According to Gram Research analysis, a qualitative study of 25 people with diabetes in Ethiopia found that while most took their medications regularly, many struggled with blood sugar monitoring, healthy eating, exercise, and foot care due to barriers including limited knowledge, poverty, stress, lack of family support, and poor access to healthcare resources. The research shows that comprehensive diabetes management requires addressing mental health, community support, and systemic barriers—not just prescribing medication.
A new study from Ethiopia explored why people with diabetes have trouble managing their condition day-to-day. Researchers interviewed 25 people with diabetes and healthcare workers to understand the real challenges they face. While most people took their medications, many struggled with checking their blood sugar, eating healthy, exercising, and caring for their feet. The biggest obstacles included not knowing enough about self-care, money problems, lack of support from family and community, stress, and difficulty accessing healthcare resources. The study shows that helping people manage diabetes requires more than just prescribing medicine—it needs mental health support, stress management, and community involvement.
Key Statistics
A phenomenological study of 25 participants in North Shoa, Ethiopia (2024) found that despite high medication adherence, many diabetic patients had inadequate practices in self-blood glucose monitoring, diet management, physical activity, and foot care.
Research reviewed by Gram identified barriers to diabetes self-care operating at three levels: individual (limited knowledge, low motivation, stress), interpersonal (lack of family and healthcare provider support), and community (cultural beliefs, poverty, poor healthcare access).
A 2024 qualitative study of diabetic patients in Ethiopia revealed that stress and mental health challenges were significant but often-overlooked barriers to effective diabetes self-management and medication adherence.
According to a 2024 phenomenological inquiry of 25 diabetes patients and healthcare workers in Ethiopia, socioeconomic constraints prevented many people from affording healthy foods, transportation to clinics, and blood glucose monitoring supplies despite wanting to follow medical advice.
The Quick Take
- What they studied: What makes it hard for people with diabetes in Ethiopia to take care of themselves properly, including checking blood sugar, eating right, exercising, and managing their condition
- Who participated: 20 people living with diabetes and 5 healthcare workers from four districts in North Shoa, Ethiopia, selected to represent different ages, genders, family situations, jobs, and types of diabetes
- Key finding: Most people took their diabetes medicines regularly, but many struggled with other important self-care tasks like monitoring blood sugar levels, following healthy diets, exercising regularly, and caring for their feet
- What it means for you: If you or someone you know has diabetes, understanding these common barriers—like lack of knowledge, money problems, stress, and limited support—can help you find solutions and ask for the right help from healthcare providers and your community
The Research Details
This was a phenomenological study, which means researchers focused on understanding people’s real-life experiences and perspectives rather than testing a specific treatment. The study took place in North Shoa, Ethiopia, from July 1-30, 2024. Researchers conducted in-depth interviews with 20 people who have diabetes and 5 healthcare workers who care for diabetic patients. They carefully selected participants to include different ages, genders, marital statuses, jobs, and types of diabetes to get a full picture of the problem.
The researchers used a structured interview guide to ask open-ended questions about daily diabetes management challenges. All interviews were recorded, written out word-for-word, and then analyzed using special software called ATLAS.Ti. This software helped identify patterns and themes in what people said about their struggles with self-care.
This research approach is important because it captures the real, human side of diabetes management that numbers alone can’t show. By listening to people’s actual experiences and the barriers they face, researchers can understand not just what people do, but why they do it—or why they don’t. This kind of understanding is essential for creating solutions that actually work in people’s real lives, especially in settings like Ethiopia where resources and healthcare access are limited.
This study has some important strengths: it was published in a peer-reviewed journal (PLOS ONE), used a systematic approach to analyze data, and included both patients and healthcare providers for a complete perspective. However, the sample size is small (25 people total), which means the findings may not apply to all people with diabetes everywhere. The study was also conducted in one specific region of Ethiopia, so results may differ in other countries or communities with different resources and cultures. The findings are best understood as insights into barriers in this particular setting rather than universal truths.
What the Results Show
The study revealed a significant gap between medication adherence and overall diabetes self-care. While most participants took their prescribed medications regularly, many failed to perform other critical self-care tasks. Specifically, inadequate practices were found in self-blood glucose monitoring (checking blood sugar at home), following recommended diets, engaging in regular physical activity, and foot care—all essential components of diabetes management.
Barriers to self-care operated at three levels: individual level (limited knowledge about diabetes, low motivation, stress, and depression), interpersonal level (lack of family support and guidance from healthcare providers), and community level (cultural beliefs that conflicted with modern diabetes care, poverty, and poor access to healthcare resources and supplies). The research showed that these barriers didn’t exist in isolation—they worked together to make self-care extremely difficult for many people.
The study identified stress and mental health challenges as significant but often-overlooked barriers to diabetes self-management. Many participants reported feeling overwhelmed by their condition, which made it harder to stay motivated and follow their care routines. Cultural beliefs also played a role—some traditional practices and beliefs about illness conflicted with modern diabetes management approaches. Additionally, socioeconomic constraints were pervasive; many people couldn’t afford healthy foods, transportation to clinics, or blood glucose monitoring supplies, even when they wanted to follow their doctor’s advice.
These findings align with previous research showing that diabetes self-management is complex and multifactorial. Similar studies in other developing countries have identified comparable barriers related to poverty, limited healthcare access, and lack of education. However, this study adds important context about how these barriers specifically manifest in the Ethiopian healthcare setting and emphasizes the critical role of mental health and community support—areas that are sometimes overlooked in diabetes management programs.
The study’s main limitation is its small sample size of 25 people, which means findings may not represent all people with diabetes in Ethiopia or other countries. The research was conducted in one specific region (North Shoa Zone) during a one-month period, so results may not apply to other areas with different resources, cultures, or healthcare systems. Additionally, the study relied on people’s self-reported experiences, which can be influenced by memory, social desirability (saying what they think researchers want to hear), or personal perspective. The findings are best understood as detailed insights into barriers in this particular setting rather than definitive conclusions about diabetes management everywhere.
The Bottom Line
Based on this research, healthcare providers and diabetes programs should: (1) Provide comprehensive diabetes education that goes beyond medication instructions to include blood sugar monitoring, nutrition, exercise, and foot care—with high confidence this addresses a major gap; (2) Integrate mental health support and stress management into diabetes care programs—moderate to high confidence based on the prominence of stress as a barrier; (3) Involve family members and community leaders in diabetes education and support—moderate confidence that this addresses the interpersonal barrier; (4) Work to improve access to affordable diabetes supplies and healthy foods—high confidence this is essential given the economic barriers identified.
People with diabetes and their families should care about these findings because they validate common struggles and suggest that asking for mental health support, family involvement, and community resources is important. Healthcare providers should care because this research shows that medication alone isn’t enough—comprehensive support is needed. Policymakers and public health officials should care because the study highlights systemic barriers (poverty, healthcare access, cultural factors) that require broader solutions beyond individual behavior change. People in developing countries with limited healthcare resources should especially pay attention, as these barriers are particularly acute in such settings.
Realistic expectations for improvement depend on which changes are made. Taking medications consistently can show benefits in blood sugar control within weeks. Dietary changes and increased physical activity may show measurable improvements in blood sugar levels within 2-4 weeks. Mental health support and stress management may take 4-8 weeks to show meaningful impact on motivation and adherence. Comprehensive improvements in all areas of self-care, supported by community and family involvement, typically require 3-6 months to become sustainable habits.
Frequently Asked Questions
Why do people with diabetes struggle to manage their condition even when they take their medicine?
A 2024 study found that medication is only one part of diabetes care. People struggle with blood sugar monitoring, healthy eating, exercise, and foot care due to lack of knowledge, money problems, stress, weak family support, and limited access to healthcare resources and supplies.
What are the biggest barriers to diabetes self-care in developing countries?
Research from Ethiopia identified three levels of barriers: individual (limited education, stress, low motivation), interpersonal (lack of family and doctor support), and community (poverty, cultural beliefs conflicting with modern care, poor healthcare access). These barriers work together to make self-care extremely difficult.
How can mental health support improve diabetes management?
A 2024 qualitative study found that stress and depression significantly reduced people’s motivation to follow diabetes routines. Integrating mental health support and stress management into diabetes care programs can help people stay motivated and consistent with their self-care practices.
What role does family support play in diabetes self-management?
The study identified lack of family guidance and support as a major interpersonal barrier to diabetes self-care. Involving family members in diabetes education and creating community support systems can help people overcome obstacles and maintain healthy behaviors.
Can improving access to healthcare resources help people manage diabetes better?
Research from Ethiopia showed that poverty and poor access to supplies prevented many people from following their doctor’s advice, even when motivated. Improving access to affordable blood glucose monitors, healthy foods, and transportation to clinics is essential for effective diabetes management.
Want to Apply This Research?
- Track daily completion of three self-care tasks: (1) medication taken (yes/no), (2) blood sugar checked (if applicable, with reading), and (3) one healthy behavior completed (healthy meal, 30-minute activity, or foot care check). This creates a simple daily scorecard showing progress across all self-care areas, not just medication.
- Use the app to set one specific, achievable self-care goal each week beyond medication—for example, ‘Check blood sugar 3 times this week’ or ‘Take a 15-minute walk 4 times this week.’ Start small and build gradually. The app can send reminders and celebrate small wins to build motivation over time.
- Create a weekly reflection feature where users answer: ‘What barriers did I face this week?’ and ‘Who helped me?’ This helps identify patterns in obstacles and recognizes support systems. Over time, users can see which barriers are most common and which strategies work best for them personally. Share this data with healthcare providers to get personalized support.
This research describes barriers to diabetes self-care in a specific region of Ethiopia and should not be interpreted as medical advice. If you have diabetes, work with your healthcare provider to develop a personalized management plan that addresses your specific barriers and circumstances. Mental health support, family involvement, and community resources are important complements to—not replacements for—medical treatment. Always consult with your doctor before making changes to your diabetes management routine.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.