- Title
- Self-care behaviours in Ghanaian adults with type 2 diabetes: adherence and barriers
- Creator
- Mogre, Victor
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2020
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- There is a dearth of data regarding adherence to self-care behaviours, and associated barriers among people with type 2 diabetes in Sub-Saharan Africa including Ghana, as described in Chapter 1. The remaining Chapters of the thesis sought to address this major gap in the literature. Chapter 2 contains a systematic review of the literature on adherence to diabetes self-care from low-and middle-income countries (LMICs), describing self-reported adherence rates for the following self-care behaviours: diet, exercise, self-monitoring of blood glucose (SMBG), medication taking and foot care. Twenty-seven quantitative studies from 18 LMICs were included in the systematic review. Adherence was described in two ways: number of days people with diabetes adhered to a self-care behaviour in the past week and the proportion of diabetes patients adhering to a recommended self-care behaviour. Adherence ranged from 2.3 to 4.6 days per week for diet, 5.5 to 6.8 days per week for medication taking, 1.8 to 5.7 days per week for exercise, 0.2 to 2.2 days per week for SMBG and 2.2 to 4.3 days per week for foot care. Proportions of participants adhering to a recommended self-care behaviour varied from 29.9 to 91.7% for diet, 26.0 to 97.0% for medication taking, 26.7 to 69.0% for exercise, 13.0 to 79.9% for SMBG and 17.0 to 77.4% for foot care. It was concluded that adherence to self-care behaviours was generally low and varied widely across studies. In Chapter 3, an evaluation of the psychometric properties of the Summary of Diabetes Self-Care Activities measure (SDSCA) was undertaken, as a potentially feasible tool for population-level use in Ghana. The SDSCA was administered to 187 adults living with type 2 diabetes from three diabetes clinics in Ghana. The analyses showed that people with type 2 diabetes found the items of the SDSCA to be understandable, readable, easy to use, clear, unambiguous and relevant to diabetes self-care. However, a revision of the diet-related item 4 may improve further the understanding of this item in a Ghanaian context. The results of a confirmatory factor analysis indicated that the four-factor structure of the SDSCA was maintained. The study presented in Chapter 4 describes self-reported adherence to the following self-care behaviours: diet, exercise, SMBG and foot care among people with type 2 diabetes people. In addition, factors associated with adherence to diabetes self-care among people with type 2 diabetes were investigated. Consenting type 2 diabetes patients (n=187) attending diabetes outpatient clinic appointments at three hospitals in the Tamale Metropolis of Ghana completed a cross-sectional survey comprising the SDSCA, demographic characteristics and diabetes history. Participants reported exercising 4.8 days on average and followed diet, foot care and SMBG for an average of 4.4, 2.9 and 2.2 days per week, respectively. Increased level of education was associated with higher adherence to exercise, diet and foot care. In addition, women were less likely to perform SMBG compared to men. It was concluded that relatively low adherence was evident in relation to diet, SMBG and foot care; and that interventions should include special attention to women and to people with a low level of education. Having identified that many people with type 2 diabetes report low adherence to diabetes self-care, Chapter 5 explored barriers to diabetes self-care as perceived by people with type 2 diabetes and their healthcare providers (HCPs). Semi-structured interviews were conducted with 23 people living with type 2 diabetes and 14 HCPs recruited from the diabetes clinics of three hospitals in Tamale, Ghana. Potential barriers were conceptualised in accordance with the constructs of the Theory of Planned Behaviour (TPB). The analysis showed a number of barriers relating to attitudes including the misconception that diabetes was caused by spiritual forces or curses, intentional non-adherence and lack of motivation to exercise. Barriers relating to subjective norms included inadequate family support, social stigma and cultural beliefs. Perceived behavioural control barriers included low income levels, lack of glucometers, and inadequate access to foods due to erratic supply or seasonality. Described in Chapter 6 are the attitudes, facilitators and barriers to the provision of self-care support as perceived by the 14 HCPs interviewed for chapter 5. Although HCPs perceived self-care was the responsibility of the individual with diabetes, they also felt a sense of urgency and responsibility to provide diabetes education. They perceived their role to be one of information sharing rather than building motivation or confidence in relation to self-care behaviours. Barriers that hindered self-care support included language barriers and poor inter-professional collaboration. Furthermore, HCPs discussed that they felt inadequately trained to provide self-care support. Other barriers included inadequate office space, inadequate staff numbers, insufficient supplies and lack of equipment in the hospital. Chapter 7 provides a quantitative evaluation of the prevalence of barriers and their association with adherence to self-care behaviours. This cross-sectional study was conducted in adults (n=252) with type 2 diabetes recruited from the diabetes clinics of three hospitals in Ghana. The most commonly reported barriers to self-care were: lack of knowledge on how to use a glucometer (59.8%); finding it difficult to change dietary habits (58.7%); and lack of money to purchase a glucometer (55.2%). The only significant association was between adherence to foot care and subjective norms barriers. Chapter 8 provides a discussion of the main findings and implications of the thesis.
- Subject
- diabetes self-care; type 2 diabetes; barriers; Ghana; adherence; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1415976
- Identifier
- uon:36980
- Rights
- Copyright 2020 Victor Mogre
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 8 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 502 KB | Adobe Acrobat PDF | View Details Download |