Barriers and facilitators of self-management behaviours among adults with type 2 diabetes in Harare, Zimbabwe: a grounded theory study

Authors

  • Blessing M. Chirewa Institute of Health and Allied Professions, Nottingham Trent University, Nottingham, United Kingdom
  • Mathew Nyashanu Institute of Health and Allied Professions, Nottingham Trent University, Nottingham, United Kingdom
  • Adam Barnard School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20261247

Keywords:

Type 2 diabetes, Barriers, Facilitators, Self-management

Abstract

Background: Improving self-management in patients with type 2 diabetes can decrease complications, encourage healthier lifestyles, and enhance quality of life. While guidelines specify key self-management practices for optimal glycaemic control, many patients find it difficult to adhere to them, especially in developing countries. This study sought to identify the barriers and facilitators impacting diabetes self-management among adults with type 2 diabetes. Gaining insight into these factors is essential for developing patient-centred strategies that effectively help improve health outcomes.

Methods: The study was guided by Charmaz’s constructivist grounded theory. It employed two sampling methods: purposive and theoretical. Initially, purposive sampling involved selecting eight adults with type 2 diabetes to generate themes for further exploration. As categories emerged from data analysis, theoretical sampling was used to refine underdeveloped categories. A total of twenty-eight face-to-face semi-structured interviews were conducted.

Results: Data analysis revealed that living with type 2 diabetes involves engaging in self-management practices. Key facilitators included: receiving social support, being motivated to make changes, taking responsibility for the illness, and building a patient-healthcare professional relationship. On the other hand, barriers compromised: having financial difficulties, experiencing societal stigma, having health illiteracy, and experiencing food insecurity.

Conclusions: Patients with type 2 diabetes encounter various barriers and facilitators in managing their condition. The analysis highlighted how interpersonal, social, and economic factors affect their self-management behaviours for diabetes. These findings emphasise the need for interventions that are contextualised, culturally sensitive, and tailored to individual patients.

Metrics

Metrics Loading ...

References

Mussie DA, Zerihun TE, Kassaw AT, Muche EA. Prevalence, determinants and consequences of delayed treatment intensification among type 2 diabetes mellitus patients at the University of Gondar Comprehensive Specialised Hospital, Northwest Ethiopia, 2024: a mixed-methods study. BMJ Open. 2025;15(11): e105455. DOI: https://doi.org/10.1136/bmjopen-2025-105455

IDF. The Diabetes Atlas. 589 million adults (20-79 years) are living with diabetes worldwide. 2025.

Tuobenyiere J, Mensah GP, Korsah KA. Patient perspective on barriers in type 2 diabetes self‐management: a qualitative study. Nurs Open. 2023;10(10):7003-13. DOI: https://doi.org/10.1002/nop2.1956

Nkomani S, Ruskaniko S, Blaauw R. The impact of existing diabetes self-management education interventions on knowledge, attitudes and practices in public health care institutions in Harare, Zimbabwe. S Afr J Clin Nutr, 2021;34(1):27-33. DOI: https://doi.org/10.1080/16070658.2019.1641272

International Diabetes Federation. IDF Diabetes Atlas. 8th Edition, International Diabetes Federation. 2017.

Kuguyo O, Mukona DM, Chikwasha V, Gwanzura L, Chirenda J, Matimba A. Prevalence and risk factors for diabetic foot complications among people living with diabetes in Harare, Zimbabwe: a cross-sectional study. BMC Public Health. 2024;24(1):677-83. DOI: https://doi.org/10.1186/s12889-023-17610-7

Smithers D, Waitzkin H. Universal health coverage as hegemonic health policy in low- and middle-income countries: a mixed-methods analysis. Soc Sci Med. 2022;302:114961. DOI: https://doi.org/10.1016/j.socscimed.2022.114961

Van de Velde D, De Zutter F, Satink T, Costa U, Janquart S, Senn D, et al. Delineating the concept of self-management in chronic conditions: a concept analysis. BMJ Open. 2019;9(7):e027775. DOI: https://doi.org/10.1136/bmjopen-2018-027775

International Diabetes Federation (2012) IDF Diabetes Atlas. 2012.

Carolan M, Holman J, Ferrari M. Experiences of diabetes self-management: a focus group study among Australians with type 2 diabetes. J Clin Nurs. 2015;24(7-8):1011-23. DOI: https://doi.org/10.1111/jocn.12724

American Diabetes Association (2020). Facilitating Behaviour Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Supplement_1):48. DOI: https://doi.org/10.2337/dc20-S005

Stephani V, Opoku D, Beran D. Self-management of diabetes in Sub-Saharan Africa: a systematic review. BMC Public Health. 2018;18(1):1148. DOI: https://doi.org/10.1186/s12889-018-6050-0

Ernersson Å, Mufunda E, Hjelm K. Audit of essential knowledge of diabetes in patients with diabetes in Zimbabwe. Pan Afr Med J. 2023;45(103):103. DOI: https://doi.org/10.11604/pamj.2023.45.103.31770

Mufunda E, Ernersson Å, Hjelm K. Limited knowledge of diabetes in patients attending an outpatient diabetes clinic at a referral hospital in Zimbabwe: a cross-sectional study. Pan Afr Med J. 2018;29(144):144. DOI: https://doi.org/10.11604/pamj.2018.29.144.12301

Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. 1st ed. London: Sage; 2006. DOI: https://doi.org/10.3402/qhw.v1i3.4932

DePoy MSW, Gitlin F. Introduction to Research. 5th ed. Chantilly: Mosby; 2015. DOI: https://doi.org/10.1016/B978-0-323-26171-5.00036-7

Świątoniowska-Lonc N, Tański W, Polański J, Jankowska-Polańska B, Mazur G. Psychosocial determinants of treatment adherence in patients with type 2 diabetes- a review. Diabetes Metab Syndr Obes. 2021;14:2701-15. DOI: https://doi.org/10.2147/DMSO.S308322

Onyango JT, Namatovu JF, Besigye IK, Kaddumukasa M, Mbalinda SN. Social support from family, associated factors and relationship with glycaemic control among diabetic patients in Uganda: a cross-sectional study. Pan Afr Med J. 2023;45:72. DOI: https://doi.org/10.11604/pamj.2023.45.72.38256

Olagbemide O, Omosanya O, Ayodapo A, Agboola S, Adeagbo A, Olukokun T. Family support and medication adherence among adult type 2 diabetes: Any meeting point? Ann Afr Med. 2021;20(4):282-7. DOI: https://doi.org/10.4103/aam.aam_62_20

Bouldin ED, Trivedi RB, Reiber GE, Rosland A, Silverman JB, Krieger J, et al. Associations between having an informal caregiver, social support, and self-care among low-income adults with poorly controlled diabetes. Chronic Illness. 2017;13(4):239-50. DOI: https://doi.org/10.1177/1742395317690032

Beverly EA, Miller CK, Wray LA. Spousal support and food-related behaviour change in middle-aged and older adults living with type 2 diabetes. Health Educ Behav. 2008;35(5):707-20. DOI: https://doi.org/10.1177/1090198107299787

Woodward A, Walters K, Davies N, Nimmons D, Protheroe J, Chew‐Graham CA, et al. Barriers and facilitators of self‐management of diabetes amongst people experiencing socioeconomic deprivation: a systematic review and qualitative synthesis. Health Expect. 2024;27(3):e14070. DOI: https://doi.org/10.1111/hex.14070

Pilkington FB, Daiski I, Lines E, Bryant T, Raphael D, Dinca-Panaitescu M, et al. Type 2 diabetes in vulnerable populations: community healthcare providers' perspectives on health service needs and policy implications. Can J Diabetes. 2011;35(5):503-11. DOI: https://doi.org/10.1016/S1499-2671(11)80006-7

Vähäsarja K, Salmela S, Villberg J, Rintala P, Vanhala M, Saaristo T, et al. Perceived need to increase physical activity levels among adults at high risk of type 2 diabetes. A cross-sectional analysis within a community-based diabetes prevention project, FIN-D2D. BMC Public Health. 2012;12(1):514. DOI: https://doi.org/10.1186/1471-2458-12-514

Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, et al. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007;116(5):572-84. DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.185214

Song CM, Chang SJ, Kim S. Strategies for enhancing information, motivation, and skills for self-management behaviour changes: a qualitative study of diabetes care for older adults in Korea. Patient Prefer Adher. 2014;8(default):219-26. DOI: https://doi.org/10.2147/PPA.S58631

Audulv Å, Asplund K, Norbergh K. Who’s in charge? The role of responsibility attribution in self-management among people with chronic illness. Patient Educ Counsell. 2010;81(1):94-100. DOI: https://doi.org/10.1016/j.pec.2009.12.007

Lawn S, McMillan J, Pulvirenti M. Chronic condition self-management: expectations of responsibility. Patient Educ Counsell. 2011;84(2): e5-8. DOI: https://doi.org/10.1016/j.pec.2010.07.008

Greenhalgh T. Cultural contexts of health: the use of narrative research in the health sector. Copenhagen: World Health Organisation. Regional Office for Europe. 2016.

Seligman HK, Jacobs EA, López A, Tschann J, Fernandez A. Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes Care. 2012;35(2):233-8. DOI: https://doi.org/10.2337/dc11-1627

Ae-Ngibise KA, Asare-Doku W, Peprah J, Mujtaba MN, Nifasha D, Donnir GM. The mental health outcomes of food insecurity and insufficiency in west Africa: a systematic narrative review. Behav Sci. 2021;11(11):146. DOI: https://doi.org/10.3390/bs11110146

Walker RJ, Grusnick J, Garacci E, Mendez C, Egede LE. Trends in food insecurity in the USA for individuals with prediabetes, undiagnosed diabetes, and diagnosed diabetes. J Gen Intern Med. 2019;34(1):33-5. DOI: https://doi.org/10.1007/s11606-018-4651-z

Campbell DJT, Manns BJ, Hemmelgarn BR, Sanmartin C, Edwards A, King-Shier K. Understanding financial barriers to care in patients with diabetes. Diabetes Educat. 2017;43(1):78-86. DOI: https://doi.org/10.1177/0145721716679276

Adhikari M, Devkota HR, Cesuroglu T. Barriers to and facilitators of diabetes self-management practices in Rupandehi, Nepal- multiple stakeholders’ perspective. BMC Public Health. 2021;21(1):1-18. DOI: https://doi.org/10.1186/s12889-021-11308-4

Maleki Chollou K, Gaffari-fam S, Babazadeh T, Daemi A, Bahadori A, Heidari S. The association of health literacy level with self-care behaviours and glycaemic control in a low education population with type 2 diabetes mellitus: a cross-sectional study in Iran. Diabetes Metab Syndr Obes. 2020;13:1685-93. DOI: https://doi.org/10.2147/DMSO.S253607

Kim MT, Kim KB, Ko J, Murry N, Xie B, Radhakrishnan K, et al. Health literacy and outcomes of a community-based self-help intervention: a case of Korean Americans with type 2 diabetes. Nurs Res. 2020;69(3):210-8. DOI: https://doi.org/10.1097/NNR.0000000000000409

Withnall A. Learning to live with chronic illness in later life: empowering myself. Aust J Adult Learn. 2017;57(3):474-89.

Akyirem S, Ekpor E, Namumbejja Abwoye D, Batten J, Nelson LE. Type 2 diabetes stigma and its association with clinical, psychological, and behavioural outcomes: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2023;202:110774. DOI: https://doi.org/10.1016/j.diabres.2023.110774

Washburn M, Brewer KB, Gearing RE, Yu M, Leal R, de la Cruz P, et al. Factors influencing diabetes and depression related stigma in Mexico. Stigma Health. 2025. DOI: https://doi.org/10.1037/sah0000629

Deng L, Liu Y, Liu S, Zheng F. Effects of an outpatient diabetes self-management education on patients with type 2 diabetes in China: a randomised controlled trial. J Diabetes Res. 2019;2019(2019):1-7. DOI: https://doi.org/10.1155/2019/1073131

Downloads

Published

2026-04-28

How to Cite

Chirewa, B. M., Nyashanu, M., & Barnard, A. (2026). Barriers and facilitators of self-management behaviours among adults with type 2 diabetes in Harare, Zimbabwe: a grounded theory study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 15(5), 1534–1542. https://doi.org/10.18203/2320-1770.ijrcog20261247

Issue

Section

Original Research Articles