Providing Diabetes Self-management Education and Support in Resource-constrained Settings: A Qualitative Enquiry Among Healthcare Providers and Persons Living with Type 1 Diabetes from India

Abstract

Background

Diabetes Self-Management Education and Support (DSMES) among children with Type 1 Diabetes (T1D) in resource-constrained settings like India is challenging.

Objectives

To gain insight regarding what all should be considered while developing a DSMES program in a resource-constrained settings.

Methods

This qualitative study was conducted in a tertiary level hospital where participants were invited to join Focused Group Discussions (FGDs) or In-Depth Interviews (IDIs). Socio-demographic data were collected using a pretested proforma and a topic guide was used to conduct the meetings. Five FGDs with 28 health care providers (doctors, nurses, dieticians, diabetes educators), and 16 IDIs with persons living with T1D, were conducted until data saturation, each lasting 45–90 minutes. Sessions were audio-recorded and transcribed verbatim into MS-Word. Thematic analysis followed COREQ guidelines. Inductive coding (using the Braun and Clarke six-phase framework) was done using MS-Excel, followed by grouping the codes into overarching themes.

Results

Critical considerations for delivering DSMES in resource-limited settings included customised dietary guidance, involvement of multiple caregivers, integration of group and individual approaches, support for developmental transitions, parental oversight, and fostering child self-management skills along with focus on present day challenges in diabetes care like parental anxiety, misleading claims of diabetes cure, and peer isolation experienced by these persons.

Conclusion

These findings can be utilized for developing a DSMES program suited to the needs of children with T1D in resource-constrained settings.