Health Providers’ Views on Education and Management Approaches for Type 2 Diabetes in Southern Nigeria

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Emerging evidence underscores the effectiveness of multidimensional and context-specific approaches to diabetes care. Despite policies promoting holistic care, evidence on how frontline healthcare workers operationalize multifaceted strategies remains limited. This study, therefore, examines practices at the University of Calabar Teaching Hospital, exploring how healthcare providers view education and management strategies of type 2 diabetes mellitus. Methods Our study employed a qualitative design approach via interviews and focus group discussions to explore health providers' perspectives on education and management strategies for type 2 diabetes mellitus (T2DM) in southern Nigeria. Participants were purposively selected at the University of Calabar Teaching Hospital (UCTH), Cross River State, Nigeria. Results The thematic analyses of the data using inductive and deductive coding produced five themes and fifteen sub-themes related to how health education strategies can improve management of T2DM in the health facilities. This qualitative study highlights how health-education strategies pan out in the management of type 2 diabetes mellitus when individualized, context-specific, and supported by team-based care. Conclusion This study highlights a coherent, evidence-based blueprint adopted by healthcare workers for enhancing T2DM management: structured diabetes self-management education delivery, addressing dietary and supplementing misconceptions using culturally sensitive counseling, prioritization of risk communication, investment in continuing professional development, and the utility of digital tools to drive better adherence. Diabetes Mellitus T2DM Healthcare Professionals Education Management Strategies Introduction The past decade has witnessed a rapid rise in type 2 diabetes (T2DM) across sub-Saharan Africa [ 1 , 2 ]. The number of affected adults increased from 14.2 million in 2015 to 23.6 million in 2021 and is projected to reach 54.9 million by 2045 without decisive interventions [ 3 , 4 ]. This surge is largely driven by urbanization, sedentary lifestyles, high-calorie diets, and an aging population [ 5 , 6 ]. Alarmingly, an estimated 62.5% of cases remain undiagnosed in the region, reflecting major gaps in detection and care [ 7 ]. In Nigeria, a recent systematic review of 60 studies involving over 124,000 participants reported a pooled T2DM prevalence of 7.0% (95% CI: 5.0–9.0%), with the highest burden in the South-South (11.35%) and the lowest in the North-Central zone (2.03%) [ 8 ]. Risk factors include family history, high socioeconomic status, physical inactivity, obesity, poor diet, and urban residence [ 9 , 10 ]. The consequences of late diagnosis and inadequate healthcare delivery are evident in severe complications such as neuropathy, retinopathy, cardiovascular disease, nephropathy, amputations, and stroke [ 7 , 11 ]. Obesity further exacerbates the burden, affecting 20–35% of adults in urban areas, with 8–22% classified as obese [ 12 ]. Together, obesity, limited diagnostic infrastructure, and a strained health system highlight the urgent need for preventive and educational interventions [ 5 , 13 ]. Emerging evidence underscores the effectiveness of multidimensional and context-specific approaches to diabetes care. Previous reviews of diabetes self-management education (DSME) in Africa found significant improvements in diabetes knowledge, glycemia, blood pressure, and foot-care practices, with modest gains in diet and physical activity [ 14 , 15 ]. Interventions were delivered individually, via technology, or in group settings. In South Africa, a cluster-randomized trial demonstrated that group-based DSME led by health-promotion workers improved self-care, reduced HbA1c by 1%, and facilitated moderate weight loss [ 16 ]. These findings affirm the feasibility and impact of structured, group-based education in low-resource contexts [ 16 ]. Yet, translating such approaches into routine care remains difficult. A Ghanaian mixed-methods study identified fragmented referrals and ad hoc education as barriers, requiring providers to adapt with peer-support groups, simplified follow-ups, and task delegation [ 17 ]. Broader barriers, including stigma, low income, cultural misconceptions, and poor health literacy, further hinder effective self-management [ 17 , 18 ]. This study focuses on Southern Nigeria, a critical yet under-researched region in T2DM management [ 8 , 19 ]. Despite policies promoting holistic, patient-centered care, evidence on how frontline providers operationalize multifaceted strategies remains limited. This research, therefore, examines practices at the University of Calabar Teaching Hospital, exploring how providers integrate pharmacotherapy, education, team-based coordination, lifestyle support, and follow-up strategies. The findings aim to inform context-specific interventions that align with national policies and strengthen structured T2DM care in resource-limited settings. Methods Study design Our study employed a qualitative design approach to explore health providers' perspectives on education and management strategies for type 2 diabetes in southern Nigeria. This method was selected as it allowed us to capture the complexities of diabetes self-management and healthcare delivery, as well as to identify barriers and facilitators to effective patient-centered care. Semi-structured key informant interviews (KIIs) and focus group discussions (FGDs) were conducted to provide participants with the opportunity to share their personal experiences and viewpoints in detail, while the findings were reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist [ 20 ]. Study setting and population This study was conducted in Calabar, the capital city of Cross River State, Nigeria. Calabar is located in the South-South geopolitical zone in Nigeria. The city is predominantly inhabited by the Efik, Efut, and Qua ethnic groups, with the Efik language being widely spoken alongside Pidgin English. The city prides itself richly as a coastal location with it as the centre for trade and cultural exchange in the country. Furthermore, the city hosts the University of Calabar Teaching Hospital, which provides specialized health services to the populace [ 21 ]. The study population comprised healthcare workers directly involved in the management and care of patients (18 years and above) with T2DM at the University of Calabar Teaching Hospital, Calabar. Sampling procedure Participants were drawn from the hospital’s diabetes clinics using a purposive sampling technique. Participants included medical doctors, nurses, and other allied healthcare professionals who provide routine care and treatment for individuals living with T2DM. Participants were recruited for KIIs and FGDs. For the KIIs, four key informants were recruited in the selected health facility, comprising a Medical Doctor in charge of the outpatient department (OPD) for Type 2 diabetic patients (or their representatives), a Nurse, and two Pharmacists involved in dispensing drugs and attending to patients. In addition, a total of fifteen participants were recruited for the FGDs. Instruments for data collection Prior to the KIIs and FGDs data collection, semi-structured guides were developed by the principal investigator, which included questions and prompts that were relevant to the study objectives and overall aim. The guides were subjected to expert review for face and content validity by the study supervisor. The guides contained open-ended and thematic prompts designed to facilitate in-depth exploration of participants’ perspectives, while allowing flexibility for participants to raise pertinent issues during the data collection exercise. The guides were pre-tested among six healthcare workers in the University of Uyo teaching hospital, Akwa Ibom State, outside the study sample. Feedback from the pre-test exercise was used to refine the structure, wording, and sequencing of the guides to ensure its cultural relevance. Data collection procedure The study data were collected by trained data collectors with prior experience and skills in qualitative research in social sciences and public health. The KIIs and FGDs were collected in Efik and Pidgin languages and moderated by the principal investigator, with support from trained research assistants. The data collection sessions took place in two locations with UCTH, which were purposively selected by the participants. Time and venues of data collection were selected to fit the schedules of the participants, allowing for a comfortable environment where they could freely share their experience and challenges of managing T2DM patients. Prior to each session, the principal investigator explained the purpose of the data collection and sought permission to audio-record the sessions. Data analysis and reporting The data collected were transcribed by trained researchers and translated from Efik and Pidgin to English, and back-translated to ensure accuracy of the information. The transcripts were completely anonymized by ensuring all identifiable information from the participants was appropriately redacted. The principal researcher thoroughly reviewed the transcripts multiple times to become familiar with the data and to develop a code frame. Both inductive and deductive approaches were employed to extract codes and relevant quotations. To ensure reliability and consistency of the codes, two independent researchers blindly coded the data and extracted the themes. The finalized themes were then used to structure the analysis and reporting, leveraging the approach by Braun and Clarke [ 22 ]. Reflexivity statement The Principal Investigator (KNO), a public health researcher with prior knowledge of diabetes prevention and management, acknowledges that they may have played a role in the interactions of the data collection exercise. To minimize potential bias, open-ended, participant-driven questions were employed, and a neutral stance was maintained to encourage participants to freely share their personal experiences and firsthand accounts of managing patients with T2DM. Furthermore, co-authors (PCA, AO, and ANO) contributed to the analysis and ensured that the themes generated reflected participants’ voices rather than preconceived notions of the researchers. Ethical considerations Our study complied with the principles of ethical research on human participants outlined in the Declaration of Helsinki [ 23 ]. Approval to conduct the study was obtained from the Head of Department, Public Health, University of Calabar, Cross River State, and appropriate ethical approval was gotten from the UCTH Research Ethics Committee Boards (Approval number: NHREC/07/10/2012). Signed informed consent forms were. Participants were informed they had the freedom to leave the study at any point during the study without any consequences. Confidentiality and anonymity were assured throughout the study, and data were securely stored and accessible only to the principal investigator. Results The thematic analyses of the data using inductive and deductive coding produced five themes and fifteen sub-themes related to how health education strategies can improve management of Type 2 DM in the health facilities. Theme 1: Patient Education and Empowerment Healthcare providers (HCPs) emphasized the importance of comprehensive patient education, offering individualized counseling and access to resources to empower patients in managing type 2 diabetes effectively. They employ various educational approaches, including discussing underlying causes, providing medication counseling, and creating personalized meal plans. By equipping patients with knowledge and support, providers aim to enhance self-management skills and promote positive health outcomes. Comprehensive Education Approach HCPs highlighted the importance of providing comprehensive education to patients about type 2 diabetes, covering various aspects such as causes, symptoms, management strategies, and potential complications. "I discuss the underlying causes of the condition, including genetic predisposition, lifestyle factors, and obesity." (46-year old Medical Doctor, KII) "Follow-up appointments are crucial. It's not enough to just tell someone about the risks once and then send them on their way. Regular check-ins can help reinforce the importance of managing diabetes and provide ongoing support and guidance." (25-year old Discussant 4, FGD) "I ensure that patients understand the progression of type 2 diabetes and how lifestyle factors such as diet and exercise can influence their condition." (38-year old Nurse, KII) "I provide educational resources such as brochures, pamphlets, and written materials on diabetes prevention, medication management, and lifestyle modifications." (38-year old Nurse, KII) Individualized Counseling HCPs noted that individualized counseling in their practice and experience involved tailoring education and guidance to meet the specific needs, preferences, and circumstances of each patient with type 2 diabetes, ensuring that they receive personalized support in managing their condition. "I work collaboratively with patients to identify realistic goals, create personalized meal plans, and provide ongoing support and encouragement to help them overcome these challenges." (38-year old Nurse, KII) "I tailor treatment plans to meet the individual needs and preferences of patients with type 2 diabetes, considering factors such as age, gender, socioeconomic status, cultural background, comorbidities, and personal preferences." (38-year old Nurse, KII) "By actively listening to patients' concerns and preferences, I tailor my counseling approach to meet their unique needs and empower them to take control of their health." (46-year old Medical Doctor, KII) Access to Resources HCPs noted that providing access to resources such as educational materials, support groups, community programs, and digital tools ensures that patients with type 2 diabetes have the necessary support and information to effectively manage their condition. "I also collaborate with other healthcare professionals, community organizations, and local schools to raise awareness about diabetes prevention and management." (38-year old Nurse, KII) "These technologies allow for more frequent communication with patients, real-time data tracking, and personalized feedback on lifestyle behaviors and medication adherence." (29-year old Pharmacist, KII) "I think it is very important to utilize clear and concise language during patient consultations. They should prioritize this even more" - (44-year old Discussant 1, FGD) Theme 2: Addressing Challenges and Misconceptions Healthcare providers noted misconceptions and other challenges that impact healthcare providers' efforts to address issues around dietary control measures and supplements in managing type 2 diabetes. Providers emphasize the importance of promoting sustainable dietary changes, debunking myths about supplements, and advocating for a multifaceted approach to management. By addressing these challenges and misconceptions, providers aim to facilitate informed decision-making and promote effective diabetes management strategies among patients. Sustainable Dietary Changes HCPs reported that sustainable dietary changes involved helping patients overcome challenges and adopt long-term healthy eating habits that support diabetes management, taking into account factors such as cultural preferences, budget constraints, and lifestyle. "Many patients struggle with unhealthy eating habits, limited access to nutritious foods, and cultural barriers to dietary modification." (38-year old Nurse, KII) "I collaborate with patients to identify culturally appropriate foods and recipes that align with their dietary preferences and provide them with practical strategies for incorporating these foods into their daily meals.” (38-year old Nurse, KII) "I provide practical tips for grocery shopping, meal preparation, and dining out, and I offer ongoing support and encouragement to help patients make sustainable dietary changes." (46-year old Medical Doctor, KII) Misconceptions about Supplements Healthcare providers highlighted that they address common misconceptions patients may have about the effectiveness of dietary supplements or herbal remedies in managing type 2 diabetes and emphasize the importance of evidence-based approaches to treatment. "One common misconception I encounter is the belief that dietary supplements or herbal remedies can cure or reverse diabetes." (46-year old Medical Doctor, KII) "I take the time to discuss the potential risks and benefits of dietary supplements with patients, helping them make informed decisions about their use in conjunction with their diabetes management plan." (38-year old Nurse, KII) "I educate patients about the lack of regulation and scientific evidence supporting many of these products and advise them to consult with their healthcare provider before starting any new supplement regimen." (44-year old Pharmacist, KII) Multifaceted Approach to Management HCPs noted that managing type 2 diabetes effectively requires a multifaceted approach that encompasses lifestyle modifications, medication therapy, regular monitoring, and ongoing support from healthcare providers to address the complex needs of patients. "From my clinical experience, I've found that a multifaceted approach is essential for achieving and maintaining glycemic control in patients with type 2 diabetes." (30-year old Nurse, KII) "In addition to medication therapy, I emphasize the importance of regular physical activity, stress management techniques, and adequate sleep as integral components of a comprehensive diabetes management plan." (29-year old Pharmacist, KII) "I tailor treatment plans to each patient's individual needs, preferences, and comorbidities, and I emphasize the importance of adherence to treatment recommendations and regular follow-up appointments to track progress and adjust therapy as needed." (46-year old Medical Doctor, KII) Theme 3: Awareness and Risk Management Healthcare providers acknowledge the varied patient perceptions of risk associated with type 2 diabetes and emphasize the importance of proactive risk management. They provide a pharmaceutical perspective on the manageable risks associated with diabetes, while also addressing barriers to effective management, such as medication adherence issues and access to healthcare services. Through personalized education and support, providers aim to enhance patient awareness, mitigate risks, and improve overall health outcomes. Varied Risk Perception Respondents reported that patients with type 2 diabetes may have varying perceptions of their risk of developing complications, ranging from high awareness and motivation to denial or lack of awareness. "Some patients are acutely aware of the potential complications and are highly motivated to manage their condition effectively." (44-year old Pharmacist, KII) "Some patients may underestimate the seriousness of their condition, so I use real-life examples and visuals to illustrate the potential consequences of uncontrolled diabetes and motivate them to prioritize their health." (46-year old Doctor, KII) "Others may be in denial or lack awareness of the serious consequences of uncontrolled diabetes ." (38-year old Nurse, KII) "Dealing with social pressure to indulge in high-carb or sugary foods is a thorn in the flesh." - (23-year old Discussant 3, FGD) Pharmaceutical Perspective Healthcare providers perceived the risk of developing complications associated with type 2 diabetes as significant but manageable with appropriate medication therapy, lifestyle modifications, and regular monitoring. "From a pharmaceutical perspective, I perceive the risk of developing complications associated with type 2 diabetes as significant but manageable with appropriate medication therapy." (44-year old Pharmacist, KII) "I discuss the potential side effects and adverse reactions of diabetes medications with patients, ensuring they understand the importance of medication adherence and are equipped to recognize and report any concerning symptoms." (44-year old Pharmacist, KII) "I emphasize the importance of medication adherence, blood sugar monitoring, and regular follow-up with healthcare providers to detect and address any complications early." (38-year old Nurse, KII) Barriers to Management HCPs reported that various challenges and barriers, including medication adherence issues, lifestyle modification challenges, access to healthcare services, and psychosocial factors, can impact the effective management of type 2 diabetes. "Some common challenges and barriers I encounter when managing patients with type 2 diabetes include medication adherence issues, lifestyle modification challenges, access to healthcare services, socioeconomic disparities, and psychosocial factors such as depression or anxiety." (46-year old Doctor, KII) "As pharmacists, we have these networks, and I collaborate with community organizations and social services to address socioeconomic barriers to care, providing patients with access to affordable medications, transportation assistance, and nutrition support programs." (29-year old Pharmacist, KII) "I address these challenges by taking a holistic approach to patient care, providing personalized support and resources, and collaborating with other healthcare professionals to develop comprehensive care plans that address the patient's unique needs and circumstances." (29-year oldNurse, KII) Theme 4: Continuous Learning and Innovation Healthcare providers highlighted their commitment to continuous learning and innovation in diabetes management. Providers stay updated through continuing education and integrate innovative technologies such as telehealth and digital health tools to enhance patient care. By fostering a culture of learning and innovation, providers aim to deliver high-quality, patient-centered care and improve outcomes for individuals living with type 2 diabetes. Continuing Education HCPs reported that staying updated with the latest advancements and guidelines in diabetes management through continuing education programs, professional journals, conferences, and online resources is essential for healthcare providers. "As a pharmacist, I stay updated with the latest advancements and guidelines in diabetes management through continuing education programs, professional journals, conferences, and online resources." (29-year old Pharmacist, KII) "I actively participate in interdisciplinary case discussions and attend conferences to stay abreast of the latest research findings and emerging treatment modalities in diabetes management." (46-year old Doctor, KII) "By staying current with the latest evidence-based information, I can provide the highest level of care to patients with type 2 diabetes." (44-year old Nurse, KII) Integration of Technology The HCPs in healthcare facilities reported that integrating innovative approaches such as telehealth, remote monitoring, digital health technologies, and group education sessions enhance diabetes management and patient engagement. "In my practice, I've integrated innovative approaches such as telehealth, remote monitoring, and digital health technologies to enhance diabetes management. I try to use some regular check apps and have time-to-time over the phone conversations with my patients towards ensuring they adhere to educational strategies and treatment regimen" (46-year old Doctor, KII) "These technologies are not far-fetched. They are not rocket science; they are for me – some routine check-ins in apps, calls, and use of Google forms allow for more frequent communication with patients, real-time data tracking, and personalized feedback on lifestyle behaviors and medication adherence." (44-year old Pharmacist, KII) Holistic Patient Care HCPs further reported that providing holistic patient-centered care involves considering various factors such as age, gender, socioeconomic status, cultural background, comorbidities, and personal preferences when developing treatment plans. "I tailor treatment plans to meet the individual needs and preferences of patients with type 2 diabetes, considering factors such as age, gender, socioeconomic status, cultural background, comorbidities, and personal preferences." (46-year old Doctor, KII) "Collaboration with other healthcare professionals, including nurses, other pharmacists, dietitians, and social workers, is essential for comprehensive diabetes care." (44-year old Pharmacist, KII) Theme 5: Adherence and Treatment Effectiveness Healthcare providers reported that they prioritize patient adherence to treatment plans and focus on optimizing treatment effectiveness. They emphasized the importance of patient education, offering personalized treatment plans, and monitoring progress through regular follow-up appointments and clinical assessments. By promoting medication adherence and tracking treatment outcomes, providers aim to improve glycemic control, reduce complications, and enhance the overall well-being of patients with type 2 diabetes. Patient Education and Support For the HCPs, providing resources such as diabetes education programs, support groups, online forums, and mobile applications helps patients manage their condition effectively and navigate the challenges of living with type 2 diabetes. "These resources provide valuable information, peer support, practical tips, and motivation to help patients navigate the challenges of living with type 2 diabetes." (38-year old Nurse, KII) "I encourage patients to participate in peer support groups and diabetes self-management programs, providing them with opportunities to connect with others who share similar experiences and learn from each other." (46-year old Doctor, KII) "Additionally, community resources such as food banks, exercise classes, and wellness programs can provide additional support for patients seeking to adopt healthier lifestyles." (44-year old Pharmacist, KII) Personalized Treatment Plans HCPs highlighted how personalized treatment plans that consider patients' individual needs, preferences, and lifestyles are crucial for promoting medication adherence and treatment effectiveness in patients with type 2 diabetes. "I tailor treatment plans to meet the individual needs and preferences of patients with type 2 diabetes, considering factors such as age, gender, socioeconomic status, cultural background, comorbidities, and personal preferences." (46-year old Doctor, KII) "I involve patients in shared decision-making regarding their treatment plan, ensuring that they feel empowered and engaged in their care." (38-year old Nurse, KII) For the healthcare providers, regular monitoring and evaluation of treatment outcomes, clinical assessments, laboratory tests, and patient-reported outcomes are essential for tracking progress, identifying barriers to adherence, and adjusting therapy as needed. "I track key metrics such as HbA1c levels, blood pressure, lipid profiles, and weight changes to monitor progress and adjust therapy as needed." (38-year old Nurse, KII) "By regularly evaluating treatment outcomes and making adjustments as needed, I strive to optimize outcomes and improve the overall well-being of patients with type 2 diabetes." ." (44-year old Pharmacist, KII) “I use patient-reported outcomes and quality-of-life assessments to evaluate the impact of diabetes management on patients' daily functioning and well-being, ensuring that treatment plans are tailored to their unique needs and priorities." (46-year old Doctor, KII) Effective Communication and Support Discussants suggested strategies for healthcare providers to better communicate the risks of complications, including personalized risk assessments, clear language, and ongoing support and resources for managing diabetes effectively, highlighting the importance of patient-centered care and empowerment in diabetes management. "Education is key. Healthcare providers should take the time to explain things clearly and answer any questions patients may have. It's important for people to fully understand the risks so they can make informed decisions about their health." - (23-year old Discussant 3, FGD) "I think it's also important for healthcare providers to address any barriers or challenges that patients may face in managing their diabetes. Whether it's access to medications, financial constraints, or cultural factors, addressing these issues can help improve outcomes and reduce the risk of complications." - (35-year old Discussant 5, FGD) "Offering free or low-cost screening programs in community centers and clinics to detect early signs of diabetes." - (25-year old Discussant 4, FGD) Discussion This qualitative study highlights how health-education strategies pan out in the management of T2DM—when individualized, context-specific, and supported by team-based care. Common among the five themes is this logic shared by health providers: equip patients with hands-on knowledge, address deep-seated misconceptions, constantly assess risk and barriers, invest in provider education and basic technologies, and hard-wire adherence monitoring into routine care. These are in congruence with regional primary and review studies in South Africa and Nigeria, which reported that diabetes self-management education and support (DSME/S) enhance glycemic control and other indices when administered structurally, driven by multidisciplinary teams of pharmacists, nurses, and dietitians [ 16 , 24 , 25 ]. The study respondents indicated a structured approach to education, which went beyond mere concept definitions to include deeper matters such as causes, symptoms, complications, and day-to-day management strategies of T2DM. According to a systematic literature review, a structured approach to T2DM education consistently lowers HbA1c and enhances self-care behaviors among patients, especially when education uses simple language and is continuous [ 26 ]. In rural South African settlements, group diabetes education by trained health providers was shown to improve glycemic control, demonstrating the effectiveness of structured education at primary levels of health care [ 16 , 27 ]. Similarly, studies in Nigeria and Ghana show similar results, as structured education and intensive counseling produced significant reductions in HbA1c [ 24 , 25 ], thus underscoring the essentiality of utilizing comprehensive education as a means of care. Healthcare providers (HCPs) also gave accounts of proffering individualized counseling, which featured the tailoring of healthcare content to culture, literacy, and socioeconomic realities. This fostered catering to the specific health needs of patients, considering their peculiar preferences and circumstances, and ensuring they received personalized and adequate support [ 28 ]. Parallel studies across East and South Africa highlight that the deployment of culturally sensitive examples, goal setting, and compromise around food preferences and gender roles increased the level of engagement among T2DM patients [ 29 , 30 ]. Increased access to resources was also another tool that respondents from this study opined to achieve increased engagement and communication with T2DM patients. These resources include digital tools, online resources, and smartphone applications that allow for real-time data tracking and better communication [ 31 , 32 ]. Other resources are factors in tools such as educational materials, support groups, and community programs [ 32 , 33 ]. Apparently, increased accessibility to these resources also helps in equipping patients with the necessary knowledge and information for efficient self-management of T2DM. This assertion gains credence from studies in South Africa, where peer-support interventions improved patients' self-management skills [ 34 , 35 ] Given the level of prevalent food insecurity in the country [ 36 , 37 ], respondents' emphasis on practical, sustainable practices proves to be quite essential. Qualitative studies in sub-Saharan Africa show that T2DM patients struggle to afford healthy foods and consequently have a hard time meeting recommended diets prescribed by healthcare providers [ 29 , 38 ]. This, therefore, necessitates the engagement of HCPs in assisting patients to adopt long-term healthy eating patterns that support diabetes management, taking into account cultural preferences, budget constraints, and lifestyle. This development further reiterates the essentiality of individualized counseling, which proves to be a vital tool in T2DM management [ 26 , 39 ]. Respondents noted encountering several misconceptions among T2DM patients regularly. A doctor reported encountering the belief that dietary supplements cure or reverse diabetes. This is suggestive of a low knowledge rate among T2DM individuals in the region, calling for the need to upscale accessibility to health education resources. Clear, incisive counseling ought to be carried out on the risks of poor information and the importance of an evidence-based approach to the treatment of the condition [ 40 , 41 ]. Additionally, HCPs noted their insistence on a multifaceted approach to the management of T2DM when dealing with patients. Effective management of diabetes requires an approach that cuts across lifestyle modifications, medication therapy, regular monitoring, and concurrent support from HCPs to address the complex health needs of patients [ 16 , 42 ]. Accounts from the study, respondents had a heterogeneous understanding of risk among people with T2DM. HCPs indicated that patients’ perceptions of risk and potential complications ranged from high awareness and motivation to denial and lack of awareness. These findings are similar to other studies across sub-Saharan Africa, which emphasized the varying levels of risk understanding among T2DM individuals [ 30 , 38 ]. T2DM patients dwelling in Africa tend to have misperceptions about "normal sugar," and tend to tackle diabetes with a symptom-focused approach rather than a risk-focused approach [ 43 ]. HCPs from our study highlighted the effectiveness of the pharmaceutical perspective in addressing T2DM, despite the significance of its complications. It is hence important that patients are enlightened about this perspective too, and the essence of adherence to medical therapy. Pharmaceutical interventions have been shown to remarkably improve HbA1c and compliance among T2DM patients in Africa, underscoring their potential efficacy in Southern Nigeria [ 42 , 44 ]. Medication costs, lifestyle modification challenges, psychosocial issues, stock-outs, transport issues, and long queues were all cited in a study in Zambia and India as barriers to effective management [ 45 , 46 ]. A number of these factors are well documented regionally and hence are suggestive of the notion that the environments of the study area play a huge role in constituting the barriers faced by T2DM patients [ 45 , 46 ]. Apparently, an improvement of the health system by the government would contribute to eliminating some of these barriers. In a bid to keep up with the pace of evolving knowledge in diabetes healthcare, HCPs described the active efforts they make to stay up to date with information. Through continuing education programs, professional journals, conferences, and online resources, health workers keep abreast of the latest advancements and guidelines in diabetes management [ 47 , 48 ]. This aligns with the evidence of knowledge gaps in diabetes care among primary HCPs in Nigeria [ 49 ]. This highlights the need for continuing professional development (CPD), case discussions, and adequate mentorships. HCPs also incorporate the integration of innovative approaches such as telehealth, remote monitoring, digital gear technologies, and group education sessions in diabetes management. In recent years, the use of digital health facilities has become common in a growing compendium of African digital-health research [ 50 ]. This, therefore, drives the need for adoption of cutting-edge technology, which offers better and smarter ways of maintaining good health indices. The emphasis of the study respondents on consideration of factors such as age, culture, gender, and socioeconomic contexts alludes to the incorporation of community health workers (CHWs) into T2DM care outfits. This would not only make for more inclusiveness but would also offer another dimension to explore in a multifaceted approach to T2DM management. CHWs have been shown to offer well-structured education and concurrent support in T2DM management when well-trained [ 51 ]. The HCPs indicated that making provisions of resources, which include T2DM education programs, online platforms, support groups, and mobile applications, empowers patients to properly manage their conditions and safely navigate the rigours of being a diabetic patient. These findings correspond with similar studies in South Africa, which showed that peer-support interventions and group education enhance patients’ self-management abilities [ 16 , 34 ]. In a bid to sustain adherence, HCPs noted that they tailored treatment plans according to patients' individual needs, preferences, and lifestyles. In Africa, shared decision-making and alignment of goals with cultural tenets are integral to achieving sustained adherence to T2DM health recommendations [ 24 , 42 ]. Respondents also indicated that monitoring and evaluation are vital tools to adopt in further maintaining adherence among patients. This includes regular tracking of HbA1c, lipids, weight, blood pressure, and other patient-related outcomes. These are in line with standard diabetes quality metrics and, hence, are crucial in determining the health indices of a diabetic individual. Overall, this study highlights a coherent, evidence-based blueprint adopted by HCPs for enhancing T2DM management: structured DSME/S delivery, addressing dietary and supplement misconceptions using culturally sensitive counseling, prioritization of risk communication, investment in CPD, and the utility of digital tools to drive better adherence. The holistic implementation of this action plan within the primary care tier would bring about improved glycemia and self-management, as has been shown by similar studies in comparable settings across Africa [ 16 , 42 ]. Effectively upscaling them would need supporting policies, teamwork, and the consideration of the perspectives of T2DM patients [ 52 ]. Strengths and Limitations This study encompasses rich and diverse professional perspectives, logical, systematic evaluation of HCP realities, and elaborate subthemes (which feature actionable points such as individualized counseling, diet co-design, and technology incorporation). In addition to being in alignment with African studies on DSME/S and pharmacist- and nurse-led care, these findings also add to the existing knowledge in these areas. However, the cross-sectional qualitative design of this study does not factor in the linking of proposed strategies to measurable results. Hence, future studies should employ longitudinal or mixed methods designs to assess the effectiveness and impact of these strategies in practice. Conclusion Findings from this study suggest the need for institutionalization of structured DSME/S at healthcare facilities using simple language and culturally sensitive curricula. HCPs should be more involved in nutrition counseling, ensuring that food recommendations for patients consider their budgets and local staples. The use of complementary and alternative medicine (CAM) should be thoroughly addressed—but respectfully and using substantial evidence. Use of digital tools is imperative, but with consideration to costs, to provide low-cost interventions that would promote affordability across social classes. Finally, CPD needs to be strengthened, with the integration of short courses and mentorship, to enhance concordance with care guidelines. Declarations Authors' contributions KNO conceptualized the study and led the development of the study methods and data collection. PCA contributed to the study design, methods, and the development of study materials. ASG contributed to data collection, development of guides, data analysis, and writing of results. PNT, TA, and CKC supported the development of the manuscript and critical reviews. AJO and AON supervised and provided critical oversight of the project proposal, ethical approval application material, reviewed and contributed to the results and discussion writing, and development of the manuscript. All authors read and approve the final manuscript. Acknowledgements The authors appreciate all our participants for their valuable contributions. Also, we wish to extend our appreciation to the staff of UCTH, Calabar, Cross Rivers, for their support throughout the study. Funding information The research was self-funded by the authors. Competing interests The authors declare no conflicts of interest. Consent to publish Not applicable. Clinical Trial Number Not applicable. Data availability All data relevant to the study are accessible upon reasonable request. Interested researchers should contact the corresponding author. References Ekoru K, Doumatey A, Bentley AR, Chen G, Zhou J, Shriner D, et al. Type 2 diabetes complications and comorbidities in Sub-Saharan Africans. eClinicalMedicine 2019;16:30–41. Motala AA, Mbanya JC, Ramaiya K, Pirie FJ, Ekoru K. Type 2 diabetes mellitus in sub-Saharan Africa: challenges and opportunities. Nat Rev Endocrinol 2022;18:219–29. 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Uncontrolled Hypertension and Its Determinants in Patients with Concomitant Type 2 Diabetes Mellitus (T2DM) in Rural South Africa. PLoS One 2016;11:e0150033. Kassahun T, Gesesew H, Mwanri L, Eshetie T. Diabetes related knowledge, self-care behaviours and adherence to medications among diabetic patients in Southwest Ethiopia: a cross-sectional survey. BMC Endocr Disord 2016;16:28. Desveaux L, Shaw J, Saragosa M, Soobiah C, Marani H, Hensel J, et al. A Mobile App to Improve Self-Management of Individuals With Type 2 Diabetes: Qualitative Realist Evaluation. Journal of Medical Internet Research 2018;20:e8712. Moonian O, Jodheea-Jutton A, Khedo KK, Baichoo S, Nagowah SD, Nagowah L, et al. Recent advances in computational tools and resources for the self-management of type 2 diabetes. Informatics for Health and Social Care 2020;45:77–95. Izquierdo V, Pazos-Couselo M, González-Rodríguez M, Rodríguez-González R. Educational programs in type 2 diabetes designed for community-dwelling older adults: A systematic review. Geriatric Nursing 2022;46:157–65. Pienaar M, Reid M. A diabetes peer support intervention: Patient experiences using the Mmogo-method®. Health SA 2021;26:1512. Pienaar M, Reid M. Self-management in face-to-face peer support for adults with type 2 diabetes living in low- or middle-income countries: a systematic review. BMC Public Health 2020;20:1834. Obayelu OA, Akpan EI, Ojo AO. Prevalence and correlates of food insecurity in rural Nigeria: A panel analysis. Economia agro-alimentare [Internet] 2021 [cited 2025 Sep 17];Available from: https://www.francoangeli.it/riviste/ [email protected] Omuemu VO, Otasowie EM, Onyiriuka U. Prevalence of food insecurity in Egor local government area of Edo State, Nigeria. Annals of African Medicine 2012;11:139. Kugbey N, Oppong Asante K, Adulai K. Illness perception, diabetes knowledge and self-care practices among type-2 diabetes patients: a cross-sectional study. BMC Res Notes 2017;10:381. Ibrahim AM, Gano FAEL, Abdel-Aziz HR, Elneblawi NH, Zaghamir DEF, Negm LMMA, et al. Tailoring nursing interventions to empower patients: personal coping strategies and self-management in type 2 diabetes care. BMC Nursing 2024;23:926. James PB, Wardle J, Steel A, Adams J. Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review. BMJ Glob Health 2018;3:e000895. Mekuria AB, Erku DA, Gebresillassie BM, Birru EM, Tizazu B, Ahmedin A. Prevalence and associated factors of herbal medicine use among pregnant women on antenatal care follow-up at University of Gondar referral and teaching hospital, Ethiopia: a cross-sectional study. BMC Complement Altern Med 2017;17:86. David EA, Soremekun RO, Abah IO, Aderemi-Williams RI. Impact of pharmacist-led care on glycaemic control of patients with uncontrolled type 2 diabetes: a randomised controlled trial in Nigeria. Pharm Pract (Granada) 2021;19:2402. Barnard Y, Lesch A, CASSIDY T. Motivational Interviewing for Poorly Controlled Type 2 Diabetics in a Rural South African Community. Annals of Clinical and Medical Case Reports 2018;2:168–81. Ihekoronye MR, Osemene KP, Oamen TE. Pharmacist-led intervention to improve treatment outcomes in type 2 diabetes: a randomized controlled trial. J Pharm Health Serv Res 2024;15:rmae005. Nyirongo S. Adherence to treatment by patients with type 2 diabetes mellitus at Monze Mission Hospital,Monze,Zambia [Internet]. 2017 [cited 2025 Sep 17];Available from: http://dspace.unza.zm/handle/123456789/5231 Pandey V, Ramanaik S, Krishnappa L, Swathe P, Shastri S, Sathyanarayana SO, et al. Invisible inequities in type I diabetes care in India: A multi-stakeholder qualitative study from Karnataka. PLOS Global Public Health 2025;5:e0005129. American Diabetes Association. 5. Lifestyle Management: Standards of Medical Care in Diabetes—2019. Diabetes Care 2018;42:S46–60. American Diabetes Association. Standards of medical care in diabetes [Internet]. 2024 [cited 2025 Aug 30];Available from: https://diabetesjournals.org/care/issue/47/Supplement_1 Ugwu E, Young E, Nkpozi M. Diabetes care knowledge and practice among primary care physicians in Southeast Nigeria: a cross-sectional study. BMC Fam Pract 2020;21:128. Awosiku OV, Gbemisola IN, Oyediran OT, Egbewande OM, Lami JH, Afolabi D, et al. Role of digital health technologies in improving health financing and universal health coverage in Sub-Saharan Africa: a comprehensive narrative review. Front Digit Health 2025;7:1391500. Egbujie BA, Delobelle PA, Levitt N, Puoane T, Sanders D, van Wyk B. Role of community health workers in type 2 diabetes mellitus self-management: A scoping review. PLoS One 2018;13:e0198424. Ødegård ES, Langbråten LS, Lundh A, Linde DS. Two-way text message interventions and healthcare outcomes in Africa: Systematic review of randomized trials with meta-analyses on appointment attendance and medicine adherence. PLoS One 2022;17:e0266717. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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The number of affected adults increased from 14.2\u0026nbsp;million in 2015 to 23.6\u0026nbsp;million in 2021 and is projected to reach 54.9\u0026nbsp;million by 2045 without decisive interventions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This surge is largely driven by urbanization, sedentary lifestyles, high-calorie diets, and an aging population [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Alarmingly, an estimated 62.5% of cases remain undiagnosed in the region, reflecting major gaps in detection and care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In Nigeria, a recent systematic review of 60 studies involving over 124,000 participants reported a pooled T2DM prevalence of 7.0% (95% CI: 5.0\u0026ndash;9.0%), with the highest burden in the South-South (11.35%) and the lowest in the North-Central zone (2.03%) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRisk factors include family history, high socioeconomic status, physical inactivity, obesity, poor diet, and urban residence [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The consequences of late diagnosis and inadequate healthcare delivery are evident in severe complications such as neuropathy, retinopathy, cardiovascular disease, nephropathy, amputations, and stroke [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Obesity further exacerbates the burden, affecting 20\u0026ndash;35% of adults in urban areas, with 8\u0026ndash;22% classified as obese [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Together, obesity, limited diagnostic infrastructure, and a strained health system highlight the urgent need for preventive and educational interventions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEmerging evidence underscores the effectiveness of multidimensional and context-specific approaches to diabetes care. Previous reviews of diabetes self-management education (DSME) in Africa found significant improvements in diabetes knowledge, glycemia, blood pressure, and foot-care practices, with modest gains in diet and physical activity [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Interventions were delivered individually, via technology, or in group settings. In South Africa, a cluster-randomized trial demonstrated that group-based DSME led by health-promotion workers improved self-care, reduced HbA1c by 1%, and facilitated moderate weight loss [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These findings affirm the feasibility and impact of structured, group-based education in low-resource contexts [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eYet, translating such approaches into routine care remains difficult. A Ghanaian mixed-methods study identified fragmented referrals and ad hoc education as barriers, requiring providers to adapt with peer-support groups, simplified follow-ups, and task delegation [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Broader barriers, including stigma, low income, cultural misconceptions, and poor health literacy, further hinder effective self-management [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study focuses on Southern Nigeria, a critical yet under-researched region in T2DM management [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Despite policies promoting holistic, patient-centered care, evidence on how frontline providers operationalize multifaceted strategies remains limited. This research, therefore, examines practices at the University of Calabar Teaching Hospital, exploring how providers integrate pharmacotherapy, education, team-based coordination, lifestyle support, and follow-up strategies. The findings aim to inform context-specific interventions that align with national policies and strengthen structured T2DM care in resource-limited settings.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eOur study employed a qualitative design approach to explore health providers' perspectives on education and management strategies for type 2 diabetes in southern Nigeria. This method was selected as it allowed us to capture the complexities of diabetes self-management and healthcare delivery, as well as to identify barriers and facilitators to effective patient-centered care. Semi-structured key informant interviews (KIIs) and focus group discussions (FGDs) were conducted to provide participants with the opportunity to share their personal experiences and viewpoints in detail, while the findings were reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy setting and population\u003c/h3\u003e\n\u003cp\u003eThis study was conducted in Calabar, the capital city of Cross River State, Nigeria. Calabar is located in the South-South geopolitical zone in Nigeria. The city is predominantly inhabited by the Efik, Efut, and Qua ethnic groups, with the Efik language being widely spoken alongside Pidgin English. The city prides itself richly as a coastal location with it as the centre for trade and cultural exchange in the country. Furthermore, the city hosts the University of Calabar Teaching Hospital, which provides specialized health services to the populace [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The study population comprised healthcare workers directly involved in the management and care of patients (18 years and above) with T2DM at the University of Calabar Teaching Hospital, Calabar.\u003c/p\u003e\n\u003ch3\u003eSampling procedure\u003c/h3\u003e\n\u003cp\u003eParticipants were drawn from the hospital\u0026rsquo;s diabetes clinics using a purposive sampling technique. Participants included medical doctors, nurses, and other allied healthcare professionals who provide routine care and treatment for individuals living with T2DM. Participants were recruited for KIIs and FGDs. For the KIIs, four key informants were recruited in the selected health facility, comprising a Medical Doctor in charge of the outpatient department (OPD) for Type 2 diabetic patients (or their representatives), a Nurse, and two Pharmacists involved in dispensing drugs and attending to patients. In addition, a total of fifteen participants were recruited for the FGDs.\u003c/p\u003e\n\u003ch3\u003eInstruments for data collection\u003c/h3\u003e\n\u003cp\u003ePrior to the KIIs and FGDs data collection, semi-structured guides were developed by the principal investigator, which included questions and prompts that were relevant to the study objectives and overall aim. The guides were subjected to expert review for face and content validity by the study supervisor. The guides contained open-ended and thematic prompts designed to facilitate in-depth exploration of participants\u0026rsquo; perspectives, while allowing flexibility for participants to raise pertinent issues during the data collection exercise. The guides were pre-tested among six healthcare workers in the University of Uyo teaching hospital, Akwa Ibom State, outside the study sample. Feedback from the pre-test exercise was used to refine the structure, wording, and sequencing of the guides to ensure its cultural relevance.\u003c/p\u003e\n\u003ch3\u003eData collection procedure\u003c/h3\u003e\n\u003cp\u003eThe study data were collected by trained data collectors with prior experience and skills in qualitative research in social sciences and public health. The KIIs and FGDs were collected in Efik and Pidgin languages and moderated by the principal investigator, with support from trained research assistants. The data collection sessions took place in two locations with UCTH, which were purposively selected by the participants. Time and venues of data collection were selected to fit the schedules of the participants, allowing for a comfortable environment where they could freely share their experience and challenges of managing T2DM patients. Prior to each session, the principal investigator explained the purpose of the data collection and sought permission to audio-record the sessions.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData analysis and reporting\u003c/h2\u003e\u003cp\u003eThe data collected were transcribed by trained researchers and translated from Efik and Pidgin to English, and back-translated to ensure accuracy of the information. The transcripts were completely anonymized by ensuring all identifiable information from the participants was appropriately redacted. The principal researcher thoroughly reviewed the transcripts multiple times to become familiar with the data and to develop a code frame. Both inductive and deductive approaches were employed to extract codes and relevant quotations. To ensure reliability and consistency of the codes, two independent researchers blindly coded the data and extracted the themes. The finalized themes were then used to structure the analysis and reporting, leveraging the approach by Braun and Clarke [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eReflexivity statement\u003c/h3\u003e\n\u003cp\u003eThe Principal Investigator (KNO), a public health researcher with prior knowledge of diabetes prevention and management, acknowledges that they may have played a role in the interactions of the data collection exercise. To minimize potential bias, open-ended, participant-driven questions were employed, and a neutral stance was maintained to encourage participants to freely share their personal experiences and firsthand accounts of managing patients with T2DM. Furthermore, co-authors (PCA, AO, and ANO) contributed to the analysis and ensured that the themes generated reflected participants\u0026rsquo; voices rather than preconceived notions of the researchers.\u003c/p\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003eOur study complied with the principles of ethical research on human participants outlined in the Declaration of Helsinki [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Approval to conduct the study was obtained from the Head of Department, Public Health, University of Calabar, Cross River State, and appropriate ethical approval was gotten from the UCTH Research Ethics Committee Boards (Approval number: NHREC/07/10/2012). Signed informed consent forms were. Participants were informed they had the freedom to leave the study at any point during the study without any consequences. Confidentiality and anonymity were assured throughout the study, and data were securely stored and accessible only to the principal investigator.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe thematic analyses of the data using inductive and deductive coding produced five themes and fifteen sub-themes related to how health education strategies can improve management of Type 2 DM in the health facilities.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eTheme 1: Patient Education and Empowerment\u003c/h2\u003e\u003cp\u003eHealthcare providers (HCPs) emphasized the importance of comprehensive patient education, offering individualized counseling and access to resources to empower patients in managing type 2 diabetes effectively. They employ various educational approaches, including discussing underlying causes, providing medication counseling, and creating personalized meal plans. By equipping patients with knowledge and support, providers aim to enhance self-management skills and promote positive health outcomes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eComprehensive Education Approach\u003c/h2\u003e\u003cp\u003eHCPs highlighted the importance of providing comprehensive education to patients about type 2 diabetes, covering various aspects such as causes, symptoms, management strategies, and potential complications.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I discuss the underlying causes of the condition, including genetic predisposition, lifestyle factors, and obesity.\"\u003c/em\u003e (46-year old Medical Doctor, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Follow-up appointments are crucial. It's not enough to just tell someone about the risks once and then send them on their way. Regular check-ins can help reinforce the importance of managing diabetes and provide ongoing support and guidance.\"\u003c/em\u003e (25-year old Discussant 4, FGD)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I ensure that patients understand the progression of type 2 diabetes and how lifestyle factors such as diet and exercise can influence their condition.\"\u003c/em\u003e (38-year old Nurse, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I provide educational resources such as brochures, pamphlets, and written materials on diabetes prevention, medication management, and lifestyle modifications.\"\u003c/em\u003e (38-year old Nurse, KII)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eIndividualized Counseling\u003c/h2\u003e\u003cp\u003eHCPs noted that individualized counseling in their practice and experience involved tailoring education and guidance to meet the specific needs, preferences, and circumstances of each patient with type 2 diabetes, ensuring that they receive personalized support in managing their condition.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I work collaboratively with patients to identify realistic goals, create personalized meal plans, and provide ongoing support and encouragement to help them overcome these challenges.\"\u003c/em\u003e (38-year old Nurse, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I tailor treatment plans to meet the individual needs and preferences of patients with type 2 diabetes, considering factors such as age, gender, socioeconomic status, cultural background, comorbidities, and personal preferences.\"\u003c/em\u003e (38-year old Nurse, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"By actively listening to patients' concerns and preferences, I tailor my counseling approach to meet their unique needs and empower them to take control of their health.\"\u003c/em\u003e (46-year old Medical Doctor, KII)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eAccess to Resources\u003c/h2\u003e\u003cp\u003eHCPs noted that providing access to resources such as educational materials, support groups, community programs, and digital tools ensures that patients with type 2 diabetes have the necessary support and information to effectively manage their condition.\u003c/p\u003e\u003cp\u003e\u003cem\u003e \"I also collaborate with other healthcare professionals, community organizations, and local schools to raise awareness about diabetes prevention and management.\"\u003c/em\u003e (38-year old Nurse, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"These technologies allow for more frequent communication with patients, real-time data tracking, and personalized feedback on lifestyle behaviors and medication adherence.\"\u003c/em\u003e (29-year old Pharmacist, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I think it is very important to utilize clear and concise language during patient consultations. They should prioritize this even more\"\u003c/em\u003e - (44-year old Discussant 1, FGD)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eTheme 2: Addressing Challenges and Misconceptions\u003c/h2\u003e\u003cp\u003eHealthcare providers noted misconceptions and other challenges that impact healthcare providers' efforts to address issues around dietary control measures and supplements in managing type 2 diabetes. Providers emphasize the importance of promoting sustainable dietary changes, debunking myths about supplements, and advocating for a multifaceted approach to management. By addressing these challenges and misconceptions, providers aim to facilitate informed decision-making and promote effective diabetes management strategies among patients.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eSustainable Dietary Changes\u003c/h2\u003e\u003cp\u003eHCPs reported that sustainable dietary changes involved helping patients overcome challenges and adopt long-term healthy eating habits that support diabetes management, taking into account factors such as cultural preferences, budget constraints, and lifestyle.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Many patients struggle with unhealthy eating habits, limited access to nutritious foods, and cultural barriers to dietary modification.\"\u003c/em\u003e (38-year old Nurse, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I collaborate with patients to identify culturally appropriate foods and recipes that align with their dietary preferences and provide them with practical strategies for incorporating these foods into their daily meals.\u0026rdquo;\u003c/em\u003e (38-year old Nurse, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I provide practical tips for grocery shopping, meal preparation, and dining out, and I offer ongoing support and encouragement to help patients make sustainable dietary changes.\"\u003c/em\u003e (46-year old Medical Doctor, KII)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eMisconceptions about Supplements\u003c/h2\u003e\u003cp\u003eHealthcare providers highlighted that they address common misconceptions patients may have about the effectiveness of dietary supplements or herbal remedies in managing type 2 diabetes and emphasize the importance of evidence-based approaches to treatment.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"One common misconception I encounter is the belief that dietary supplements or herbal remedies can cure or reverse diabetes.\"\u003c/em\u003e (46-year old Medical Doctor, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I take the time to discuss the potential risks and benefits of dietary supplements with patients, helping them make informed decisions about their use in conjunction with their diabetes management plan.\"\u003c/em\u003e (38-year old Nurse, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I educate patients about the lack of regulation and scientific evidence supporting many of these products and advise them to consult with their healthcare provider before starting any new supplement regimen.\"\u003c/em\u003e (44-year old Pharmacist, KII)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eMultifaceted Approach to Management\u003c/h2\u003e\u003cp\u003eHCPs noted that managing type 2 diabetes effectively requires a multifaceted approach that encompasses lifestyle modifications, medication therapy, regular monitoring, and ongoing support from healthcare providers to address the complex needs of patients.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"From my clinical experience, I've found that a multifaceted approach is essential for achieving and maintaining glycemic control in patients with type 2 diabetes.\"\u003c/em\u003e (30-year old Nurse, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"In addition to medication therapy, I emphasize the importance of regular physical activity, stress management techniques, and adequate sleep as integral components of a comprehensive diabetes management plan.\"\u003c/em\u003e (29-year old Pharmacist, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I tailor treatment plans to each patient's individual needs, preferences, and comorbidities, and I emphasize the importance of adherence to treatment recommendations and regular follow-up appointments to track progress and adjust therapy as needed.\"\u003c/em\u003e (46-year old Medical Doctor, KII)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eTheme 3: Awareness and Risk Management\u003c/h2\u003e\u003cp\u003eHealthcare providers acknowledge the varied patient perceptions of risk associated with type 2 diabetes and emphasize the importance of proactive risk management. They provide a pharmaceutical perspective on the manageable risks associated with diabetes, while also addressing barriers to effective management, such as medication adherence issues and access to healthcare services. Through personalized education and support, providers aim to enhance patient awareness, mitigate risks, and improve overall health outcomes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eVaried Risk Perception\u003c/h2\u003e\u003cp\u003eRespondents reported that patients with type 2 diabetes may have varying perceptions of their risk of developing complications, ranging from high awareness and motivation to denial or lack of awareness.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Some patients are acutely aware of the potential complications and are highly motivated to manage their condition effectively.\"\u003c/em\u003e (44-year old Pharmacist, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Some patients may underestimate the seriousness of their condition, so I use real-life examples and visuals to illustrate the potential consequences of uncontrolled diabetes and motivate them to prioritize their health.\"\u003c/em\u003e (46-year old Doctor, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Others may be in denial or lack awareness of the serious consequences of uncontrolled diabetes\u003c/em\u003e.\" (38-year old Nurse, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Dealing with social pressure to indulge in high-carb or sugary foods is a thorn in the flesh.\" -\u003c/em\u003e (23-year old Discussant 3, FGD)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003ePharmaceutical Perspective\u003c/h2\u003e\u003cp\u003eHealthcare providers perceived the risk of developing complications associated with type 2 diabetes as significant but manageable with appropriate medication therapy, lifestyle modifications, and regular monitoring.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"From a pharmaceutical perspective, I perceive the risk of developing complications associated with type 2 diabetes as significant but manageable with appropriate medication therapy.\"\u003c/em\u003e (44-year old Pharmacist, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I discuss the potential side effects and adverse reactions of diabetes medications with patients, ensuring they understand the importance of medication adherence and are equipped to recognize and report any concerning symptoms.\"\u003c/em\u003e (44-year old Pharmacist, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I emphasize the importance of medication adherence, blood sugar monitoring, and regular follow-up with healthcare providers to detect and address any complications early.\"\u003c/em\u003e (38-year old Nurse, KII)\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eBarriers to Management\u003c/h2\u003e\u003cp\u003eHCPs reported that various challenges and barriers, including medication adherence issues, lifestyle modification challenges, access to healthcare services, and psychosocial factors, can impact the effective management of type 2 diabetes.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Some common challenges and barriers I encounter when managing patients with type 2 diabetes include medication adherence issues, lifestyle modification challenges, access to healthcare services, socioeconomic disparities, and psychosocial factors such as depression or anxiety.\"\u003c/em\u003e (46-year old Doctor, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"As pharmacists, we have these networks, and I collaborate with community organizations and social services to address socioeconomic barriers to care, providing patients with access to affordable medications, transportation assistance, and nutrition support programs.\"\u003c/em\u003e (29-year old Pharmacist, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I address these challenges by taking a holistic approach to patient care, providing personalized support and resources, and collaborating with other healthcare professionals to develop comprehensive care plans that address the patient's unique needs and circumstances.\"\u003c/em\u003e (29-year oldNurse, KII)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eTheme 4: Continuous Learning and Innovation\u003c/h2\u003e\u003cp\u003eHealthcare providers highlighted their commitment to continuous learning and innovation in diabetes management. Providers stay updated through continuing education and integrate innovative technologies such as telehealth and digital health tools to enhance patient care. By fostering a culture of learning and innovation, providers aim to deliver high-quality, patient-centered care and improve outcomes for individuals living with type 2 diabetes.\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eContinuing Education\u003c/h2\u003e\u003cp\u003e HCPs reported that staying updated with the latest advancements and guidelines in diabetes management through continuing education programs, professional journals, conferences, and online resources is essential for healthcare providers.\u003c/p\u003e\u003cp\u003e\u003cem\u003e \"As a pharmacist, I stay updated with the latest advancements and guidelines in diabetes management through continuing education programs, professional journals, conferences, and online resources.\"\u003c/em\u003e (29-year old Pharmacist, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I actively participate in interdisciplinary case discussions and attend conferences to stay abreast of the latest research findings and emerging treatment modalities in diabetes management.\"\u003c/em\u003e (46-year old Doctor, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"By staying current with the latest evidence-based information, I can provide the highest level of care to patients with type 2 diabetes.\"\u003c/em\u003e (44-year old Nurse, KII)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003eIntegration of Technology\u003c/h2\u003e\u003cp\u003eThe HCPs in healthcare facilities reported that integrating innovative approaches such as telehealth, remote monitoring, digital health technologies, and group education sessions enhance diabetes management and patient engagement.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"In my practice, I've integrated innovative approaches such as telehealth, remote monitoring, and digital health technologies to enhance diabetes management. I try to use some regular check apps and have time-to-time over the phone conversations with my patients towards ensuring they adhere to educational strategies and treatment regimen\"\u003c/em\u003e (46-year old Doctor, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"These technologies are not far-fetched. They are not rocket science; they are for me \u0026ndash; some routine check-ins in apps, calls, and use of Google forms allow for more frequent communication with patients, real-time data tracking, and personalized feedback on lifestyle behaviors and medication adherence.\"\u003c/em\u003e (44-year old Pharmacist, KII)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003eHolistic Patient Care\u003c/h2\u003e\u003cp\u003eHCPs further reported that providing holistic patient-centered care involves considering various factors such as age, gender, socioeconomic status, cultural background, comorbidities, and personal preferences when developing treatment plans.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I tailor treatment plans to meet the individual needs and preferences of patients with type 2 diabetes, considering factors such as age, gender, socioeconomic status, cultural background, comorbidities, and personal preferences.\"\u003c/em\u003e (46-year old Doctor, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Collaboration with other healthcare professionals, including nurses, other pharmacists, dietitians, and social workers, is essential for comprehensive diabetes care.\"\u003c/em\u003e (44-year old Pharmacist, KII)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003eTheme 5: Adherence and Treatment Effectiveness\u003c/h2\u003e\u003cp\u003eHealthcare providers reported that they prioritize patient adherence to treatment plans and focus on optimizing treatment effectiveness. They emphasized the importance of patient education, offering personalized treatment plans, and monitoring progress through regular follow-up appointments and clinical assessments. By promoting medication adherence and tracking treatment outcomes, providers aim to improve glycemic control, reduce complications, and enhance the overall well-being of patients with type 2 diabetes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003ePatient Education and Support\u003c/h2\u003e\u003cp\u003eFor the HCPs, providing resources such as diabetes education programs, support groups, online forums, and mobile applications helps patients manage their condition effectively and navigate the challenges of living with type 2 diabetes.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"These resources provide valuable information, peer support, practical tips, and motivation to help patients navigate the challenges of living with type 2 diabetes.\"\u003c/em\u003e (38-year old Nurse, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I encourage patients to participate in peer support groups and diabetes self-management programs, providing them with opportunities to connect with others who share similar experiences and learn from each other.\"\u003c/em\u003e (46-year old Doctor, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Additionally, community resources such as food banks, exercise classes, and wellness programs can provide additional support for patients seeking to adopt healthier lifestyles.\"\u003c/em\u003e (44-year old Pharmacist, KII)\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePersonalized Treatment Plans\u003c/h3\u003e\n\u003cp\u003eHCPs highlighted how personalized treatment plans that consider patients' individual needs, preferences, and lifestyles are crucial for promoting medication adherence and treatment effectiveness in patients with type 2 diabetes.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I tailor treatment plans to meet the individual needs and preferences of patients with type 2 diabetes, considering factors such as age, gender, socioeconomic status, cultural background, comorbidities, and personal preferences.\"\u003c/em\u003e (46-year old Doctor, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I involve patients in shared decision-making regarding their treatment plan, ensuring that they feel empowered and engaged in their care.\"\u003c/em\u003e (38-year old Nurse, KII)\u003c/p\u003e\u003cp\u003eFor the healthcare providers, regular monitoring and evaluation of treatment outcomes, clinical assessments, laboratory tests, and patient-reported outcomes are essential for tracking progress, identifying barriers to adherence, and adjusting therapy as needed.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I track key metrics such as HbA1c levels, blood pressure, lipid profiles, and weight changes to monitor progress and adjust therapy as needed.\"\u003c/em\u003e (38-year old Nurse, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"By regularly evaluating treatment outcomes and making adjustments as needed, I strive to optimize outcomes and improve the overall well-being of patients with type 2 diabetes.\" .\"\u003c/em\u003e (44-year old Pharmacist, KII)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I use patient-reported outcomes and quality-of-life assessments to evaluate the impact of diabetes management on patients' daily functioning and well-being, ensuring that treatment plans are tailored to their unique needs and priorities.\"\u003c/em\u003e (46-year old Doctor, KII)\u003c/p\u003e\u003cdiv id=\"Sec31\" class=\"Section2\"\u003e\u003ch2\u003eEffective Communication and Support\u003c/h2\u003e\u003cp\u003eDiscussants suggested strategies for healthcare providers to better communicate the risks of complications, including personalized risk assessments, clear language, and ongoing support and resources for managing diabetes effectively, highlighting the importance of patient-centered care and empowerment in diabetes management.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Education is key. Healthcare providers should take the time to explain things clearly and answer any questions patients may have. It's important for people to fully understand the risks so they can make informed decisions about their health.\" -\u003c/em\u003e (23-year old Discussant 3, FGD)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I think it's also important for healthcare providers to address any barriers or challenges that patients may face in managing their diabetes. Whether it's access to medications, financial constraints, or cultural factors, addressing these issues can help improve outcomes and reduce the risk of complications.\"\u003c/em\u003e - (35-year old Discussant 5, FGD)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Offering free or low-cost screening programs in community centers and clinics to detect early signs of diabetes.\"\u003c/em\u003e - (25-year old Discussant 4, FGD)\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis qualitative study highlights how health-education strategies pan out in the management of T2DM\u0026mdash;when individualized, context-specific, and supported by team-based care. Common among the five themes is this logic shared by health providers: equip patients with hands-on knowledge, address deep-seated misconceptions, constantly assess risk and barriers, invest in provider education and basic technologies, and hard-wire adherence monitoring into routine care. These are in congruence with regional primary and review studies in South Africa and Nigeria, which reported that diabetes self-management education and support (DSME/S) enhance glycemic control and other indices when administered structurally, driven by multidisciplinary teams of pharmacists, nurses, and dietitians [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe study respondents indicated a structured approach to education, which went beyond mere concept definitions to include deeper matters such as causes, symptoms, complications, and day-to-day management strategies of T2DM. According to a systematic literature review, a structured approach to T2DM education consistently lowers HbA1c and enhances self-care behaviors among patients, especially when education uses simple language and is continuous [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In rural South African settlements, group diabetes education by trained health providers was shown to improve glycemic control, demonstrating the effectiveness of structured education at primary levels of health care [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Similarly, studies in Nigeria and Ghana show similar results, as structured education and intensive counseling produced significant reductions in HbA1c [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], thus underscoring the essentiality of utilizing comprehensive education as a means of care.\u003c/p\u003e\u003cp\u003eHealthcare providers (HCPs) also gave accounts of proffering individualized counseling, which featured the tailoring of healthcare content to culture, literacy, and socioeconomic realities. This fostered catering to the specific health needs of patients, considering their peculiar preferences and circumstances, and ensuring they received personalized and adequate support [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Parallel studies across East and South Africa highlight that the deployment of culturally sensitive examples, goal setting, and compromise around food preferences and gender roles increased the level of engagement among T2DM patients [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Increased access to resources was also another tool that respondents from this study opined to achieve increased engagement and communication with T2DM patients. These resources include digital tools, online resources, and smartphone applications that allow for real-time data tracking and better communication [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Other resources are factors in tools such as educational materials, support groups, and community programs [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Apparently, increased accessibility to these resources also helps in equipping patients with the necessary knowledge and information for efficient self-management of T2DM. This assertion gains credence from studies in South Africa, where peer-support interventions improved patients' self-management skills [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eGiven the level of prevalent food insecurity in the country [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], respondents' emphasis on practical, sustainable practices proves to be quite essential. Qualitative studies in sub-Saharan Africa show that T2DM patients struggle to afford healthy foods and consequently have a hard time meeting recommended diets prescribed by healthcare providers [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. This, therefore, necessitates the engagement of HCPs in assisting patients to adopt long-term healthy eating patterns that support diabetes management, taking into account cultural preferences, budget constraints, and lifestyle. This development further reiterates the essentiality of individualized counseling, which proves to be a vital tool in T2DM management [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRespondents noted encountering several misconceptions among T2DM patients regularly. A doctor reported encountering the belief that dietary supplements cure or reverse diabetes. This is suggestive of a low knowledge rate among T2DM individuals in the region, calling for the need to upscale accessibility to health education resources. Clear, incisive counseling ought to be carried out on the risks of poor information and the importance of an evidence-based approach to the treatment of the condition [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Additionally, HCPs noted their insistence on a multifaceted approach to the management of T2DM when dealing with patients. Effective management of diabetes requires an approach that cuts across lifestyle modifications, medication therapy, regular monitoring, and concurrent support from HCPs to address the complex health needs of patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccounts from the study, respondents had a heterogeneous understanding of risk among people with T2DM. HCPs indicated that patients\u0026rsquo; perceptions of risk and potential complications ranged from high awareness and motivation to denial and lack of awareness. These findings are similar to other studies across sub-Saharan Africa, which emphasized the varying levels of risk understanding among T2DM individuals [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. T2DM patients dwelling in Africa tend to have misperceptions about \"normal sugar,\" and tend to tackle diabetes with a symptom-focused approach rather than a risk-focused approach [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. HCPs from our study highlighted the effectiveness of the pharmaceutical perspective in addressing T2DM, despite the significance of its complications. It is hence important that patients are enlightened about this perspective too, and the essence of adherence to medical therapy. Pharmaceutical interventions have been shown to remarkably improve HbA1c and compliance among T2DM patients in Africa, underscoring their potential efficacy in Southern Nigeria [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Medication costs, lifestyle modification challenges, psychosocial issues, stock-outs, transport issues, and long queues were all cited in a study in Zambia and India as barriers to effective management [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. A number of these factors are well documented regionally and hence are suggestive of the notion that the environments of the study area play a huge role in constituting the barriers faced by T2DM patients [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Apparently, an improvement of the health system by the government would contribute to eliminating some of these barriers.\u003c/p\u003e\u003cp\u003eIn a bid to keep up with the pace of evolving knowledge in diabetes healthcare, HCPs described the active efforts they make to stay up to date with information. Through continuing education programs, professional journals, conferences, and online resources, health workers keep abreast of the latest advancements and guidelines in diabetes management [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. This aligns with the evidence of knowledge gaps in diabetes care among primary HCPs in Nigeria [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. This highlights the need for continuing professional development (CPD), case discussions, and adequate mentorships. HCPs also incorporate the integration of innovative approaches such as telehealth, remote monitoring, digital gear technologies, and group education sessions in diabetes management. In recent years, the use of digital health facilities has become common in a growing compendium of African digital-health research [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. This, therefore, drives the need for adoption of cutting-edge technology, which offers better and smarter ways of maintaining good health indices.\u003c/p\u003e\u003cp\u003eThe emphasis of the study respondents on consideration of factors such as age, culture, gender, and socioeconomic contexts alludes to the incorporation of community health workers (CHWs) into T2DM care outfits. This would not only make for more inclusiveness but would also offer another dimension to explore in a multifaceted approach to T2DM management. CHWs have been shown to offer well-structured education and concurrent support in T2DM management when well-trained [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe HCPs indicated that making provisions of resources, which include T2DM education programs, online platforms, support groups, and mobile applications, empowers patients to properly manage their conditions and safely navigate the rigours of being a diabetic patient. These findings correspond with similar studies in South Africa, which showed that peer-support interventions and group education enhance patients\u0026rsquo; self-management abilities [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. In a bid to sustain adherence, HCPs noted that they tailored treatment plans according to patients' individual needs, preferences, and lifestyles. In Africa, shared decision-making and alignment of goals with cultural tenets are integral to achieving sustained adherence to T2DM health recommendations [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Respondents also indicated that monitoring and evaluation are vital tools to adopt in further maintaining adherence among patients. This includes regular tracking of HbA1c, lipids, weight, blood pressure, and other patient-related outcomes. These are in line with standard diabetes quality metrics and, hence, are crucial in determining the health indices of a diabetic individual.\u003c/p\u003e\u003cp\u003eOverall, this study highlights a coherent, evidence-based blueprint adopted by HCPs for enhancing T2DM management: structured DSME/S delivery, addressing dietary and supplement misconceptions using culturally sensitive counseling, prioritization of risk communication, investment in CPD, and the utility of digital tools to drive better adherence. The holistic implementation of this action plan within the primary care tier would bring about improved glycemia and self-management, as has been shown by similar studies in comparable settings across Africa [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Effectively upscaling them would need supporting policies, teamwork, and the consideration of the perspectives of T2DM patients [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec33\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and Limitations\u003c/h2\u003e\u003cp\u003eThis study encompasses rich and diverse professional perspectives, logical, systematic evaluation of HCP realities, and elaborate subthemes (which feature actionable points such as individualized counseling, diet co-design, and technology incorporation). In addition to being in alignment with African studies on DSME/S and pharmacist- and nurse-led care, these findings also add to the existing knowledge in these areas. However, the cross-sectional qualitative design of this study does not factor in the linking of proposed strategies to measurable results. Hence, future studies should employ longitudinal or mixed methods designs to assess the effectiveness and impact of these strategies in practice.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFindings from this study suggest the need for institutionalization of structured DSME/S at healthcare facilities using simple language and culturally sensitive curricula. HCPs should be more involved in nutrition counseling, ensuring that food recommendations for patients consider their budgets and local staples. The use of complementary and alternative medicine (CAM) should be thoroughly addressed\u0026mdash;but respectfully and using substantial evidence. Use of digital tools is imperative, but with consideration to costs, to provide low-cost interventions that would promote affordability across social classes. Finally, CPD needs to be strengthened, with the integration of short courses and mentorship, to enhance concordance with care guidelines.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKNO conceptualized the study and led the development of the study methods and data collection. PCA contributed to the study design, methods, and the development of study materials. ASG contributed to data collection, development of guides, data analysis, and writing of results. PNT, TA, and CKC supported the development of the manuscript and critical reviews. AJO and AON supervised and provided critical oversight of the project proposal, ethical approval application material, reviewed and contributed to the results and discussion writing, and development of the manuscript. All authors read and approve the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors appreciate all our participants for their valuable contributions. Also, we wish to extend our appreciation to the staff of UCTH, Calabar, Cross Rivers, for their support throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was self-funded by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data relevant to the study are accessible upon reasonable request. Interested researchers should contact the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEkoru K, Doumatey A, Bentley AR, Chen G, Zhou J, Shriner D, et al. Type 2 diabetes complications and comorbidities in Sub-Saharan Africans. eClinicalMedicine 2019;16:30\u0026ndash;41. \u003c/li\u003e\n\u003cli\u003eMotala AA, Mbanya JC, Ramaiya K, Pirie FJ, Ekoru K. Type 2 diabetes mellitus in sub-Saharan Africa: challenges and opportunities. Nat Rev Endocrinol 2022;18:219\u0026ndash;29. \u003c/li\u003e\n\u003cli\u003eArmocida B, Monasta L, Sawyer SM, Bustreo F, Onder G, Castelpietra G, et al. The Burden of Type 1 and Type 2 Diabetes Among Adolescents and Young Adults in 24 Western European Countries, 1990\u0026ndash;2019: Results From the Global Burden of Disease Study 2019. Int J Public Health 2024;68:1606491. \u003c/li\u003e\n\u003cli\u003eCox D. Diabetes Is Rising in Africa. Could It Lead to New Breakthroughs? [Internet]. 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BMC Res Notes 2017;10:381. \u003c/li\u003e\n\u003cli\u003eIbrahim AM, Gano FAEL, Abdel-Aziz HR, Elneblawi NH, Zaghamir DEF, Negm LMMA, et al. Tailoring nursing interventions to empower patients: personal coping strategies and self-management in type 2 diabetes care. BMC Nursing 2024;23:926. \u003c/li\u003e\n\u003cli\u003eJames PB, Wardle J, Steel A, Adams J. Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review. BMJ Glob Health 2018;3:e000895. \u003c/li\u003e\n\u003cli\u003eMekuria AB, Erku DA, Gebresillassie BM, Birru EM, Tizazu B, Ahmedin A. Prevalence and associated factors of herbal medicine use among pregnant women on antenatal care follow-up at University of Gondar referral and teaching hospital, Ethiopia: a cross-sectional study. BMC Complement Altern Med 2017;17:86. \u003c/li\u003e\n\u003cli\u003eDavid EA, Soremekun RO, Abah IO, Aderemi-Williams RI. 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Role of digital health technologies in improving health financing and universal health coverage in Sub-Saharan Africa: a comprehensive narrative review. Front Digit Health 2025;7:1391500. \u003c/li\u003e\n\u003cli\u003eEgbujie BA, Delobelle PA, Levitt N, Puoane T, Sanders D, van Wyk B. Role of community health workers in type 2 diabetes mellitus self-management: A scoping review. PLoS One 2018;13:e0198424. \u003c/li\u003e\n\u003cli\u003e\u0026Oslash;deg\u0026aring;rd ES, Langbr\u0026aring;ten LS, Lundh A, Linde DS. Two-way text message interventions and healthcare outcomes in Africa: Systematic review of randomized trials with meta-analyses on appointment attendance and medicine adherence. PLoS One 2022;17:e0266717. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Diabetes Mellitus, T2DM, Healthcare Professionals, Education, Management Strategies","lastPublishedDoi":"10.21203/rs.3.rs-7871008/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7871008/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eManagement of diabetes in Nigeria remains a major public health challenge. Emerging evidence underscores the effectiveness of multidimensional and context-specific approaches to diabetes care. Despite policies promoting holistic care, evidence on how frontline healthcare workers operationalize multifaceted strategies remains limited. This study, therefore, examines practices at the University of Calabar Teaching Hospital, exploring how healthcare providers view education and management strategies of type 2 diabetes mellitus.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eOur study employed a qualitative design approach via interviews and focus group discussions to explore health providers' perspectives on education and management strategies for type 2 diabetes mellitus (T2DM) in southern Nigeria. Participants were purposively selected at the University of Calabar Teaching Hospital (UCTH), Cross River State, Nigeria.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe thematic analyses of the data using inductive and deductive coding produced five themes and fifteen sub-themes related to how health education strategies can improve management of T2DM in the health facilities. This qualitative study highlights how health-education strategies pan out in the management of type 2 diabetes mellitus when individualized, context-specific, and supported by team-based care.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study highlights a coherent, evidence-based blueprint adopted by healthcare workers for enhancing T2DM management: structured diabetes self-management education delivery, addressing dietary and supplementing misconceptions using culturally sensitive counseling, prioritization of risk communication, investment in continuing professional development, and the utility of digital tools to drive better adherence.\u003c/p\u003e","manuscriptTitle":"Health Providers’ Views on Education and Management Approaches for Type 2 Diabetes in Southern Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 09:36:00","doi":"10.21203/rs.3.rs-7871008/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"51d039ae-26e9-4089-867f-258a4afc2c64","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-01T13:10:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 09:36:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7871008","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7871008","identity":"rs-7871008","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}