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Impact of Diabetes Self-Management Education on Self-Care Practices among Adults with Diabetes in Nigeria

Abstract

Diabetes mellitus is a major public health concern in Nigeria and requires continuous self-management to prevent complications and improve health outcomes. Adults living with diabetes are expected to engage in several self-care practices, including appropriate dietary management, regular physical activity, medication adherence, blood glucose monitoring, foot care, and timely healthcare attendance. However, inadequate knowledge, limited access to diabetes education, financial constraints, misconceptions about diabetes, poor continuity of care, and limited support for self-management may affect adherence to recommended practices. Diabetes self-management education provides an important opportunity to equip individuals with the knowledge, skills, confidence, and practical strategies required to manage their condition effectively. Against this background, this study investigates the impact of diabetes self-management education on self-care practices among adults with diabetes in Nigeria. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and Social Ecological Model. The Health Belief Model explains how individuals' perceptions of diabetes susceptibility, perceived severity of complications, perceived benefits of self-care, perceived barriers, and cues to action may influence diabetes self-management behaviours. Social Cognitive Theory emphasizes the roles of knowledge, behavioural capability, self-efficacy, observational learning, reinforcement, and environmental support in developing and maintaining appropriate self-care practices. The Social Ecological Model emphasizes the influence of individual, family, community, healthcare, socioeconomic, and environmental factors on diabetes self-management. Collectively, these theoretical perspectives provide a suitable framework for explaining how diabetes self-management education may influence self-care practices among adults with diabetes in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise adults aged 18 years and above diagnosed with diabetes and receiving care in selected healthcare facilities across Nigeria. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, diabetes clinics, and eligible participants. Diabetes self-management education will be assessed using indicators such as exposure to diabetes education sessions, frequency and duration of education, educational content, individualized counselling, dietary education, physical activity education, medication-management education, blood glucose monitoring education, foot-care education, recognition of diabetes complications, and follow-up support. Self-care practices will be assessed using indicators such as medication adherence, dietary adherence, physical activity, blood glucose monitoring, foot care, attendance at scheduled clinic appointments, appropriate management of illness, and timely healthcare-seeking. Data will be collected using structured questionnaires, diabetes clinic records, education registers, medical records, and relevant programme documents. Validated diabetes self-management and self-care assessment instruments may be used where appropriate. Descriptive statistics will be used to summarize participants' characteristics, exposure to education, knowledge levels, and self-care practices. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of diabetes self-management education on self-care practices. Where a quasi-experimental design is adopted, self-care practice scores before and after structured diabetes self-management education may be compared, while relevant demographic, socioeconomic, clinical, and healthcare-related factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that diabetes self-management education has a significant positive impact on self-care practices among adults with diabetes in Nigeria. Adults who receive comprehensive and structured diabetes self-management education are expected to demonstrate better adherence to recommended dietary practices, medication use, physical activity, blood glucose monitoring, foot care, and routine healthcare attendance than adults with limited access to diabetes education. Education may improve knowledge of diabetes, strengthen self-efficacy, increase awareness of complications, promote healthier behaviours, and encourage timely healthcare-seeking. However, sustained self-care may be influenced by medication and healthcare costs, food affordability, social support, employment demands, access to monitoring equipment, cultural beliefs, and availability of continuous diabetes care. The study therefore expects accessible, individualized, continuous, and culturally appropriate diabetes self-management education, supported by adequate healthcare services, to contribute significantly to improved self-care practices among adults with diabetes in Nigeria. The study is expected to contribute to the literature on diabetes self-management education, diabetes self-care practices, diabetes mellitus, chronic disease management, health education, patient empowerment, primary healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, healthcare facilities, diabetes clinics, endocrinologists, physicians, nurses, dietitians, pharmacists, community health workers, development partners, and policymakers regarding strategies for strengthening diabetes management. The study will also provide evidence-based recommendations for integrating structured diabetes self-management education into routine diabetes care, strengthening healthcare-worker capacity, improving access to self-monitoring resources, providing individualized dietary and lifestyle counselling, strengthening follow-up and support systems, reducing barriers to diabetes care, and integrating diabetes education into broader non-communicable disease prevention and management programmes across Nigeria.

Keywords: Diabetes self-management education, self-care practices, diabetes mellitus, medication adherence, blood glucose monitoring, dietary management, foot care, chronic disease management, adults with diabetes, Nigeria, public health.