Beyond medications: A study on competencies of self-care practices among type 2 diabetic patients and diabetes health education among ASHA workers.

Abstract

Background: Self-care behaviours like healthy eating, being active, taking medication, monitoring blood sugar levels, reducing risk, problem-solving and healthy coping are the mainstay for the control of diabetes and the prevention of its complications. Despite the proven benefits of self-care practices, studies indicate poor adherence to such practices, especially in rural India.

Objectives: (1) To assess the self-care practices among diabetic patients using the 'Diabetes Self-Management Profile' (DSMP) questionnaire, (2) to explore the factors influencing their self-care practices, (3) to explore the need for diabetes health education (DHE) among Accredited Social Health Activist (ASHA) workers.

Methodology: The study employed a sequential explanatory mixed-method design (QUAN → QUAL). Three villages were randomly selected from the field practice area of the Medical College, where the Family Doctor Program is being implemented. Focus group discussions (FGDs) were conducted one among diabetic patients (n = 7) and one among ASHA workers (n = 8) using the FGD guide and the data was analysed using the thematic framework approach.

Results: Out of a total of 75 participants (mean age 61.36 ± 9.35), only 16% adhered to at least four self-care behaviours. Notably, 40% exhibited good dietary behaviour; only 26.6% engaged in physical activity three times per week, and nearly three-fourths of participants had good drug compliance. Hypoglycaemia prevention practices were low (17.3%), and none had a glucose monitoring device. Glucose levels were checked once in 3 months by 52% of them. Disturbingly, 88% were unaware of diabetes complications, and 53.3% occasionally felt distressed. Qualitative analysis revealed 'limited patient knowledge', 'uninformed health care services' and 'uninvolved family support' as the themes influencing poor self-care practices. ASHA workers were found to have a limited understanding of diabetes and self-care and hence unable to address patient problems and misconceptions. They felt the need for training to impart effective behavioural change communication.

Conclusion: Effective self-care practices in diabetic patients require a holistic approach. It is crucial to provide training for ASHA workers to enable them to effectively share knowledge with patients.