Send to

Choose Destination
PLoS One. 2019 Mar 19;14(3):e0213530. doi: 10.1371/journal.pone.0213530. eCollection 2019.

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

Author information

Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
School of Public Health, University of the Western Cape, Belville, South Africa.
Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa.
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Molecular Medicine & Surgery, Diabetes and Endocrine Unit, Karolinska Institutet, Stockholm, Sweden.
Department of Learning, Informatics, Management & Ethics, Karolinska Institutet, Stockholm, Sweden.
Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Collaborative Care Systems Finland, Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.


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.

Conflict of interest statement

The authors have declared that no competing interests exist.

Supplemental Content

Full text links

Icon for Public Library of Science Icon for PubMed Central
Loading ...
Support Center