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Aims and objectives: To explore patient and healthcare provider (HCP) perspectives about patients' barriers to the performance of diabetic self‐care behaviours in Ghana. Background: Sub‐Saharan African urban populations are increasingly affected by type 2 diabetes due to nutrition transition, sedentary lifestyles and ageing. Diabetic self‐care is critical to improving clinical outcomes. However, little is known about barriers to diabetic self‐care (diet, exercise, medication taking, self‐monitoring of blood glucose and foot care) in sub‐Saharan Africa. Design: Qualitative study that followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Methods: Semi‐structured interviews were conducted among 23 people living with type 2 diabetes and 14 HCPs recruited from the diabetes clinics of three hospitals in Tamale, Ghana. Interviews were audiotaped and transcribed verbatim. The constant comparative method of data analysis was used and identified themes classified according to constructs of the theory of planned behaviour (TPB): attitudes/behavioural beliefs, subjective norms and perceived behavioural control. Results: Barriers relating to attitudes included misconceptions that diabetes was caused by spiritual forces or curses, use of herbal medicines, intentional nonadherence, difficulty changing old habits, and feeling or lacking motivation to exercise. Barriers relating to subjective norms were inadequate family support, social stigma (usually by spouses and other members of the community) and cultural beliefs. Perceived behavioural control barriers were poor income levels, lack of glucometers, busy work schedules, long distance to the hospital and inadequate access to variety of foods due to erratic supply of foods or seasonality. Conclusions: Both patients and HCPs discussed similar barriers and those relating to attitude and behavioural control were commonly discussed. Relevance to Clinical Practice: Interventions to improve adherence to diabetic self‐care should focus on helping persons with diabetes develop favourable attitudes and how to overcome behavioural control barriers. Such interventions should have both individualised and community‐wide approaches. [ABSTRACT FROM AUTHOR]

Background: Previous research has failed to examine more than one self-care behaviour in type 2 diabetes patients in Ghana. The purpose of this study is to investigate adult Ghanaian type 2 diabetes patients' adherence to four self-care activities: diet (general and specific), exercise, self-monitoring of blood glucose (SMBG) and foot care. Methods: Consenting type 2 diabetes patients attending diabetes outpatient clinic appointments at three hospitals in the Tamale Metropolis of Ghana completed a cross-sectional survey comprising the Summary of Diabetes Self-Care Activities Measure, and questions about demographic characteristics and diabetes history. Height and weight were also measured. Multiple linear regression analyses were conducted to identify the factors associated with adherence to each of the four self-care behaviours. Results: In the last 7 days, participants exercised for a mean (SD) of 4.78 (2.09) days and followed diet, foot care and SMBG for a mean (SD) of 4.40 (1.52), 2.86 (2.16) and 2.15 (0.65) days, respectively. More education was associated with a higher frequency of reported participation in exercise (r = 0.168, p = 0.022), following a healthy diet (r =0.223, p = 0.002) and foot care (r =0.153, p = 0.037) in the last 7 days. Males reported performing SMBG (r = 0.198, p = 0.007) more frequently than their female counterparts. Conclusion: Adherence to diet, SMBG and checking of feet were relatively low. People with low education and women may need additional support to improve adherence to self-care behaviours in this type 2 diabetes population. [ABSTRACT FROM AUTHOR]

Aims: We evaluated the content validity, factorial structure, internal consistency, construct validity, and floor and ceiling effects of the SDSCA among Ghanaian persons with type 2 diabetes.Methods: The summary of diabetes self-care activities measure (SDSCA) was administered to 187 adults living with type 2 diabetes from three diabetes clinics.Results: A confirmatory factor analysis maintained the four factor structure of the SDSCA. However, two items, 3 (fruit and vegetable servings) and 4 (red meat or full-fat dairy products) had factor loadings of 0.26 and 0.16 respectively. The model also had a statistical power of 0.72 (below acceptable criteria). Modification of the model by removing item 4 resulted in an improved revised model with a power of 0.82. Construct validity was found for the exercise and diet subscales of the SDSCA but not for the self-monitoring of blood glucose and foot care subscales. The internal consistency of the SDSCA measure was 0.68, below acceptable criteria for internal consistency. No floor effects were present but the exercise subscale had ceiling effects.Conclusion: The SDSCA measure had content validity, maintained its multidimensionality and met the criteria for floor effects but not for construct validity, internal consistency and ceiling effects. The SDSCA measure may require improvements to evaluate self-care behaviours of adult type 2 diabetes patients in Ghana and probably in other sub-Saharan countries. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Self-care support provided by healthcare providers (HCPs) is critical to diabetes self-care. However, a number of barriers prevent HCPs from providing self-care support to people with diabetes. We explored attitudes towards, barriers and facilitators of the provision of diabetes self-care support among Ghanaian HCPs., Methods: Fourteen semi-structured interviews were conducted among HCPs recruited from three diabetes clinics in Tamale, Ghana. All interviews were digitally recorded and transcribed verbatim. Transcripts were coded and analysed thematically., Results: HCPs reported a sense of responsibility and urgency to provide self-care education to diabetes patients; while believing it was the patients' responsibility to self-care for their diabetes condition. Accordingly, HCPs perceived their role to be limited to information sharing rather than behaviour change interventions. Facilitators to the provision of self-care support included patients' motivation, and team work among healthcare professionals. 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. Healthcare-system-related barriers were inadequate office space, lack of professional development programmes, high patient numbers, inadequate staff numbers, inadequate health insurance and a lack of sufficient supplies and equipment in the hospital., Conclusion: HCPs attitudes were generally favourable towards supporting self-care, albeit with a focus on information provision rather than behaviour change. Training in effective strategies for providing self-care support are needed, and better use of the resources that are available., (Copyright © 2019 Diabetes India. All rights reserved.)