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Keywords

diabetes mellitus, health disparity, health equity, mixed methods, Nepal, self-care, self-efficacy, social support

 

Authors

  1. Bhandari, Pratibha
  2. Kim, Miyoung

Abstract

Background: Most previously reported literature on diabetes self-care is either solely quantitative or qualitative research conducted in developed countries; findings may not be generalizable to developing countries with different sociodemographic and cultural factors.

 

Purpose: The study aims to develop an explanatory mediation model for self-care and enhance model interpretation through qualitative input.

 

Methods: A quantitatively driven, sequential, mixed method design was used. Structured questionnaires were used to collect data for the quantitative component from 230 participants. Participants for the qualitative interview were selected using maximum variation sampling (n = 13), and interviewing was guided by semistructured questions.

 

Results: Diabetes management self-efficacy had the strongest influence on diabetes self-care (standardized path coefficient = .42, p < .001), followed by perceived social support (standardized path coefficient = .26, p < .001), and educational status (standardized path coefficient = -.22, p < .001). Diabetes management self-efficacy significantly and partially mediated the relationship between diabetes duration and diabetes self-care (Sobel's z = 2.65, p < .001) and between expectation regarding aging and diabetes self-care (Sobel's z = 3.03, p < .001). Perceived social support significantly and partially mediated the relation between educational status and diabetes self-care (Sobel's z = -2.81, p < .001). The qualitative component elucidated nine themes interwoven in Nepalese culture, social structure, and religious belief. Responsibilities toward family and belief in God acted as boosters for self-care in the case of Nepalese adults, which differed by age, gender, and literacy status.

 

Discussion: The results from this study suggest that tailored psychosocial interventions to promote diabetes management self-efficacy may be beneficial in promoting self-care among Nepalese adults with diabetes mellitus.