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Diabetes self-management in three different income settings: Cross-learning of barriers and opportunities
Inst Trop Med, Dept Publ Hlth, Antwerp, Belgium;Univ Antwerp, Dept Primary & Interdisciplinary Care, Antwerp, Belgium.
Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.ORCID iD: 0000-0002-9532-6059
Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.
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2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 3, article id e0213530Article in journal (Refereed) Published
Abstract [en]

The burden of type 2 diabetes is increasing rapidly, not least in Sub-Saharan Africa, and disadvantaged populations are disproportionally affected. Self-management is a key strategy for people at risk of or with type 2 diabetes, but implementation is a challenge. The objective of this study is to assess the determinants of self-management from an implementation perspective in three settings: two rural districts in Uganda, an urban township in South Africa, and socio-economically disadvantaged suburbs in Sweden. Data collection followed an exploratory multiple-case study design, integrating data from interviews, focus group discussions, and observations. Data collection and analysis were guided by a contextualized version of a transdisciplinary framework for self-management. Findings indicate that people at risk of or with type 2 diabetes are aware of major self-management strategies, but fail to integrate these into their daily lives. Depending on the setting, opportunities to facilitate implementation of self-management include: improving patient-provider interaction, improving health service delivery, and encouraging community initiatives supporting self-management. Modification of the physical environment (e.g. accessibility to healthy food) and the socio-cultural environment (i.e. norms, values, attitudes, and social support) may have an important influence on people's lifestyle. Regarding the study methodology, we learned that this innovative approach can lead to a comprehensive analysis of self-management determinants across different settings. An important barrier was the difficult contextualization of concepts like perceived autonomy and self-efficacy. Intervention studies are needed to confirm whether the pathways suggested by this study are valid and to test the proposed opportunities for change.

Place, publisher, year, edition, pages
2019. Vol. 14, no 3, article id e0213530
National Category
Public Health, Global Health, Social Medicine and Epidemiology
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URN: urn:nbn:se:uu:diva-381072DOI: 10.1371/journal.pone.0213530ISI: 000461573000021PubMedID: 30889215OAI: oai:DiVA.org:uu-381072DiVA, id: diva2:1306396
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EU, Horizon 2020, 643692Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2019-04-23Bibliographically approved

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