A model to support adult patients living with diabetes mellitus in their self-care management at community health centres in Limpopo Province, South Africa

Abstract

ntroduction: Global management of diabetes mellitus is guided by the World Health Organization and International diabetes guidelines. Global literature revealed different strategies that are used in the management of diabetes mellitus, with diabetes self-care management education, and support as an integral component worldwide. Support of patients living with diabetes mellitus in self-care management is imperative to reduce and delay diabetes complications. Purpose: The purpose of this study was to develop a model to support adult patients living with diabetes mellitus in self-care management at the community health centres of Limpopo Province, South Africa. Setting: The study was conducted in the community health centres of the Vhembe and Mopani Districts of Limpopo Province, South Africa. Phase 1 - Research Methodology: This study employed a qualitative, exploratory, contextual, descriptive design. The study population consisted of patients living with diabetes mellitus, professional nurses, and family members. A non-probability, purposive sampling was used to select the community health centres, professional nurses, patients, and family members. A semi-structured in-depth interview, using an interview guide, was used to collect data from the patients. Central questions were used to collect data from the professional nurses and family members. Sample size of participants were determined by data saturation. Data was analysed using Tesch’s open-coding method. Ethical principles and measures to ensure trustworthiness were considered. Findings: The following major themes emerged from data analysis: • Self-care practices, • Challenges experienced by patients living with diabetes mellitus, and • Support expressed by patients living with diabetes mellitus. The findings of the study revealed ineffective support of patients by family members and professional nurses in diabetic self-care management. Phase 2 - Concept Analysis: The concept of ‘‘support’’ was identified from data analysis conducted in Phase 1. The findings of study in Phase 1 revealed the support of patients living with diabetes mellitus as a challenge to professional nurses, and family members. The findings v prompted the researcher to analyse ‘‘support’ ’as fundamental concept of the study guided by Walker and Avant (2019) concept analysis method. Phase 3: Model Development and Validation: Development of a model was guided by the objectives of the study as stated in Chapter 1, analysed concept, and Orem’s self-care deficit theory. Validation of a model employed a qualitative approach, using semi-structured in-depth interviews. Validators included professional nurses, operational managers, family members, patients with diabetes mellitus, and consultation with diabetic educators. Conclusion: The findings of this study demonstrate insufficient support of adult patients living with diabetes mellitus. Challenges such as lack of resources and insufficient information about diabetes mellitus were found as some compounding factors affecting self-care management and support of adult patients living with diabetes mellitus.