Diabetes self-management in three different income settings: cross-learning of barriers and opportunities

Jeroen De Man, Juliet Aweko, Meena Daivadanam, Helle Mölsted Alvesson, Peter Delobelle, Roy William Mayega, Claes-Göran Östenson, Barbara Kirunda, Francis Xavier Kasujja, David Guwattude, Thandi Puoane, David Sanders, Stefan Peterson, Göran Tomson, Carl Johan Sundberg, Pilvikki Absetz, Josefien van Olmen

Research output: Contribution to journalA1: Web of Science-articlepeer-review

14 Downloads (Pure)


The burden of type 2 diabetes is increasing rapidly, not least in Sub-Saharan Africa, and disadvantaged populations are disproportionally affected. Self-management is a key strategy for people at risk of or with type 2 diabetes, but implementation is a challenge. The objective of this study is to assess the determinants of self-management from an implementation perspective in three settings: two rural districts in Uganda, an urban township in South Africa, and socio-economically disadvantaged suburbs in Sweden. Data collection followed an exploratory multiple-case study design, integrating data from interviews, focus group discussions, and observations. Data collection and analysis were guided by a contextualized version of a transdisciplinary framework for self-management. Findings indicate that people at risk of or with type 2 diabetes are aware of major self-management strategies, but fail to integrate these into their daily lives. Depending on the setting, opportunities to facilitate implementation of self-management include: improving patient-provider interaction, improving health service delivery, and encouraging community initiatives supporting self-management. Modification of the physical environment (e.g. accessibility to healthy food) and the socio-cultural environment (i.e. norms, values, attitudes, and social support) may have an important influence on people's lifestyle. Regarding the study methodology, we learned that this innovative approach can lead to a comprehensive analysis of self-management determinants across different settings. An important barrier was the difficult contextualization of concepts like perceived autonomy and self-efficacy. Intervention studies are needed to confirm whether the pathways suggested by this study are valid and to test the proposed opportunities for change.

Original languageEnglish
Article number0213530
JournalPLoS ONE
Issue number3
Number of pages22
Publication statusPublished - 2019


  • CARE


Dive into the research topics of 'Diabetes self-management in three different income settings: cross-learning of barriers and opportunities'. Together they form a unique fingerprint.

Cite this