Self-care management among patients with type 2 diabetes in East Jerusalem

Objective: Little research exists on diabetes self-care management (DSCM) in Arab populations. We examined the contribution of health belief constructs, socioeconomic position (SEP) and clinical factors (glycated haemoglobin [HbA1C] level, type of diabetes treatments, and receiving professional guidance) to DSCM among Arab patients in East Jerusalem with type 2 diabetes. Method: Using a structured questionnaire, we conducted face-to-face interviews with a random sample of 230 patients with type 2 diabetes in a large diabetes clinic. DSCM included engagement in any of the following in the last week: physical activity, consumption of low-fat and low-sugar diet, self-monitoring of blood glucose, medication uptake and foot care. We obtained HbA1C levels from the clinic's patient registry. We used linear regression to examine the contribution of health beliefs, SEP and clinical factors to explaining DSCM. Results: Adherence to DSCM was low. Most patients (84.8%) were physically inactive, 64.3% did not consume a low-fat or low-sugar diet (46.5%) and 51% did not self-monitor blood glucose. However, medication adherence (95.7%) and foot care were high (77.4%). About 71% of participants had high HbA1C (>7.0%). In the multivariate analysis, total DSCM scores were higher among patients with low financial barriers, high perception of the benefits of DSCM and higher self-efficacy. Patients using oral medication (vs insulin) had significantly lower DSCM scores. Conclusion: Among Arab patients with diabetes, more interventions are needed to encourage DSCM, specifically in areas of lifestyle (diet and physical activity). Patients' financial barriers, benefits of DSCM and patient self-efficacy should be emphasised.