Date of Award
2025
Document Type
Thesis
Publisher
Edith Cowan University
Degree Name
Doctor of Philosophy
School
School of Nursing and Midwifery
First Supervisor
Lisa Whitehead
Second Supervisor
Gemma Doleman
Third Supervisor
Deborah Kirk
Abstract
Background
Type 2 diabetes is a growing concern in Malawi because of the increasing prevalence and limited resources available for diabetes care and management. A shortage of healthcare providers, inadequate healthcare infrastructure, limited access to diabetes medications and supplies, and the high cost of treatment limits access to diabetes care and support for people with type 2 diabetes in Malawi. This can impact the provision of comprehensive care that addresses their needs and preferences. To control the impact of the disease on their health and wellbeing and reduce the risk of complications, people living with type 2 diabetes need to consistently engage in self-management activities. It is important to understand the supportive care needs of people living with type 2 diabetes, including the factors that facilitate or hinder their self-management efforts to inform the provision of support that will help people living with type 2 diabetes to effectively manage their condition. This study sought to understand the supportive care needs of people living with type 2 diabetes in Malawi and explore the factors that facilitate of hinder self-management behaviours.
Methods
This research was conducted at two public referral hospitals in Malawi: Kamuzu Central Hospital (KCH) and Queen Elizabeth Central Hospital (QECH) using a sequential explanatory mixed methods design. In the first phase, a survey with questions soliciting information about demographics and disease related information, followed by a modified Supportive Care Needs Survey (SCNS-SF34) was administered to a convenience sample of 286 adults living with type 2 diabetes who were attending diabetes clinic at KCH or QECH. Data were analysed using IBM Statistical Package for Social Sciences (SPSS) Statistics version 29.0.1.0 for Windows. Descriptive and logistic regression models were used to assess supportive care needs and determine associated factors, respectively.
In the second phase face-to-face semi-structured interviews were conducted with a purposive sample of 12 participants to explore their perceptions and experiences of supportive care needs, as well as barriers and facilitators to self-management. The data were analysed using thematic analysis.
Data integration occurred at various points in the study, including at the design, methods, interpretation, and reporting levels. Findings from the two phases were integrated narratively using a joint display approach to provide a comprehensive understanding of the supportive care needs and self-management challenges.
Results
Quantitative results
A total of 286 adults who had been diagnosed with type 2 diabetes (156 at KCH and 130 at QECH) completed the survey. The mean age of participants was 51.2 years (SD ± 13.19), and the majority were female (n = 194; 67.8%) and married (n = 186; 65%). Most participants (n = 186; 65%) were prescribed oral antidiabetic medications and the median time since diagnosis was 6 years (IQR 2 – 11 years). The prevalence of unmet needs was high across all domains of supportive care. Health systems and information needs (n = 266; 93%) were most likely to be unmet, followed by patient care and support needs (n = 243; 85%). The prevalence of unmet needs among participants at KCH was significantly higher for psychological needs (91% vs 67.7%; p = .001), physical and daily living needs (88.5% vs 70.8%; p ≤ .001), patient care and support needs (89.7% vs 79.2%; p = .013) and needs related to sexuality (75.6% vs 64.6%; p = .042). For participants at KCH, having secondary education increased the odds of reporting unmet health systems and information needs (AOR 1.054; 95% CI 1.05–68.99); in turn, older age (AOR .949; 95% CI .01–.99) reduced the likelihood of reporting unmet needs relating to sexuality. At QECH, female participants were less likely to report unmet needs relating to sexuality (AOR .309; 95% CI .099–.966), and the likelihood of reporting unmet psychological needs was lower for participants who were employed (AOR.151; 95% CI .037–.610).
Qualitative results
The thematic analysis of qualitative data revealed specific needs and self-management facilitators and barriers that supported, expanded on and, in some instances, contradicted the quantitative findings. The themes were categorised according to three a priori headings, namely 1) Supportive care needs, 2) Self-management facilitators, and 3) Barriers to self-management. Several subthemes were generated within each category.
The analysis demonstrated that the perceptions of unmet supportive care needs related to physical and daily living, psychological aspects, sexuality, patient care and support and information and health care systems emerged consistently in both the quantitative and qualitative results. In addition, integration of the results deepened understanding, by revealing relationships between supportive care needs and identified self-management facilitators and barriers. An important finding of this study is the significant variation in needs reported by participants at the two hospitals, despite both being tertiary-level public hospitals. Application of the socioecological model for interpreting and discussing the results demonstrated that all levels of the model (factors at the intrapersonal, interpersonal, community, organisational and policy levels) influenced perceived unmet supportive care needs and barriers and facilitators to self-management.
Conclusions
This study revealed high levels of unmet supportive care needs in adults living with type 2 diabetes in two areas of Malawi. Unmet needs were prevalent across several domains particularly within health systems and information, patient care and support and psychological. These needs were most pronounced among participants from KCH in Lilongwe compared to QECH in Blantyre and associations between unmet needs with self-management barriers and facilitators were observed. Limited access to self-management resources, inadequate family and social support, and challenges within the healthcare system, were identified as barriers to self-management. However, supportive family and social networks adherence to medical advice, acceptance of the condition, and motivation were identified as factors that support self-management. Addressing unmet supportive care needs and barriers for people living with type 2 diabetes in Malawi requires strengthening health care systems, enhancing patient education and promoting comprehensive support. The study highlights the need for effective health policies and patient centred approaches tailored to people’s needs and preferences to improve quality of life and health outcomes.
DOI
10.25958/2zrt-pk93
Access Note
Access to this thesis is embargoed until 7th February 2030
Recommended Citation
Kuchawo, M. G. (2025). Understanding needs, barriers, and facilitators to self-management among people living with type 2 diabetes in Lilongwe and Blantyre, Malawi. Edith Cowan University. https://doi.org/10.25958/2zrt-pk93