Improving Self-care Behavior and Removing Barriers by Structured Diabetes Education Program in Primary Health-care Settings of Puducherry: Evidence from a Mixed-method Intervention Study

Diabetes self-management education (DSME) improves patients’ clinical outcomes and quality of life by encouraging self-care behavior. This study aimed to find out the effectiveness of a DSME by comparing changes in stages of self-care behavior and to explore perceived barriers in diet, exercise, and foot care among patients with type 2 diabetes mellitus in an urban primary health center (PHC) of Puducherry. A mixed-method intervention study was conducted among 314 patients with type 2 diabetes mellitus in two urban PHCs randomly allocated to intervention and control arm. The stages of behavior change and barriers perceived in the domains of diet, physical activity, and foot care were captured using a pretested questionnaire. Intervention consisted of DSME along with information leaflets and self-care kits for the intervention group. At the end of 6 months, end-line assessment and in-depth interviews were conducted. Quantitative data were analyzed in STATA while manual coding and deductive thematic analysis were done for qualitative data. Footcare showed an improvement of 31%, while diet and exercise domains saw an improvement of 5% each from preaction to action stage when compared with control arm. The main barriers perceived in dietary modification and foot care were lack of awareness. For exercise, the main barriers were lack of perceived need and being physically unfit. Foot-care barriers witnessed maximum resolution (27%) following the intervention. DSME intervention helps in improving stages of behavior change while resolving self-care barriers. Culturally-oriented DSME and patient-tailored interventions are key to empower people living with diabetes by improving self-care.