Exploring type 2 diabetes management in Nepalese patients

Abstract

Development of strategies to improve diabetes management in Nepal is challenged by the limited understanding of patients’ diabetes related behaviour and factors influencing these behaviours. This study aimed to identify interventions to facilitate diabetes management in Nepal, by using data from interviews conducted with Nepalese patients with type 2 diabetes (T2D) and with healthcare professionals (HCPs). In-depth face-to-face interviews were conducted with Nepalese patients with T2D in Australia and Nepal, followed by interviews with HCPs in Nepal. Interviews were transcribed verbatim and thematically analysed. An intervention plan to promote diabetes management was developed using the intervention mapping approach. Overall, the studies showed inadequate self-management practices in Nepalese patients; and identified a range of personal, cultural, socio-economic and healthcare related factors that impacted patients’ self-management. Patients struggled with healthy diet practices, conducting regular exercise, and were likely to delay or cease their medications. Perceptions about diabetes self-management were similar between patients in Nepal and Australia. HCPs’ perceptions of patients’ behaviour largely corroborated with patients’ report. HCPs reported absence of diabetes educators and lack of effective collaboration amongst HCPs as major barriers to effective diabetes care in Nepal. They perceived insufficient knowledge, misconceptions, patients’ education level and socio-economic status as fundamental issues impacting patients’ diabetes management. Patients and HCPs perceived education, motivation, cheaper healthcare services, support and strategies for effective lifestyle practices essential to improve diabetes management. To facilitate diabetes management in Nepal it is imperative to have targeted strategies at patient, community, HCP, healthcare system and regulatory levels. At the patient-level, there is a need to improve patients’ behaviour by modifying their capabilities, motivation and opportunities. Strategies involving a social-marketing model at the community level and a multidisciplinary collaborative care approach to diabetes care at healthcare level were identified as appropriate approaches, and have been proposed for future implementation.