diabetes self-management. This study emphasizes that the self-management of diabetes was mostly on average among patients and was associated with the aforementioned factors. Innovative approaches are perhaps needed to make diabetes education more effective. Face-to-face sessions delivered generally during clinic visits should be better tailored to the individual circumstances of diabetes patients. Considerations should be given to the options of leveraging information technology to ensure the continuity of diabetes education beyond clinic visits. Additional effort is also needed to meet the self-care needs of all patients.

Multimorbidity, Treatment, and Determinants among Chronic Patients Attending Primary Health Facilities in Tshwane, South Africa

“…The most common condition was hypertension (62%), which was self-reported as diagnosed first among almost half of the patients (49%), followed by diabetes (45%) as the second most prevalent chronic condition. High prevalence rates (21% to 77.9%) have been recorded in South Africa and remain the highest in the Southern Africa region [ 59 , 60 ], while the prevalence of diabetes has tripled since 2000 to date [ 61 , 62 , 63 , 64 ] with concerns of self-management [ 51 , 65 ]. The prevalence of hypertension and diabetes have been reported to increase significantly with age in South Africa [ 66 , 67 ] and in other countries, such as Kenya, [ 66 ] Ghana [ 66 ], Tanzania [ 68 ], and the United Arab Emirates (UAE) [ 48 ].…”

“…These lifestyle factors have been associated with an increase in multimorbidity, in addition to population ageing [ 10 , 79 ]. In particular, alarming rates of overweight/obesity are being observed in South Africa, higher than in other Africa continues, and almost similar as in HIC countries [ 51 , 80 , 81 ].…”

“…A systematic review on multimorbidity in South Africa has reported hypertension as the most frequent condition, and it is associated with other diseases [ 27 ]. Furthermore, most of the above-mentioned multimorbidity patterns have been reported in South Africa [ 27 ] and occur commonly among primary care patients in South Africa [ 13 , 14 , 51 , 82 , 89 ]. The occurrence of multimorbidity is further consistent with the findings from several countries, like Brazil [ 19 ], India [ 90 ] Ghana [ 91 ], and the UAE [ 48 ].…”

“…The research team was made up of the principal researcher and two tutored research assistants administered a pre-tested questionnaire in either English, Setswana, or isiZulu languages preferred by the patient. The questionnaire was modified from previous similar studies carried out among patients with chronic conditions and collected demographic information and access to treatment and adherence [ 4 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. Additional medical data were extrapolated from the patients’ file, and any information that was missing in the records was collected through self-reporting from patients.…”

“…Socio-demographic information included in the questionnaire entailed sex (male and female), age categories (18–39 years, 40–59 years, and ≥60 years), race (African, White, Coloured, and Asian), place of residence (informal settlements, peri-urban, and urban), marital status (single, married, and divorced), education level (no education, primary, secondary, grade 12, and tertiary education) and education level (i.e., completed grade 12 and tertiary), and employment status (employed, unemployed, or pensioner). Household information included the household income ($266.85; $266.85–$533.80; $533.80–$800.40; >$800.40), household size (<5 and ≥5 members), type of house [shack, RDP (Reconstruction and Development Programme) house and brick], electricity (no or yes), use of a refrigerator (no or yes), water access (no or yes), electricity access (no or yes), and type of a toilet (pit latrine or flush toilet), adapted from other studies conducted on chronic diseases [ 50 , 51 ].…”