What does self-care mean to us? Self-care Package for Type-2 diabetes mellitus patients in rural area: findings from a Formative Research Study

What does self-care mean to us? 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Self-care Package for Type-2 diabetes mellitus patients in rural area: findings from a Formative Research Study Aditya Varma Samanthapudi, Swati Misra, Badal Chandrakant Bhandarkar, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6329292/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aims: Diabetes is a growing challenge in rural India, where limited healthcare and cultural beliefs hinder self-care. A structured, culturally relevant self-care package is crucial to improve management and reduce complications. This study explores self-care practices in rural Maharashtra to develop a community-driven package. Methods: This formative phase is part of a larger study using a stepped wedge cluster randomized feasibility trial with a closed cohort to assess the self-care package’s impact on glycemic control and well-being. Conducted in rural central Maharashtra (Nov 2023–March 2024), it explored diabetes self-care practices through a literature review, free listing, pile sorting, and in-depth interviews. Sample size was guided by data saturation to ensure richness and feasibility. Thematic analysis revealed key themes, with data triangulation ensuring culturally relevant insights. Results: The most salient practices included reducing sugar intake, regular walking, medication adherence, and dietary modifications. The study identified key components of diabetes self-care lifestyle, disease management, stress and addiction, diet and hydration, physical activity, and social well-being—highlighting community-driven strategies for a culturally relevant diabetes care framework. Conclusions: A structured, community-driven diabetes self-care package is essential for effective management in rural settings. Integrating cultural practices with evidence-based care enhances adherence and glycemic control. Preventive Medicine Co-Design Strategy Diabetes Self-Care Context-Specific Intervention Indigenous Health Practices Qualitative Research Lifestyle Modification Patient-Centered Care Community-Based Intervention Participatory Research Figures Figure 1 Figure 2 1. Introduction Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels, which can lead to complications affecting blood vessels, eyes, kidneys, and nerves ( 1 , 2 ). It has become a significant public health concern in India, with its prevalence increasing sharply in recent decades ( 3 ). Globally, approximately 537 million adults aged 20–79 years have diabetes, representing 10.5% of this age group ( 4 , 5 ). Projections indicate that the global diabetes population will rise to 643 million (11.3%) by 2030 and 783 million (12.2%) by 2045. In India, as of 2021, the estimated prevalence of diabetes among adults aged 20–79 years is 8.3% ( 4 ). 1.1 Escalating Diabetes Crisis in Rural India A study in Maharashtra reported an adjusted diabetes prevalence of 8.4% across rural and urban areas. ( 6 ). In 1979, a survey reported a rural diabetes prevalence of just 1.5%, which escalated to 8.3% in certain rural regions by 2011 ( 7 ). Early detection can't curb obesity, diabetes, hypertension, or heart disease alone. Since 80–90% of chronic illnesses stem from lifestyle, addressing root causes is crucial for prevention and control. ( 8 – 11 ) 1.2 Challenges in Diabetes Self-Care in Rural Areas India, known as the diabetes capital, faces a growing burden, especially in rural areas with limited healthcare and low health literacy ( 12 , 13 ). Effective control requires not just treatment but self-care like diet, exercise, medication adherence, and regular monitoring.( 14 , 15 ). Self-care is essential for glycemic control and long-term health, ( 16 ) but rural populations face barriers like low awareness, socio-cultural beliefs, economic constraints, and inadequate healthcare. Addressing these is crucial for effective diabetes self-management.( 17 ). 1.3 Concept of Self-Care and Its Role in Diabetes Management Self-care enables individuals, families, and communities to maintain health, prevent disease, and manage illness with or without medical support. It includes health promotion, disease prevention, self-medication, caregiving, seeking medical care, and rehabilitation. Self-care interventions, such as medications, medical devices, diagnostics, and digital tools, support these practices and can be used independently or alongside healthcare services, often beyond formal medical settings ( 18 , 19 ). 1.4 Existing Global Models for a holistic approach to chronic diseases Globally, self-care packages and lifestyle programs support diabetes management. The CDC’s Diabetes Self-Management Education and Support (DSMES) program ( 20 – 22 ) promotes healthy eating, physical activity, medication adherence, glucose monitoring, and psychosocial well-being. The American College of Lifestyle Medicine (ACLM) ( 23 ) takes a preventive approach, focusing on a plant-based diet, exercise, sleep, stress management, social support, and avoiding harmful substances. Dr. Rangan Chatterjee’s Four-Pillar Plan ( 24 ) simplifies chronic disease care into food, movement, sleep, and relaxation to enhance insulin sensitivity and overall health. These models provide structured, evidence-based strategies to support sustainable diabetes management and improved glycemic control ( 25 – 27 ). A formative needs assessment is essential to understand community needs, existing knowledge, and challenges in diabetes management. By analyzing insights from patients, caregivers, and healthcare providers, a tailored self-care package can be designed to align with the socio-cultural and healthcare landscape of rural India. This study investigates self-care practices among diabetic patients in rural areas, identifying key factors that influence self-management. It explores barriers and facilitators, including medication adherence, dietary habits, physical activity, and glucose monitoring. By addressing challenges and leveraging community strengths, the research aims to develop a locally adaptable, evidence-based self-care package to improve glycemic control and long-term health outcomes. 2. Methods 2.1 Study Design and Methods This study was part of a larger research initiative registered under the Clinical Trials Registry of India (CTRI/2023/10/058427) as a postgraduate thesis. It used a qualitative exploratory design to understand self-care practices, challenges, and perceptions of people with T2DM in rural India, aiming to develop a culturally tailored self-care package. This study focused on the formative phase of research for the development of self-care package, followed by a community-based stepped wedge cluster randomized feasibility trial using a closed cohort design to assess its effectiveness. 2.2 Study Settings and Duration The study took place in villages within the field practice area of the Community Medicine Department at a Medical College of central Maharashtra, India, from November 2023 to December 2024. 2.3 Study Procedure Desk review of literature: Carried out to explore and identify essential components for developing the self-care. The review was guided by key frameworks, including CDC’s Diabetes Self-Management Education and Support (DSMES) program (21), the American College of Lifestyle Medicine (ACLM) approach (23), and Dr. Rangan Chatterjee’s Four-Pillar Plan (24). Qualitative Methods : In-depth interviews, free listing, and pile sorting were used to identify relevant self-care content. Content Validation: Assessed by a panel of experts, including the District Health Officer, an Internal Medicine Specialist, and a Community Medicine Specialist. 2.4 Sample size, Participants and Sampling method This formative research explores self-care practices among diabetic patients in rural India to develop a context-specific self-care package. Since this is a qualitative study, the sample size was determined by data saturation, meaning data collection continued until no new themes or insights emerged. Table 1 provided an overview of the data collection methods, their purpose, and the number of participants involved. Purposive sampling was used to include participants with diverse age, gender, socioeconomic status, and diabetes duration. The inclusion criteria required participants to be 18 years or older, diagnosed with diabetes, willing to participate, and capable of providing informed consent. Those with cognitive impairments or bedridden conditions and pregnant women were excluded. Table 1: Overview of data collection methods, their purposes, and corresponding sample sizes S.N. Method Sample size Purpose of data collection 1. Free Listing 30 To identify domains for self-care package and commonly associated concepts within the community. 2. Pile Sorting 5 groups (Total 30 participants) Understanding mental models and cultural perceptions of self-care practices in diabetes. 3. IDIs 10 Perceptions about self-care practices for diabetes Difficulties in the implementation of self-care practices Support required to improve self-care practices Understanding self-efficacy and readiness for self-care in diabetes 2.5 Data Collection Process Free Listing was conducted among 30 participants to identify culturally relevant diabetes self-care practices. Initially, participants individually listed practices they associated with diabetes care. Salience index was monitored after every 5–10 responses to assess saturation, reflecting both frequency and rank order of listed items. Although saturation was observed after 20 participants, data collection continued to 30 as planned for accuracy and completeness. Regular monitoring salience helped capture community-specific perceptions and priorities, aiding development of a culturally relevant diabetes self-care package. Participants were identified with support from local field staff and interviewed in their respective homes at their convenience. Participant details and questionnaire are provided in the supplementary material (Table S1). Pile Sorting was conducted in five groups among 30 participants with a minimum of 5 participants per group. Self-care practices mentioned by at least three participants during free-listing were selected for pile-sorting, which was conducted with a different set of participants (not involved in free-listing) identified through field staff familiar with the community. Each item was written on a card separately and 26 cards were prepared. Participants grouped cards based on perceived similarity, forming as many piles as they felt appropriate, through group consensus. This revealed how the community understands and categorizes diabetes self-care practices. Sessions were held in accessible spaces like Gram Panchayats, sub-centers, or village areas to ensure comfort and participation. The pile-sorting questionnaire and participant’s details are provided in supplementary material (Table S2). In-depth interviews (IDIs) began with a pilot phase involving a social worker and a biostatistics faculty member with diabetes. Based on their feedback, questions were finalized. Our field staff (ANM and social worker) who had a rapport with the study participants introduced them to the interviewers and explained the purpose of the interview. Trained investigators with principal investigator conducted semi-structured interviews in Hindi or Marathi, covering symptoms, self-care, challenges, and support systems by keeping cultural appropriateness and contextual accuracy. Each interview, held at the participant’s home, lasted 45–60 minutes. To ensure validation, interview notes were summarized, reviewed with participants, and cross-checked with the final transcript. IDIs included participants receiving diabetes care from diverse settings—private clinics, government centers, and tertiary hospitals—to capture varied perspectives. All interviews were audio-recorded with verbal consent. Participants’ list with questionnaire is provided in supplementary material (Table S3). 2.6 Data Analysis and Software Free Listing: The data collected through free listing was analyzed to identify the self-care practices for Diabetes within the community. Spelling errors and minor variations were corrected while ensuring the original meaning remained intact. For consistency, the free-listed items were translated into English from Hindi/ Marathi. These items were then analyzed using ANTHROPAC (v1.0.1.36), a software designed for cultural domain analysis, to further explore how participants categorize self-care practices and identify key community perceptions. The Smith’s Salience Index was then calculated to measure the relative importance of each self-care practice. Pile sorting: Data were analyzed using cluster analysis to understand how participants grouped self-care practices. Since some practices were more commonly recognized than others, the top 26 most salient self-care practices were chosen for grouping. Cluster analysis grouped practices by shared features, revealing how the community naturally categorized self-care. It offered a structured view of diabetes management behaviors aligned with community perspectives and priorities. Further, a Concept Map was created using ANTHROPAC (v1.0.2.60) to visualize relationships among self-care practices. The concept map showed relationships among self-care practices, placing similar items closer based on participant groupings. By mapping out these connections, the analysis provided deeper insight into how individuals associate and categorize behaviors, revealing key perception patterns. The combination of cluster analysis and concept mapping allowed for a structured and clear understanding of community perspectives, ensuring that self-care interventions are aligned with culturally relevant practices. IDIs: All IDIs were audio-recorded, transcribed word-for-word, and translated from Hindi/Marathi to English to ensure clarity while preserving the original meaning. Translations were reviewed by a bilingual expert to ensure accuracy and consistency. Two coders manually coded the data using a mixed coding approach, combining predefined codes from existing research (21,23,24) with new themes that emerged from the data. Data were analyzed using thematic analysis , to identify barriers, facilitators, and self-care practices. Two coders reached consensus on themes, refining them through multiple coding cycles for accuracy and reliability. Data saturation was assessed during analysis, and coding continued until no new themes emerged. Confidentiality was maintained by anonymizing participant details, and illustrative quotes were de-identified before reporting. This approach integrated both participant insights and existing knowledge to guide culturally relevant self-care strategies. Triangulation To enhance the validity and depth of the findings, methodological triangulation integrated data from free listing, pile sorting, and IDIs. This approach strengthened credibility and provided a culturally grounded view of diabetes self-care. Free listing identified common practices based on frequency and salience, while pile sorting grouped the top 26 salient practices into meaningful clusters, reflecting how participants categorized them. Concept mapping and cluster analysis helped in understanding community-driven classifications, ensuring that interventions align with local perspectives. 3. Results Table 2 identified the key self-care practices adopted by individuals for diabetes management, with Smith’s Salience(S) reflecting their relative importance and cognitive accessibility of self-care practices in diabetes management. Higher salience values indicate commonly mentioned and prioritized behaviors, while lower values represent less frequently recalled or individualized strategies. The most frequently mentioned practices were reducing sugar intake (63.3%) and walking (63.3%), both of which had high salience scores (0.494 and 0.417, respectively), indicating their perceived importance in diabetes management. Regular medication intake (43.3%) ranked third, followed by exercise (33.3%) and dietary modifications such as reducing rice consumption (33.3%). Certain dietary practices, including complete avoidance of sugar (23.3%), wound care (30.0%), and blood sugar testing (36.7%), were also reported, though with relatively lower salience scores. Community members emphasized the importance of recognizing symptoms of high blood sugar (16.7%) and consuming specific food items such as fenugreek powder (13.3%), neem leaves (13.3%), and bitter gourd juice (10.0%) as part of diabetes management. Table 2 Free Listing Analysis regarding Self-Care Behaviors among Diabetic Patients Item Frequency (%) Average Rank Smith’s Salience (S) Reduce sugar 63.3 2.63 0.494 Walking 63.3 3.68 0.417 Take medications regularly 43.3 3.31 0.332 Exercise 33.3 4.20 0.206 Reduce rice 33.3 4.50 0.202 No sugar 23.3 4.29 0.168 Wound care 30.0 5.56 0.120 Blood sugar testing 36.7 7.36 0.116 Reduce potato 20.0 5.50 0.111 Be aware about symptoms for increased blood sugar levels 16.7 5.40 0.111 Eat food at right time 16.7 4.80 0.102 Take fenugreek powder 13.3 4.25 0.099 Reduce tea 16.7 3.60 0.097 No rice 13.3 3.50 0.093 Eat neem leaves 13.3 4.50 0.092 Sleep well 26.7 8.75 0.092 Drink Bitter gourd juice 10.0 2.67 0.083 Eye care 26.7 8.25 0.083 Keep food under control 6.7 1.00 0.067 No addiction 23.3 9.57 0.065 Use sugar free tablet in tea 10.0 4.00 0.062 Work in farm 13.3 5.75 0.060 Take tea with jaggery 10.0 5.33 0.058 Keep blood sugar levels under control 10.0 5.00 0.056 Eat vegetables 6.7 3.50 0.055 Eat jowar roti 6.7 4.50 0.054 Take raw garlic 6.7 4.00 0.046 Eat pulses 6.7 5.00 0.044 Relax 23.3 11.14 0.043 No banana 6.7 7.00 0.041 Yoga asanas 6.7 6.00 0.034 Drink black tea 6.7 6.50 0.034 No tea 3.3 1.00 0.033 Wake up 4.30am 3.3 1.00 0.033 Take Ayurveda and allopathy medications regularly 3.3 1.00 0.033 Weight management 10.0 6.00 0.033 Running 3.3 1.00 0.033 Morning walking 3.3 1.00 0.033 No Non veg and masala 3.3 2.00 0.031 Take luke warm water 3.3 2.00 0.031 Reduce roti 3.3 2.00 0.030 Take green tea 3.3 2.00 0.030 Take carom seeds 3.3 4.00 0.028 Reduce milk 3.3 3.00 0.027 Take greenleafy vegetables 3.3 4.00 0.025 Reduce oily and spicy foods 3.3 5.00 0.022 No milk 3.3 6.00 0.022 Eat fruits and vegetables 3.3 5.00 0.021 Be aware about reduced and increased blood sugar level symptoms 3.3 4.00 0.019 Meditation 10.0 10.33 0.018 Do not want to reach a stage of insulin 3.3 6.00 0.017 Reduce sour food 3.3 3.00 0.017 Take tea without sugar 3.3 6.00 0.017 Aware about hypoglycemia symptoms 3.3 11.00 0.015 Positive thinking 3.3 6.00 0.015 Walking without chappal in sand keeps sugar under control 3.3 8.00 0.014 Pranayama 6.7 9.50 0.013 No alcohol 3.3 4.00 0.013 Eat leaves (Guava, neem, custard apple) 3.3 12.00 0.013 Reduce maida 3.3 8.00 0.010 Maintain mental health 3.3 10.00 0.008 Stay away from food not healthy for diabetes 3.3 4.00 0.008 Wake up at 5.30am 3.3 10.00 0.008 No non veg 3.3 5.00 0.007 No outside food 3.3 9.00 0.004 Have good will power 3.3 17.00 0.004 Trekking 3.3 12.00 0.003 Keep stomach clean 3.3 12.00 0.003 Take ayurveda medicines 3.3 10.00 0.003 No tension 3.3 15.00 0.002 Eat 2 times per day 3.3 18.00 0.002 Lifestyle-related practices such as adequate sleep (26.7%), relaxation (23.3%), and avoiding addictions (23.3%) were also reported but had lower overall salience scores. Traditional and alternative approaches, including the use of Ayurvedic medications, home remedies like consuming raw garlic (6.7%), and yoga or pranayama (6.7%), were mentioned by a few participants. The findings suggest a strong emphasis on dietary modifications, physical activity, and medication adherence as key self-care behaviors, while traditional and behavioral practices hold a secondary but meaningful place. Community interventions should reinforce high-salience behaviors while integrating evidence-based approaches to lower-salience yet culturally relevant practices, ensuring a comprehensive diabetes self-care framework. Figure 1 showing Concept Map , provided a structured view of how respondents categorized various diabetes self-care practices based on their perceived similarities. The clusters formed in the plot highlighted distinct groups, indicating key themes in diabetes self-care. The blue cluster included behaviors related to physical activity and lifestyle habits, showing that respondents associated these practices with maintaining overall health. The black cluster primarily focused on dietary modifications, such as specific foods and traditional remedies, emphasizing the role of nutrition in diabetes control. The pink cluster represented medical adherence, check-ups, and structured self-care practices, indicating that these aspects were considered essential yet distinct from lifestyle-based interventions. The gray connections between clusters suggested overlaps in perception, where some behaviors, like dietary changes and physical activity, were seen as interconnected. Additionally, an outlier marked in green indicated a behavior that was not strongly associated with any specific cluster, suggesting its varied recognition among respondents. The spatial arrangement of the clusters in the plot showed that people grouped diabetes self-care into three main areas: lifestyle, diet, and medical adherence . This means that they saw managing diabetes as a combination of staying active, eating the right foods, and following medical advice, including taking medicines and monitoring blood sugar levels. The findings highlighted the importance of creating a well-rounded self-care plan that includes all these aspects. Additionally, some self-care practices were less common or not widely used, indicating the need to raise awareness and encourage their adoption. A holistic self-care approach that combines lifestyle changes, proper diet, and medical care can help improve diabetes management, especially in rural communities. The thematic analysis in Table 3 highlighted the insights of individuals with diabetes, emphasizing key aspects of self-care, challenges, and support systems. Self-care & lifestyle practices revolved around patient awareness, rapport building, personal motivation, goal setting. Patients demonstrated varied levels of adherence to self-care practices, influenced largely by their awareness of diabetes management and intrinsic motivation. Participants highlighted the importance of setting achievable health goals and emphasized that sustained motivation was necessary for effective self-care. Recognizing and managing diabetes highlighted diverse pathways to diagnosis, varying awareness of complications, and differing approaches to treatment. Few relied on medications, though others preferred traditional remedies and lifestyle changes. Managing Stress and Addictions reveals emotional burdens, fear of complications, and differing coping mechanisms, with gender differences in stress management. Diet and hydration themes reflected participants' food and water consumption patterns, dietary changes following diagnosis, struggles with cravings, and challenges in managing dietary restrictions. Participants reported changes in eating habits post-diagnosis, noting difficulties in adjusting to dietary requirements and managing persistent cravings. They also emphasized the importance of adequate hydration and related adjustments after diagnosis. Sleep, stretch, and strengthen captured physical activity practices, barriers to exercise, and perceived benefits of sleep and movement in diabetes control. It emphasized how adequate sleep and regular physical activity contributed to improved diabetes management, while also acknowledging common obstacles individuals faced in maintaining these practices. Social health and healing were influenced by family, community, and cultural beliefs, shaping perceptions of peer support and diabetes education. Positive social connections played a crucial role in self-care journeys, highlighting the importance of facilitators who promoted peer interactions and introduced concepts like diabetes reversal. Based on the analysis of the current study, a diabetes self-care package was developed, comprising six core components as shown in Fig. 2 . The comparison between existing self-care and lifestyle packages and the newly developed components in the current study is shown in Table S4 (Supplementary material). Table 3 Thematic Analysis of Diabetes Self-Care and Lifestyle Themes Subthemes Verbatim 1. Self-care & Lifestyle Awareness and Understanding of Self-care IDI 1 (56, M, DM x 14 yrs): "I am aware about self-care. I was advised by Sevagram doctor about walking for diabetes, eating on time, and eating a lot of fiber and vegetables." IDI 2 (68, M, DM x 13 yrs): "Taking medicines on time, eating on time, relaxation, walking, and not eating sweet food are important self-care aspects." IDI 4 (77, M, DM x 5 yrs): "I go to PHC and check my sugar levels once in 15 days or per month." Intrinsic Motivation and Purpose-driven Goals IDI 5 (60, F, DM x 9 yrs): "I feel responsible for my health, as I do not want to depend on others for daily activities." IDI 12 (65, M, DM x 3 yrs): "If we take self-care, we can prevent complications." IDI 9 (44, F, DM x 1 year): "I want to live a healthy life so that I do not become a burden on my family." Consciousness of Health and Well-being IDI 5 (60, F, DM x 9 yrs): "Due to weakness, I am not able to work on the farm as much as I used to. Now, I only do household work." IDI 10 (37, F, DM x 10 yrs): "I do not travel much anymore because my sugar levels fluctuate, and I am afraid of falling sick outside." Medication Compliance and Challenges IDI 11 (44, M, DM x 5 yrs): "I follow my medication routine strictly because I don’t want my sugar levels to go out of control." IDI 6 (60, F, HTN&DM x 4 yrs): "Sometimes I miss my medicines because I run out of stock, and I need to visit the hospital to get them." Addressing Diabetes Misconceptions IDI 5 (60, F, DM x 9 yrs): "Initially, I thought eating sweets alone caused diabetes, but now I understand other factors also contribute." IDI 7 (62, M, DM x 5 yrs): "Some say diabetes always leads to blindness or amputation…but with control we can avoid these complications...understanding the truth has greatly reduced my fears." Economic Constraints in Diabetes Care IDI 9 (44, F, DM x 1 year): "I have to spend ₹1000 every 15 days on medicines, as they are not available in government hospitals." IDI 6 (60, F, HTN&DM x 4 yrs): "Due to financial issues, I sometimes skip my sugar tests." IDI 12 (65, M, DM x 3 yrs): "I avoid going for regular checkups because traveling to the hospital costs money." IDI 8 (52, F, DM x 1 year): "It is difficult to afford healthy food like green vegetables and fruits regularly." 2. Recognizing and Managing Diabetes Early Signs & Symptoms and Diagnosis IDI 7 (62, M, DM x 5 yrs): "I was diagnosed with diabetes after feeling dizzy and weak for a few days." IDI 11 (44, M, DM x 5 yrs): "I had excessive thirst and frequent urination before I was diagnosed." IDI 5 (60, F, DM x 9 yrs): "I had no idea I had diabetes until my wound didn’t heal for weeks." IDI 3 (34, F, DM x 6 yrs): "My sugar levels were high during pregnancy, and after five years, I was diagnosed with diabetes again." Blood Sugar Monitoring Practices IDI 2 (68, M, DM x 13 yrs): "I get my sugar checked regularly once a month at the primary health center to keep track of my diabetes." IDI 1 (56, M, DM x 14 yrs): " Regular monitoring helps me adjust my diet and medicines, so I check my sugar at home weekly. Dietary Modifications and Adjustments IDI 7 (62, M, DM x 5 yrs): “I consume neem juice and jamun seeds powder every morning for diabetes control." IDI 10 (37, F, DM x 10 yrs): "I avoid outside food and fried snacks almost all times.” IDI 4 (77, M, DM x 5 yrs): "I have reduced my tea intake from five cups to two per day." Prioritizing Lifestyle above Medicines IDI 7 (62, M, DM x 5 yrs): "I believe lifestyle changes like walking and diet are better than medicine IDI 3 (34, F, DM x 6 yrs): "..seen few people who managed diabetes with yoga and natural herbs, but I don’t know if it works for everyone.." Awareness and Understanding of Complications IDI 2 (68, M, DM x 13 yrs): "I had cataract surgery, and the doctor told me that diabetes was the reason for my blurred vision." IDI 5 (60, F, DM x 9 yrs): "I know that diabetes can cause slow wound healing, so I take precautions when I get injured." IDI 7 (62, M, DM x 5 yrs): "I never thought diabetes could lead to heart issues until I had an angioplasty." IDI 12 (65, M, DM x 3 yrs): "I have pain in my legs and tingling sensations, and I think it is because of my sugar levels." Foot Care Practices IDI 2 (68, M, DM x 13 yrs): “I always wear slippers inside the house and shoes outside to avoid injuries." IDI 6 (60, F, HTN&DM x 4 yrs): "I wash my feet every night before sleeping but don’t check for cuts or wounds." IDI 12 (65, M, DM x 3 yrs): "I have tingling sensations in my feet, so I try to avoid walking barefoot." Barriers to Effective Diabetes Management IDI 3 (34, F, DM x 6 yrs): "I check my sugar only when I feel unwell, as frequent testing is expensive." IDI 9 (44, F, DM x 1 year): "I try to reduce salt and oil, but my family still cooks the way they used to." 3. Managing Stress and Addictions Perceived Severity and Fear of Diabetes IDI 10 (37, F, DM x 10 yrs): "I was told that diabetes is a slow poison that affects different parts of the body over time." IDI 11 (44, M, DM x 5 yrs): "I fear that one day, I might lose my eyesight because of diabetes." IDI 7 (62, M, DM x 5 yrs): "I have heard that if sugar levels are not controlled, one can lose their legs." IDI 9 (44, F, DM x 1 year): "I am scared that I will become completely dependent on my family if my condition worsens." Mental Impact of Social Isolation IDI 10 (37, F, DM x 10 yrs): "I feel disconnected from my friends since I stopped drinking tea and snacks with them." IDI 4 (77, M, DM x 5 yrs): "People assume I am sick all the time, so they treat me differently, which makes me feel lonely." IDI 9 (44, F, DM x 1 year): "I don’t go to family functions much anymore because people keep asking about my health." IDI 5 (60, F, DM x 9 yrs): "I feel left out when my family eats outside, as I cannot eat the same food." Gender Differences in Stress Management IDI 8 (52, F, DM x 1 year): "Men can go outside and walk to relieve stress, but women have too many responsibilities." IDI 7 (62, M, DM x 5 yrs): "I manage my stress by engaging in farming work, it helps me stay active." Personal Coping Strategies and Recreation IDI 1 (56, M, DM x 14 yrs): "Whenever I feel stressed, I listen to bhajans (devotional songs) or go to the temple." IDI 3 (34, F, DM x 6 yrs): "Talking to my friends helps me forget about my worries." IDI 5 (60, F, DM x 9 yrs): "I believe keeping myself busy with housework helps me avoid negative thoughts." IDI 7 (62, M, DM x 5 yrs): "Whenever I feel tense, I go for a walk to clear my mind." Behavioral Addictions and Health Risks IDI 1 (56, M, DM x 14 yrs): "I have been chewing tobacco for years, but I don’t think it affects my sugar levels." IDI 8 (52, F, DM x 1 year): "Drinking tea multiple times a day was a habit, but now I have reduced sugar in it." IDI 10 (37, F, DM x 10 yrs): "I know sweets are harmful, but sometimes I eat them secretly." IDI 3 (34, F, DM x 6 yrs): "I used to drink a lot of soft drinks before my diagnosis, and now I have completely stopped." 4. Diet and Hydration Dietary Restrictions and Modifications IDI 2 (68, M, DM x 13 yrs): "I switched from flaxseed oil to soybean oil and reduced oil in cooking." IDI 5 (60, F, DM x 9 yrs): "I completely stopped eating rice and potatoes and now eat jowar roti occasionally." IDI 7 (62, M, DM x 5 yrs): "My family prepares separate food for me with less oil and healthier options." IDI 2 (68, M, DM x 13 yrs): "I used to eat non-veg 7–8 times a month, but now I eat it only once a month." Meal Timing and Eating Patterns IDI 2 (68, M, DM x 13 yrs): "I maintain a fixed meal schedule and eat dinner between 9–9:30 PM." IDI 9 (44, F, DM x 1 year): "I follow a strict meal pattern, but during festivals, I prepare sweets for my family and try to limit my intake." Struggles with Dietary Restrictions and Cravings IDI 6 (60, F, HTN&DM x 4 yrs): "It is difficult to completely stop eating sweets when you have been eating them your whole life." IDI 10 (37, F, DM x 10 yrs): "I reduced my portion sizes, but it is difficult to completely avoid my cravings." IDI 11 (44, M, DM x 5 yrs): "I want to control my cravings, but sometimes I give in and regret it later." Changes in Cooking Practices and Food Preparation IDI 5 (60, F, DM x 9 yrs): "I avoid deep frying snacks and prefer roasting or steaming." IDI 5 (60, F, DM x 9 yrs): "Now, I started having jowar roti instead of wheat chapati.” IDI 1 (56, M, DM x 14 yrs): "I used to drink full-fat milk, but now I have switched to buttermilk." Emotional and Psychological Relationship with Food IDI 11 (44, M, DM x 5 yrs): "Whenever I feel stressed, I feel the urge to eat something sweet." IDI 5 (60, F, DM x 9 yrs): "I feel emotionally drained because I have to think so much about what to eat every day." Hydration Practices IDI 3 (34, F, DM x 6 yrs): "I drink 10–15 glasses of water daily to stay hydrated." IDI 12 (65, M, DM x 3 yrs): "I experienced a burning sensation while urinating when my sugar levels were high, so I drink more water now." IDI 9 (44, F, DM x 1 year): "I drink a lot of water, but it causes frequent urination issues." 5. Sleep, Stretch, and Strengthen Physical Activity Practices IDI 1 (56, M, DM x 14 yrs): "I walk 2 km daily until I sweat; also do light body stretches." IDI 9 (44, F, DM x 1 year): "I rarely exercise separately but sometimes walk after dinner before sleeping." IDI 11 (44, M, DM x 5 yrs): "I believe walking promotes insulin secretion and stabilizes blood sugar." Barriers to Physical Activity IDI 2 (68, M, DM x 13 yrs): "I experience breathlessness, fatigue, and leg cramps when I walk for long." IDI 3 (34, F, DM x 6 yrs): "I have severe heel pain and have taken multiple injections for relief, but nothing has helped." IDI 10 (37, F, DM x 10 yrs): "I lack motivation to do regular exercise, even though I know it is good for me." Effect of Sleep Quality on Health IDI 4 (77, M, DM x 5 yrs): "I sleep well, but I wake up multiple times at night for urination." IDI 1 (56, M, DM x 14 yrs): "I recognize sleep as important but am unaware of its specific link to diabetes." IDI 10 (37, F, DM x 10 yrs): "Sometimes I feel very sleepy, and other times, I struggle to fall asleep." Sleep Patterns and Practices IDI 3 (34, F, DM x 6 yrs): "I take afternoon naps sometimes, even though I heard it may not be good for diabetics." IDI 10 (37, F, DM x 10 yrs): "I follow a fixed sleep routine, but sometimes I feel very sleepy, and other times, I struggle to fall asleep." Perceived Benefits of Exercise and Sleep in Diabetes Management IDI 7 (62, M, DM x 5 yrs): "Walking and good sleep help reduce irritability. IDI 2 (68, M, DM x 13 yrs): "I feel refreshed and more energetic when I sleep well." IDI 10 (37, F, DM x 10 yrs): "I follow yoga and walking because I feel it helps my overall health." IDI 1 (56, M, DM x 14 yrs): "Exercise keeps my body active, and I feel less lazy when I walk in the morning." 6. Social Health and Healing Family Support IDI 12 (65, M, DM x 3 yrs): "Family members remind me to take my medicines and visit the hospital." IDI 11 (44, M, DM x 5 yrs): "My family joins me for morning walks sometimes to keep me motivated." IDI 6 (60, F, HTN&DM x 4 yrs): "I believe family should provide motivation, but the patient must decide on their diet." Peer Interaction and Sharing Experiences IDI 11 (44, M, DM x 5 yrs): "I learned about the benefits of morning walks from fellow villagers who manage their diabetes effectively…sometimes in village gatherings, elders discuss their diabetes journey, and it inspires me to manage mine better. " IDI 10 (37, F, DM x 10 yrs): "In our self-help group…we often discuss about diseases openly which help everyone to handle their health problems effectively. " Perception & Attitude towards Diabetes Remission IDI 3 (34, F, DM x 6 yrs): "I want to reverse the disease as it was diagnosed at an early age." IDI 7 (62, M, DM x 5 yrs): "I have heard about diabetes reversal through Ayurveda, but I am not sure if it works since it has to be taken along with allopathy." IDI 2 (68, M, DM x 13 yrs): "I think lifestyle changes help, but I don’t know if they can completely reverse diabetes." Cultural & Traditional Health Practices IDI 10 (37, F, DM x 10 yrs): "Some people in my village still believe that herbal remedies can cure diabetes completely." IDI 7 (62, M, DM x 5 yrs): "In our culture, we eat a lot of home-cooked food, which I think helps control diabetes." IDI 5 (60, F, DM x 9 yrs): "Our elders always said eating bitter foods like neem and karela helps control sugar, so I follow that practice." IDI 9 (44, F, DM x 1 year): "I think religious activities help keep the mind calm, which is also important for health." Routine and Structure in Self-care IDI 6 (60, F, HTN&DM x 4 yrs): "I follow a fixed routine of taking my medications on time." IDI 8 (52, F, DM x 1 year): "I take small meals throughout the day instead of eating heavy portions." Local Initiatives for Diabetes Education IDI 7 (62, M, DM x 5 yrs): "I believe diabetes awareness camps should be organized so people can learn to manage their health." IDI 10 (37, F, DM x 10 yrs): "Hospitals should conduct group awareness sessions for diabetes education." IDI 10 (37, F, DM x 10 yrs): "Group meetings and discussions at hospitals would be helpful in clearing doubts about diabetes." 4. Discussion The findings from the current study on self-care practices in rural diabetes management align with global frameworks for diabetes self-care and highlight unique socio-cultural influences that shape self-care behaviors in rural India. Our study identified key self-care behaviors such as dietary modifications, physical activity, medication adherence, and glucose monitoring as essential components of diabetes self-care. Notably, the highest salience in our study was observed for reducing sugar intake and walking, reflecting a strong community awareness of these practices. These behaviors were widely recognized for their role in glycemic control, which is consistent with the principles of the CDC’s Diabetes Self-Management Education and Support (DSMES) program ( 21 ), which emphasizes nutrition, physical activity, and medication adherence as core self-care components​. CDC’s approach broadly emphasizes lifestyle and preventive health behaviors, while our study integrates deeper patient engagement, motivational aspects, and self-empowerment strategies. Current study revealed that individuals categorized self-care into three broad domains: lifestyle modifications, diet, and medical adherence (Concept Map). This aligns with Dr. Rangan Chatterjee’s Four-Pillar Plan ( 24 ), which underscores the importance of food, movement, sleep, and relaxation in diabetes management. Similar to our findings, Chatterjee's approach recognizes the interconnection between lifestyle factors and metabolic health, emphasizing a need for holistic diabetes care. Dr. Chatterjee's model is broader and universally applicable, while current study specifically tailored recommendations toward diabetes management and personalized goal-setting for self-care. Current study findings echo the principles advocated by the American College of Lifestyle Medicine (ACLM) ( 23 ), which promotes intensive lifestyle interventions as a primary strategy for diabetes remission. The ACLM highlights those structured dietary changes, particularly a whole-food, plant-based diet, combined with moderate exercise, can significantly improve glycemic control and even lead to remission​. Both frameworks significantly overlap and complement each other, emphasizing nutrition, exercise, sleep, stress management, addiction management, and social connectedness. However, our study uniquely added tailored diabetic education (Recognizing and Managing Diabetes), structured goal-setting, personal narratives (Self-care & Lifestyle), and the specific concept of "Diabetes Reversal," which is not explicitly outlined in ACLM’s broader lifestyle recommendations. Despite strong adherence to core self-care practices, the study identified barriers such as financial constraints, healthcare accessibility, and cultural beliefs, which influenced self-care behaviors. The WHO guidelines ( 19 ) on self-care interventions highlight the need for community-driven models that empower individuals to take an active role in their health. In our study, financial difficulties led to inconsistent medication adherence and irregular blood glucose monitoring, reflecting broader challenges seen in low-resource settings. Similarly, findings from the World Diabetes Foundation's community-based diabetes prevention program in Maharashtra indicated that limited affordability of medications and diagnostic tests hindered optimal diabetes management ( 27 ). Findings from Gopichandran et al. ( 7 ) in urban southern India similarly reported that diet control and walking were among the most commonly practiced self-care behaviors. However, current study noted additional barriers unique to rural populations, such as financial constraints, limited healthcare accessibility, and socio-cultural influences on dietary habits. Cultural beliefs influenced self-care, evident in the use of herbal remedies like neem juice, jamun seeds, and bitter gourd. While deeply rooted in tradition, integrating them into evidence-based care remains challenging. Gopichandran et al. ( 7 ) also found traditional remedies commonly used alongside allopathy in urban southern India, underscoring the need for community health education to balance tradition with biomedical care. The study findings underscore the role of stress management, social support, and mental well-being in diabetes care. Participants reported fear of complications, social isolation, and gender-based differences in stress management. The ACLM’s six pillars of lifestyle medicine ( 23 ) emphasize stress reduction, sleep quality, and social support as key determinants of metabolic health​. Similarly, the WHO's self-care guidelines ( 19 ) advocate for integrating mental health and psychosocial support into self-care interventions​. 5. Conclusion The current study highlighted dietary modifications, particularly reduced sugar intake, and physical activities like walking as the most salient self-care practices prioritized by rural individuals managing diabetes. Participants categorized self-care into three distinct but interconnected domains—lifestyle modifications, diet, and medical adherence—emphasizing the necessity of an integrated approach to diabetes management. Also, thematic analysis revealed the critical role of patient education, personalized goal-setting, intrinsic motivation, stress management, and positive social connections in influencing self-care adherence. However, significant barriers such as financial constraints, limited healthcare accessibility, persistent dietary cravings, and cultural beliefs posed ongoing challenges. These barriers make it difficult for people to maintain consistent self-care practices, increasing their risk of complications. Thus, as per the current study, there is the urgent need for a structured diabetes self-care package that is suited to the realities of rural India. In order to overcome the challenges, a comprehensive self-care package must be simple, affordable, and culturally relevant. A community-driven, evidence-based self-care package will help individuals develop sustainable diabetes management strategies while addressing local needs. Future interventions should focus on integrating self-care into existing healthcare structures, making diabetes management more accessible and practical for people in rural areas. By strengthening self-care practices, individuals can improve their health, prevent complications, and enhance their overall quality of life. Limitation of the study This study provides important insights into diabetes self-care in rural India, but it has some limitations. Since it was conducted in specific rural communities, the findings may not apply to all regions. As a qualitative study, it did not measure the direct impact of self-care practices on blood sugar control. Cultural and economic differences influence self-care behaviors, making them vary across populations. Declarations Ethics Ethical approval for the research was obtained from the Institutional Ethics Committee (IEC) for Research on Human Subjects at MGIMS prior to initiation of the study, in accordance with IEC approval letter no. 2484, dated 10 th July, 2023. Verbal informed consent was taken by each participant for their participation and audio recording. Funding This study (Proposal ID- MDMS23Dec-0181) and (File No: HRD-Head/PG thesis-program/2023-2024(30) dated 27th July 2024) was being by funded the Indian Council of Medical Research (ICMR). Declaration of Competing interests We declare no competing interests. The authors have no financial, personal, or professional affiliations that could be perceived as influencing the work reported in this study. This ensures the integrity, objectivity, and transparency of the research presented. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Acknowledgements We are grateful to the Department of Community Medicine, MGIMS, Sevagram, India, for providing the necessary resources and field support. Special thanks to Bharambhe Sir, Mr. Praveen Bhusari, Nalini Sister, Mr. Jayprakash More, Sarika Sister, Bhavana Sister, and Alka Tai for their dedicated support in identifying participants and accompanying the team during data collection. We extend our heartfelt appreciation to ASHA workers, ANMs, and local healthcare providers for their invaluable assistance in facilitating data collection and engaging with the community. We also thankful to all the study participants for their valuable time and willingness to share their experiences, which contributed significantly to the findings. 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Self-care Package for Type-2 diabetes mellitus patients in rural area: findings from a Formative Research Study\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eDiabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels, which can lead to complications affecting blood vessels, eyes, kidneys, and nerves (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). It has become a significant public health concern in India, with its prevalence increasing sharply in recent decades (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Globally, approximately 537\u0026nbsp;million adults aged 20\u0026ndash;79 years have diabetes, representing 10.5% of this age group (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Projections indicate that the global diabetes population will rise to 643\u0026nbsp;million (11.3%) by 2030 and 783\u0026nbsp;million (12.2%) by 2045. In India, as of 2021, the estimated prevalence of diabetes among adults aged 20\u0026ndash;79 years is 8.3% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Escalating Diabetes Crisis in Rural India\u003c/h2\u003e \u003cp\u003eA study in Maharashtra reported an adjusted diabetes prevalence of 8.4% across rural and urban areas. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In 1979, a survey reported a rural diabetes prevalence of just 1.5%, which escalated to 8.3% in certain rural regions by 2011 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Early detection can't curb obesity, diabetes, hypertension, or heart disease alone. Since 80\u0026ndash;90% of chronic illnesses stem from lifestyle, addressing root causes is crucial for prevention and control. (\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Challenges in Diabetes Self-Care in Rural Areas\u003c/h2\u003e \u003cp\u003eIndia, known as the diabetes capital, faces a growing burden, especially in rural areas with limited healthcare and low health literacy (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Effective control requires not just treatment but self-care like diet, exercise, medication adherence, and regular monitoring.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Self-care is essential for glycemic control and long-term health, (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) but rural populations face barriers like low awareness, socio-cultural beliefs, economic constraints, and inadequate healthcare. Addressing these is crucial for effective diabetes self-management.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Concept of Self-Care and Its Role in Diabetes Management\u003c/h2\u003e \u003cp\u003eSelf-care enables individuals, families, and communities to maintain health, prevent disease, and manage illness with or without medical support. It includes health promotion, disease prevention, self-medication, caregiving, seeking medical care, and rehabilitation. Self-care interventions, such as medications, medical devices, diagnostics, and digital tools, support these practices and can be used independently or alongside healthcare services, often beyond formal medical settings (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.4 Existing Global Models for a holistic approach to chronic diseases\u003c/h2\u003e \u003cp\u003eGlobally, self-care packages and lifestyle programs support diabetes management. The \u003cb\u003eCDC\u0026rsquo;s Diabetes Self-Management Education and Support (DSMES) program\u003c/b\u003e (\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) promotes healthy eating, physical activity, medication adherence, glucose monitoring, and psychosocial well-being. The \u003cb\u003eAmerican College of Lifestyle Medicine (ACLM)\u003c/b\u003e (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) takes a preventive approach, focusing on a plant-based diet, exercise, sleep, stress management, social support, and avoiding harmful substances. \u003cb\u003eDr. Rangan Chatterjee\u0026rsquo;s Four-Pillar Plan\u003c/b\u003e (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) simplifies chronic disease care into food, movement, sleep, and relaxation to enhance insulin sensitivity and overall health. These models provide structured, evidence-based strategies to support sustainable diabetes management and improved glycemic control (\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA formative needs assessment is essential to understand community needs, existing knowledge, and challenges in diabetes management. By analyzing insights from patients, caregivers, and healthcare providers, a tailored self-care package can be designed to align with the socio-cultural and healthcare landscape of rural India. This study investigates self-care practices among diabetic patients in rural areas, identifying key factors that influence self-management. It explores barriers and facilitators, including medication adherence, dietary habits, physical activity, and glucose monitoring. By addressing challenges and leveraging community strengths, the research aims to develop a locally adaptable, evidence-based self-care package to improve glycemic control and long-term health outcomes.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2.1 Study Design and Methods\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was part of a larger research initiative registered under the Clinical Trials Registry of India (CTRI/2023/10/058427) as a postgraduate thesis. It used a qualitative exploratory design to understand self-care practices, challenges, and perceptions of people with T2DM in rural India, aiming to develop a culturally tailored self-care package. This study focused on the formative phase of research for the development of self-care package, followed by a community-based stepped wedge cluster randomized feasibility trial using a closed cohort design to assess its effectiveness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2.2 Study Settings and Duration\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study took place in villages within the field practice area of the Community Medicine Department at a Medical College of central Maharashtra, India, from November 2023 to December 2024.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2.3 Study Procedure\u003c/em\u003e\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eDesk review of literature:\u003c/strong\u003e Carried out to explore and identify essential components for developing the self-care. The review was guided by key frameworks, including CDC\u0026rsquo;s Diabetes Self-Management Education and Support (DSMES) program (21), the American College of Lifestyle Medicine (ACLM) approach (23), and Dr. Rangan Chatterjee\u0026rsquo;s Four-Pillar Plan (24).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eQualitative Methods\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eIn-depth interviews, free listing, and pile sorting were used to identify relevant self-care content.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eContent Validation:\u003c/strong\u003e Assessed by a panel of experts, including the District Health Officer, an Internal Medicine Specialist, and a Community Medicine Specialist.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2.4 Sample size, Participants and Sampling method\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis formative research explores self-care practices among diabetic patients in rural India to develop a context-specific self-care package. Since this is a qualitative study, the sample size was determined by data saturation, meaning data collection continued until no new themes or insights emerged. \u003cstrong\u003eTable 1\u003c/strong\u003e provided an overview of the data collection methods, their purpose, and the number of participants involved. Purposive sampling was used to include participants with diverse age, gender, socioeconomic status, and diabetes duration. The inclusion criteria required participants to be 18 years or older, diagnosed with diabetes, willing to participate, and capable of providing informed consent. Those with cognitive impairments or bedridden conditions and pregnant women were excluded.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 1: Overview of data collection methods, their purposes, and corresponding sample sizes\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eS.N.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMethod\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePurpose of data collection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFree Listing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003eTo identify domains for self-care package and commonly associated concepts within the community.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePile Sorting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 groups\u003c/p\u003e\n \u003cp\u003e(Total 30 participants)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003eUnderstanding mental models and cultural perceptions of self-care practices in diabetes.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIDIs\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003ePerceptions about self-care practices for diabetes\u003c/li\u003e\n \u003cli\u003eDifficulties in the implementation of self-care practices\u003c/li\u003e\n \u003cli\u003eSupport required to improve self-care practices\u003c/li\u003e\n \u003cli\u003eUnderstanding self-efficacy and readiness for self-care in diabetes\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2.5 Data Collection Process\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eFree Listing\u0026nbsp;\u003c/strong\u003ewas conducted among 30 participants to identify culturally relevant diabetes self-care practices. Initially, participants individually listed practices they associated with diabetes care. Salience index was monitored after every 5\u0026ndash;10 responses to assess saturation, reflecting both frequency and rank order of listed items. Although saturation was observed after 20 participants, data collection continued to 30 as planned for accuracy and completeness. Regular monitoring salience helped capture community-specific perceptions and priorities, aiding development of a culturally relevant diabetes self-care package. Participants were identified with support from local field staff and interviewed in their respective homes at their convenience. Participant details and questionnaire are provided in the supplementary material (Table S1).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePile Sorting\u0026nbsp;\u003c/strong\u003ewas conducted in five groups among 30 participants with a minimum of 5 participants per group. Self-care practices mentioned by at least three participants during free-listing were selected for pile-sorting, which was conducted with a different set of participants (not involved in free-listing) identified through field staff familiar with the community. Each item was written on a card separately and 26 cards were prepared. Participants grouped cards based on perceived similarity, forming as many piles as they felt appropriate, through group consensus. This revealed how the community understands and categorizes diabetes self-care practices. Sessions were held in accessible spaces like Gram Panchayats, sub-centers, or village areas to ensure comfort and participation. The pile-sorting questionnaire and participant\u0026rsquo;s details are provided in supplementary material (Table S2).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIn-depth interviews (IDIs)\u003c/strong\u003e began with a pilot phase involving a social worker and a biostatistics faculty member with diabetes. Based on their feedback, questions were finalized. Our field staff (ANM and social worker) who had a rapport with the study participants introduced them to the interviewers and explained the purpose of the interview. Trained investigators with principal investigator conducted semi-structured interviews in Hindi or Marathi, covering symptoms, self-care, challenges, and support systems by keeping cultural appropriateness and contextual accuracy. Each interview, held at the participant\u0026rsquo;s home, lasted 45\u0026ndash;60 minutes. To ensure validation, interview notes were summarized, reviewed with participants, and cross-checked with the final transcript. IDIs included participants receiving diabetes care from diverse settings\u0026mdash;private clinics, government centers, and tertiary hospitals\u0026mdash;to capture varied perspectives. All interviews were audio-recorded with verbal consent. Participants\u0026rsquo; list with questionnaire is provided in supplementary material (Table S3).\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2.6 Data Analysis and Software\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eFree Listing:\u003c/strong\u003e The data collected through free listing was analyzed to identify the self-care practices for Diabetes within the community. Spelling errors and minor variations were corrected while ensuring the original meaning remained intact. For consistency, the free-listed items were translated into English from Hindi/ Marathi. These items were then analyzed using ANTHROPAC (v1.0.1.36), a software designed for cultural domain analysis, to further explore how participants categorize self-care practices and identify key community perceptions. The \u003cstrong\u003eSmith\u0026rsquo;s Salience Index\u003c/strong\u003e was then calculated to measure the relative importance of each self-care practice.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePile sorting:\u003c/strong\u003e Data were analyzed using cluster analysis to understand how participants grouped self-care practices. Since some practices were more commonly recognized than others, the top 26 most salient self-care practices were chosen for grouping. \u003cstrong\u003eCluster analysis\u003c/strong\u003e grouped practices by shared features, revealing how the community naturally categorized self-care. It offered a structured view of diabetes management behaviors aligned with community perspectives and priorities. Further, a \u003cstrong\u003eConcept Map\u0026nbsp;\u003c/strong\u003ewas created using ANTHROPAC (v1.0.2.60) to visualize relationships among self-care practices. The concept map showed relationships among self-care practices, placing similar items closer based on participant groupings. By mapping out these connections, the analysis provided deeper insight into how individuals associate and categorize behaviors, revealing key perception patterns. The combination of cluster analysis and concept mapping allowed for a structured and clear understanding of community perspectives, ensuring that self-care interventions are aligned with culturally relevant practices.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIDIs:\u0026nbsp;\u003c/strong\u003eAll IDIs were audio-recorded, transcribed word-for-word, and translated from Hindi/Marathi to English to ensure clarity while preserving the original meaning. Translations were reviewed by a bilingual expert to ensure accuracy and consistency. Two coders manually coded the data using a mixed coding approach, combining predefined codes from existing research\u0026nbsp;(21,23,24)\u0026nbsp;with new themes that emerged from the data. Data were analyzed using \u003cstrong\u003ethematic analysis\u003c/strong\u003e,\u0026nbsp;to identify barriers, facilitators, and self-care practices. Two coders reached consensus on themes, refining them through multiple coding cycles for accuracy and reliability.\u0026nbsp;Data saturation was assessed during analysis, and coding continued until no new themes emerged. Confidentiality was maintained by anonymizing participant details, and illustrative quotes were de-identified before reporting. This approach integrated both participant insights and existing knowledge to guide culturally relevant self-care strategies.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTriangulation\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo enhance the validity and depth of the findings, methodological triangulation integrated data from free listing, pile sorting, and IDIs. This approach strengthened credibility and provided a culturally grounded view of diabetes self-care. Free listing identified common practices based on frequency and salience, while pile sorting grouped the top 26 salient practices into meaningful clusters, reflecting how participants categorized them. Concept mapping and cluster analysis helped in understanding community-driven classifications, ensuring that interventions align with local perspectives.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e identified the key self-care practices adopted by individuals for diabetes management, with Smith\u0026rsquo;s Salience(S) reflecting their relative importance and cognitive accessibility of self-care practices in diabetes management. Higher salience values indicate commonly mentioned and prioritized behaviors, while lower values represent less frequently recalled or individualized strategies. The most frequently mentioned practices were reducing sugar intake (63.3%) and walking (63.3%), both of which had high salience scores (0.494 and 0.417, respectively), indicating their perceived importance in diabetes management. Regular medication intake (43.3%) ranked third, followed by exercise (33.3%) and dietary modifications such as reducing rice consumption (33.3%). Certain dietary practices, including complete avoidance of sugar (23.3%), wound care (30.0%), and blood sugar testing (36.7%), were also reported, though with relatively lower salience scores. Community members emphasized the importance of recognizing symptoms of high blood sugar (16.7%) and consuming specific food items such as fenugreek powder (13.3%), neem leaves (13.3%), and bitter gourd juice (10.0%) as part of diabetes management.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFree Listing Analysis regarding Self-Care Behaviors among Diabetic Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAverage Rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSmith\u0026rsquo;s Salience (S)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduce sugar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.494\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWalking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.417\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTake medications regularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.206\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduce rice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.202\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo sugar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood sugar testing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduce potato\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBe aware about symptoms for increased blood sugar levels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEat food at right time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTake fenugreek powder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduce tea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo rice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEat neem leaves\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep well\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrink Bitter gourd juice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEye care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKeep food under control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo addiction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse sugar free tablet in tea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork in farm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTake tea with jaggery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKeep blood sugar levels under control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEat vegetables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEat jowar roti\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTake raw garlic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEat pulses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo banana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYoga asanas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrink black tea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo tea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWake up 4.30am\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTake Ayurveda and allopathy medications regularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRunning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMorning walking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Non veg and masala\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTake luke warm water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduce roti\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTake green tea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTake carom seeds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduce milk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTake greenleafy vegetables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduce oily and spicy foods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo milk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEat fruits and vegetables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBe aware about reduced and increased blood sugar level symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeditation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo not want to reach a stage of insulin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduce sour food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTake tea without sugar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware about hypoglycemia symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive thinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWalking without chappal in sand keeps sugar under control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePranayama\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo alcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEat leaves (Guava, neem, custard apple)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduce maida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaintain mental health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStay away from food not healthy for diabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWake up at 5.30am\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo non veg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo outside food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave good will power\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrekking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKeep stomach clean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTake ayurveda medicines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo tension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEat 2 times per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eLifestyle-related practices such as adequate sleep (26.7%), relaxation (23.3%), and avoiding addictions (23.3%) were also reported but had lower overall salience scores. Traditional and alternative approaches, including the use of Ayurvedic medications, home remedies like consuming raw garlic (6.7%), and yoga or pranayama (6.7%), were mentioned by a few participants. The findings suggest a strong emphasis on dietary modifications, physical activity, and medication adherence as key self-care behaviors, while traditional and behavioral practices hold a secondary but meaningful place. Community interventions should reinforce high-salience behaviors while integrating evidence-based approaches to lower-salience yet culturally relevant practices, ensuring a comprehensive diabetes self-care framework.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 1\u003c/b\u003e showing \u003cb\u003eConcept Map\u003c/b\u003e, provided a structured view of how respondents categorized various diabetes self-care practices based on their perceived similarities. The clusters formed in the plot highlighted distinct groups, indicating key themes in diabetes self-care. The blue cluster included behaviors related to physical activity and lifestyle habits, showing that respondents associated these practices with maintaining overall health. The black cluster primarily focused on dietary modifications, such as specific foods and traditional remedies, emphasizing the role of nutrition in diabetes control. The pink cluster represented medical adherence, check-ups, and structured self-care practices, indicating that these aspects were considered essential yet distinct from lifestyle-based interventions. The gray connections between clusters suggested overlaps in perception, where some behaviors, like dietary changes and physical activity, were seen as interconnected. Additionally, an outlier marked in green indicated a behavior that was not strongly associated with any specific cluster, suggesting its varied recognition among respondents.\u003c/p\u003e \u003cp\u003eThe spatial arrangement of the clusters in the plot showed that people grouped diabetes self-care into three main areas: \u003cb\u003elifestyle, diet, and medical adherence\u003c/b\u003e. This means that they saw managing diabetes as a combination of staying active, eating the right foods, and following medical advice, including taking medicines and monitoring blood sugar levels. The findings highlighted the importance of creating a well-rounded self-care plan that includes all these aspects. Additionally, some self-care practices were less common or not widely used, indicating the need to raise awareness and encourage their adoption. A holistic self-care approach that combines lifestyle changes, proper diet, and medical care can help improve diabetes management, especially in rural communities.\u003c/p\u003e \u003cp\u003eThe thematic analysis in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e highlighted the insights of individuals with diabetes, emphasizing key aspects of self-care, challenges, and support systems. \u003cb\u003eSelf-care \u0026amp; lifestyle\u003c/b\u003e practices revolved around patient awareness, rapport building, personal motivation, goal setting. Patients demonstrated varied levels of adherence to self-care practices, influenced largely by their awareness of diabetes management and intrinsic motivation. Participants highlighted the importance of setting achievable health goals and emphasized that sustained motivation was necessary for effective self-care. \u003cb\u003eRecognizing and managing diabetes\u003c/b\u003e highlighted diverse pathways to diagnosis, varying awareness of complications, and differing approaches to treatment. Few relied on medications, though others preferred traditional remedies and lifestyle changes. \u003cb\u003eManaging Stress and Addictions\u003c/b\u003e reveals emotional burdens, fear of complications, and differing coping mechanisms, with gender differences in stress management. \u003cb\u003eDiet and hydration\u003c/b\u003e themes reflected participants' food and water consumption patterns, dietary changes following diagnosis, struggles with cravings, and challenges in managing dietary restrictions. Participants reported changes in eating habits post-diagnosis, noting difficulties in adjusting to dietary requirements and managing persistent cravings. They also emphasized the importance of adequate hydration and related adjustments after diagnosis. \u003cb\u003eSleep, stretch, and strengthen\u003c/b\u003e captured physical activity practices, barriers to exercise, and perceived benefits of sleep and movement in diabetes control. It emphasized how adequate sleep and regular physical activity contributed to improved diabetes management, while also acknowledging common obstacles individuals faced in maintaining these practices. \u003cb\u003eSocial health and healing\u003c/b\u003e were influenced by family, community, and cultural beliefs, shaping perceptions of peer support and diabetes education. Positive social connections played a crucial role in self-care journeys, highlighting the importance of facilitators who promoted peer interactions and introduced concepts like diabetes reversal. Based on the analysis of the current study, a diabetes self-care package was developed, comprising six core components as shown in \u003cb\u003eFig.\u0026nbsp;2\u003c/b\u003e. The comparison between existing self-care and lifestyle packages and the newly developed components in the current study is shown in \u003cb\u003eTable S4\u003c/b\u003e (Supplementary material).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThematic Analysis of Diabetes Self-Care and Lifestyle\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubthemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVerbatim\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"15\" rowspan=\"16\"\u003e \u003cp\u003e1. \u003cb\u003eSelf-care \u0026amp; Lifestyle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAwareness and Understanding of Self-care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 1 (56, M, DM x 14 yrs): \"I am aware about self-care. I was advised by Sevagram doctor about walking for diabetes, eating on time, and eating a lot of fiber and vegetables.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 2 (68, M, DM x 13 yrs): \"Taking medicines on time, eating on time, relaxation, walking, and not eating sweet food are important self-care aspects.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 4 (77, M, DM x 5 yrs): \"I go to PHC and check my sugar levels once in 15 days or per month.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIntrinsic Motivation and Purpose-driven Goals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 5 (60, F, DM x 9 yrs): \"I feel responsible for my health, as I do not want to depend on others for daily activities.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 12 (65, M, DM x 3 yrs): \"If we take self-care, we can prevent complications.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 9 (44, F, DM x 1\u0026nbsp;year): \"I want to live a healthy life so that I do not become a burden on my family.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eConsciousness of Health and Well-being\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 5 (60, F, DM x 9 yrs): \"Due to weakness, I am not able to work on the farm as much as I used to. Now, I only do household work.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 10 (37, F, DM x 10 yrs): \"I do not travel much anymore because my sugar levels fluctuate, and I am afraid of falling sick outside.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMedication Compliance and Challenges\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 11 (44, M, DM x 5 yrs): \"I follow my medication routine strictly because I don\u0026rsquo;t want my sugar levels to go out of control.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 6 (60, F, HTN\u0026amp;DM x 4 yrs): \"Sometimes I miss my medicines because I run out of stock, and I need to visit the hospital to get them.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAddressing Diabetes Misconceptions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 5 (60, F, DM x 9 yrs): \"Initially, I thought eating sweets alone caused diabetes, but now I understand other factors also contribute.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 7 (62, M, DM x 5 yrs): \"Some say diabetes always leads to blindness or amputation\u0026hellip;but with control we can avoid these complications...understanding the truth has greatly reduced my fears.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEconomic Constraints in Diabetes Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 9 (44, F, DM x 1\u0026nbsp;year): \"I have to spend ₹1000 every 15 days on medicines, as they are not available in government hospitals.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 6 (60, F, HTN\u0026amp;DM x 4 yrs): \"Due to financial issues, I sometimes skip my sugar tests.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 12 (65, M, DM x 3 yrs): \"I avoid going for regular checkups because traveling to the hospital costs money.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 8 (52, F, DM x 1\u0026nbsp;year): \"It is difficult to afford healthy food like green vegetables and fruits regularly.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"19\" rowspan=\"20\"\u003e \u003cp\u003e2. \u003cb\u003eRecognizing and Managing Diabetes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEarly Signs \u0026amp; Symptoms and Diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 7 (62, M, DM x 5 yrs): \"I was diagnosed with diabetes after feeling dizzy and weak for a few days.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 11 (44, M, DM x 5 yrs): \"I had excessive thirst and frequent urination before I was diagnosed.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 5 (60, F, DM x 9 yrs): \"I had no idea I had diabetes until my wound didn\u0026rsquo;t heal for weeks.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 3 (34, F, DM x 6 yrs): \"My sugar levels were high during pregnancy, and after five years, I was diagnosed with diabetes again.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBlood Sugar Monitoring Practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 2 (68, M, DM x 13 yrs): \"I get my sugar checked regularly once a month at the primary health center to keep track of my diabetes.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 1 (56, M, DM x 14 yrs): \" Regular monitoring helps me adjust my diet and medicines, so I check my sugar at home weekly.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDietary Modifications and Adjustments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 7 (62, M, DM x 5 yrs): \u0026ldquo;I consume neem juice and jamun seeds powder every morning for diabetes control.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 10 (37, F, DM x 10 yrs): \"I avoid outside food and fried snacks almost all times.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 4 (77, M, DM x 5 yrs): \"I have reduced my tea intake from five cups to two per day.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrioritizing Lifestyle above Medicines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 7 (62, M, DM x 5 yrs): \"I believe lifestyle changes like walking and diet are better than medicine\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 3 (34, F, DM x 6 yrs): \"..seen few people who managed diabetes with yoga and natural herbs, but I don\u0026rsquo;t know if it works for everyone..\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAwareness and Understanding of Complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 2 (68, M, DM x 13 yrs): \"I had cataract surgery, and the doctor told me that diabetes was the reason for my blurred vision.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 5 (60, F, DM x 9 yrs): \"I know that diabetes can cause slow wound healing, so I take precautions when I get injured.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 7 (62, M, DM x 5 yrs): \"I never thought diabetes could lead to heart issues until I had an angioplasty.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 12 (65, M, DM x 3 yrs): \"I have pain in my legs and tingling sensations, and I think it is because of my sugar levels.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFoot Care Practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 2 (68, M, DM x 13 yrs): \u0026ldquo;I always wear slippers inside the house and shoes outside to avoid injuries.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 6 (60, F, HTN\u0026amp;DM x 4 yrs): \"I wash my feet every night before sleeping but don\u0026rsquo;t check for cuts or wounds.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 12 (65, M, DM x 3 yrs): \"I have tingling sensations in my feet, so I try to avoid walking barefoot.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBarriers to Effective Diabetes Management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 3 (34, F, DM x 6 yrs): \"I check my sugar only when I feel unwell, as frequent testing is expensive.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 9 (44, F, DM x 1\u0026nbsp;year): \"I try to reduce salt and oil, but my family still cooks the way they used to.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"17\" rowspan=\"18\"\u003e \u003cp\u003e3. \u003cb\u003eManaging Stress and Addictions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePerceived Severity and Fear of Diabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 10 (37, F, DM x 10 yrs): \"I was told that diabetes is a slow poison that affects different parts of the body over time.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 11 (44, M, DM x 5 yrs): \"I fear that one day, I might lose my eyesight because of diabetes.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 7 (62, M, DM x 5 yrs): \"I have heard that if sugar levels are not controlled, one can lose their legs.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 9 (44, F, DM x 1\u0026nbsp;year): \"I am scared that I will become completely dependent on my family if my condition worsens.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMental Impact of Social Isolation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 10 (37, F, DM x 10 yrs): \"I feel disconnected from my friends since I stopped drinking tea and snacks with them.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 4 (77, M, DM x 5 yrs): \"People assume I am sick all the time, so they treat me differently, which makes me feel lonely.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 9 (44, F, DM x 1\u0026nbsp;year): \"I don\u0026rsquo;t go to family functions much anymore because people keep asking about my health.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 5 (60, F, DM x 9 yrs): \"I feel left out when my family eats outside, as I cannot eat the same food.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender Differences in Stress Management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 8 (52, F, DM x 1\u0026nbsp;year): \"Men can go outside and walk to relieve stress, but women have too many responsibilities.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 7 (62, M, DM x 5 yrs): \"I manage my stress by engaging in farming work, it helps me stay active.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePersonal Coping Strategies and Recreation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 1 (56, M, DM x 14 yrs): \"Whenever I feel stressed, I listen to bhajans (devotional songs) or go to the temple.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 3 (34, F, DM x 6 yrs): \"Talking to my friends helps me forget about my worries.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 5 (60, F, DM x 9 yrs): \"I believe keeping myself busy with housework helps me avoid negative thoughts.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 7 (62, M, DM x 5 yrs): \"Whenever I feel tense, I go for a walk to clear my mind.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBehavioral Addictions and Health Risks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 1 (56, M, DM x 14 yrs): \"I have been chewing tobacco for years, but I don\u0026rsquo;t think it affects my sugar levels.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 8 (52, F, DM x 1\u0026nbsp;year): \"Drinking tea multiple times a day was a habit, but now I have reduced sugar in it.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 10 (37, F, DM x 10 yrs): \"I know sweets are harmful, but sometimes I eat them secretly.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 3 (34, F, DM x 6 yrs): \"I used to drink a lot of soft drinks before my diagnosis, and now I have completely stopped.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"16\" rowspan=\"17\"\u003e \u003cp\u003e4. \u003cb\u003eDiet and Hydration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDietary Restrictions and Modifications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 2 (68, M, DM x 13 yrs): \"I switched from flaxseed oil to soybean oil and reduced oil in cooking.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 5 (60, F, DM x 9 yrs): \"I completely stopped eating rice and potatoes and now eat jowar roti occasionally.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 7 (62, M, DM x 5 yrs): \"My family prepares separate food for me with less oil and healthier options.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 2 (68, M, DM x 13 yrs): \"I used to eat non-veg 7\u0026ndash;8 times a month, but now I eat it only once a month.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMeal Timing and Eating Patterns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 2 (68, M, DM x 13 yrs): \"I maintain a fixed meal schedule and eat dinner between 9\u0026ndash;9:30 PM.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 9 (44, F, DM x 1\u0026nbsp;year): \"I follow a strict meal pattern, but during festivals, I prepare sweets for my family and try to limit my intake.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eStruggles with Dietary Restrictions and Cravings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 6 (60, F, HTN\u0026amp;DM x 4 yrs): \"It is difficult to completely stop eating sweets when you have been eating them your whole life.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 10 (37, F, DM x 10 yrs): \"I reduced my portion sizes, but it is difficult to completely avoid my cravings.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 11 (44, M, DM x 5 yrs): \"I want to control my cravings, but sometimes I give in and regret it later.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eChanges in Cooking Practices and Food Preparation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 5 (60, F, DM x 9 yrs): \"I avoid deep frying snacks and prefer roasting or steaming.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 5 (60, F, DM x 9 yrs): \"Now, I started having jowar roti instead of wheat chapati.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 1 (56, M, DM x 14 yrs): \"I used to drink full-fat milk, but now I have switched to buttermilk.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEmotional and Psychological Relationship with Food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 11 (44, M, DM x 5 yrs): \"Whenever I feel stressed, I feel the urge to eat something sweet.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 5 (60, F, DM x 9 yrs): \"I feel emotionally drained because I have to think so much about what to eat every day.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHydration Practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 3 (34, F, DM x 6 yrs): \"I drink 10\u0026ndash;15 glasses of water daily to stay hydrated.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 12 (65, M, DM x 3 yrs): \"I experienced a burning sensation while urinating when my sugar levels were high, so I drink more water now.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 9 (44, F, DM x 1\u0026nbsp;year): \"I drink a lot of water, but it causes frequent urination issues.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"14\" rowspan=\"15\"\u003e \u003cp\u003e5. \u003cb\u003eSleep, Stretch, and Strengthen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePhysical Activity Practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 1 (56, M, DM x 14 yrs): \"I walk 2 km daily until I sweat; also do light body stretches.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 9 (44, F, DM x 1\u0026nbsp;year): \"I rarely exercise separately but sometimes walk after dinner before sleeping.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 11 (44, M, DM x 5 yrs): \"I believe walking promotes insulin secretion and stabilizes blood sugar.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBarriers to Physical Activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 2 (68, M, DM x 13 yrs): \"I experience breathlessness, fatigue, and leg cramps when I walk for long.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 3 (34, F, DM x 6 yrs): \"I have severe heel pain and have taken multiple injections for relief, but nothing has helped.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 10 (37, F, DM x 10 yrs): \"I lack motivation to do regular exercise, even though I know it is good for me.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEffect of Sleep Quality on Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 4 (77, M, DM x 5 yrs): \"I sleep well, but I wake up multiple times at night for urination.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 1 (56, M, DM x 14 yrs): \"I recognize sleep as important but am unaware of its specific link to diabetes.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 10 (37, F, DM x 10 yrs): \"Sometimes I feel very sleepy, and other times, I struggle to fall asleep.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSleep Patterns and Practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 3 (34, F, DM x 6 yrs): \"I take afternoon naps sometimes, even though I heard it may not be good for diabetics.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 10 (37, F, DM x 10 yrs): \"I follow a fixed sleep routine, but sometimes I feel very sleepy, and other times, I struggle to fall asleep.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePerceived Benefits of Exercise and Sleep in Diabetes Management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 7 (62, M, DM x 5 yrs): \"Walking and good sleep help reduce irritability.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 2 (68, M, DM x 13 yrs): \"I feel refreshed and more energetic when I sleep well.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 10 (37, F, DM x 10 yrs): \"I follow yoga and walking because I feel it helps my overall health.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 1 (56, M, DM x 14 yrs): \"Exercise keeps my body active, and I feel less lazy when I walk in the morning.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"16\" rowspan=\"17\"\u003e \u003cp\u003e6. \u003cb\u003eSocial Health and Healing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFamily Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 12 (65, M, DM x 3 yrs): \"Family members remind me to take my medicines and visit the hospital.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 11 (44, M, DM x 5 yrs): \"My family joins me for morning walks sometimes to keep me motivated.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 6 (60, F, HTN\u0026amp;DM x 4 yrs): \"I believe family should provide motivation, but the patient must decide on their diet.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePeer Interaction and Sharing Experiences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 11 (44, M, DM x 5 yrs): \"I learned about the benefits of morning walks from fellow villagers who manage their diabetes effectively\u0026hellip;sometimes in village gatherings, elders discuss their diabetes journey, and it inspires me to manage mine better. \"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 10 (37, F, DM x 10 yrs): \"In our self-help group\u0026hellip;we often discuss about diseases openly which help everyone to handle their health problems effectively. \"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePerception \u0026amp; Attitude towards Diabetes Remission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 3 (34, F, DM x 6 yrs): \"I want to reverse the disease as it was diagnosed at an early age.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 7 (62, M, DM x 5 yrs): \"I have heard about diabetes reversal through Ayurveda, but I am not sure if it works since it has to be taken along with allopathy.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 2 (68, M, DM x 13 yrs): \"I think lifestyle changes help, but I don\u0026rsquo;t know if they can completely reverse diabetes.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCultural \u0026amp; Traditional Health Practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 10 (37, F, DM x 10 yrs): \"Some people in my village still believe that herbal remedies can cure diabetes completely.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 7 (62, M, DM x 5 yrs): \"In our culture, we eat a lot of home-cooked food, which I think helps control diabetes.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 5 (60, F, DM x 9 yrs): \"Our elders always said eating bitter foods like neem and karela helps control sugar, so I follow that practice.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 9 (44, F, DM x 1\u0026nbsp;year): \"I think religious activities help keep the mind calm, which is also important for health.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRoutine and Structure in Self-care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 6 (60, F, HTN\u0026amp;DM x 4 yrs): \"I follow a fixed routine of taking my medications on time.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 8 (52, F, DM x 1\u0026nbsp;year): \"I take small meals throughout the day instead of eating heavy portions.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLocal Initiatives for Diabetes Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 7 (62, M, DM x 5 yrs): \"I believe diabetes awareness camps should be organized so people can learn to manage their health.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 10 (37, F, DM x 10 yrs): \"Hospitals should conduct group awareness sessions for diabetes education.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIDI 10 (37, F, DM x 10 yrs): \"Group meetings and discussions at hospitals would be helpful in clearing doubts about diabetes.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe findings from the current study on self-care practices in rural diabetes management align with global frameworks for diabetes self-care and highlight unique socio-cultural influences that shape self-care behaviors in rural India. Our study identified key self-care behaviors such as dietary modifications, physical activity, medication adherence, and glucose monitoring as essential components of diabetes self-care. Notably, the highest salience in our study was observed for reducing sugar intake and walking, reflecting a strong community awareness of these practices. These behaviors were widely recognized for their role in glycemic control, which is consistent with the principles of the CDC\u0026rsquo;s Diabetes Self-Management Education and Support (DSMES) program (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), which emphasizes nutrition, physical activity, and medication adherence as core self-care components​. CDC\u0026rsquo;s approach broadly emphasizes lifestyle and preventive health behaviors, while our study integrates deeper patient engagement, motivational aspects, and self-empowerment strategies.\u003c/p\u003e \u003cp\u003eCurrent study revealed that individuals categorized self-care into three broad domains: lifestyle modifications, diet, and medical adherence (Concept Map). This aligns with Dr. Rangan Chatterjee\u0026rsquo;s Four-Pillar Plan (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), which underscores the importance of food, movement, sleep, and relaxation in diabetes management. Similar to our findings, Chatterjee's approach recognizes the interconnection between lifestyle factors and metabolic health, emphasizing a need for holistic diabetes care. Dr. Chatterjee's model is broader and universally applicable, while current study specifically tailored recommendations toward diabetes management and personalized goal-setting for self-care.\u003c/p\u003e \u003cp\u003eCurrent study findings echo the principles advocated by the American College of Lifestyle Medicine (ACLM) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), which promotes intensive lifestyle interventions as a primary strategy for diabetes remission. The ACLM highlights those structured dietary changes, particularly a whole-food, plant-based diet, combined with moderate exercise, can significantly improve glycemic control and even lead to remission​. Both frameworks significantly overlap and complement each other, emphasizing nutrition, exercise, sleep, stress management, addiction management, and social connectedness. However, our study uniquely added tailored diabetic education (Recognizing and Managing Diabetes), structured goal-setting, personal narratives (Self-care \u0026amp; Lifestyle), and the specific concept of \"Diabetes Reversal,\" which is not explicitly outlined in ACLM\u0026rsquo;s broader lifestyle recommendations.\u003c/p\u003e \u003cp\u003eDespite strong adherence to core self-care practices, the study identified barriers such as financial constraints, healthcare accessibility, and cultural beliefs, which influenced self-care behaviors. The WHO guidelines (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) on self-care interventions highlight the need for community-driven models that empower individuals to take an active role in their health. In our study, financial difficulties led to inconsistent medication adherence and irregular blood glucose monitoring, reflecting broader challenges seen in low-resource settings. Similarly, findings from the World Diabetes Foundation's community-based diabetes prevention program in Maharashtra indicated that limited affordability of medications and diagnostic tests hindered optimal diabetes management (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFindings from Gopichandran et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) in urban southern India similarly reported that diet control and walking were among the most commonly practiced self-care behaviors. However, current study noted additional barriers unique to rural populations, such as financial constraints, limited healthcare accessibility, and socio-cultural influences on dietary habits. Cultural beliefs influenced self-care, evident in the use of herbal remedies like neem juice, jamun seeds, and bitter gourd. While deeply rooted in tradition, integrating them into evidence-based care remains challenging. Gopichandran et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) also found traditional remedies commonly used alongside allopathy in urban southern India, underscoring the need for community health education to balance tradition with biomedical care. The study findings underscore the role of stress management, social support, and mental well-being in diabetes care. Participants reported fear of complications, social isolation, and gender-based differences in stress management. The ACLM\u0026rsquo;s six pillars of lifestyle medicine (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) emphasize stress reduction, sleep quality, and social support as key determinants of metabolic health​. Similarly, the WHO's self-care guidelines (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) advocate for integrating mental health and psychosocial support into self-care interventions​.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe current study highlighted dietary modifications, particularly reduced sugar intake, and physical activities like walking as the most salient self-care practices prioritized by rural individuals managing diabetes. Participants categorized self-care into three distinct but interconnected domains—lifestyle modifications, diet, and medical adherence—emphasizing the necessity of an integrated approach to diabetes management. Also, thematic analysis revealed the critical role of patient education, personalized goal-setting, intrinsic motivation, stress management, and positive social connections in influencing self-care adherence. However, significant barriers such as financial constraints, limited healthcare accessibility, persistent dietary cravings, and cultural beliefs posed ongoing challenges. These barriers make it difficult for people to maintain consistent self-care practices, increasing their risk of complications.\u003c/p\u003e\n\u003cp\u003eThus, as per the current study, there is the urgent need for a structured diabetes self-care package that is suited to the realities of rural India. In order to overcome the challenges, a comprehensive self-care package must be simple, affordable, and culturally relevant. A community-driven, evidence-based self-care package will help individuals develop sustainable diabetes management strategies while addressing local needs. Future interventions should focus on integrating self-care into existing healthcare structures, making diabetes management more accessible and practical for people in rural areas. By strengthening self-care practices, individuals can improve their health, prevent complications, and enhance their overall quality of life.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study provides important insights into diabetes self-care in rural India, but it has some limitations. Since it was conducted in specific rural communities, the findings may not apply to all regions. As a qualitative study, it did not measure the direct impact of self-care practices on blood sugar control. Cultural and economic differences influence self-care behaviors, making them vary across populations.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the research was obtained from the Institutional Ethics Committee (IEC) for Research on Human Subjects at MGIMS prior to initiation of the study, in accordance with IEC approval letter no. 2484, dated 10\u003csup\u003eth\u003c/sup\u003e July, 2023. Verbal informed consent was taken by each participant for their participation and audio recording.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study (Proposal ID- MDMS23Dec-0181) and (File No: HRD-Head/PG thesis-program/2023-2024(30) dated 27th July 2024) was being by funded the Indian Council of Medical Research (ICMR).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe declare no competing interests. The authors have no financial, personal, or professional affiliations that could be perceived as influencing the work reported in this study. This ensures the integrity, objectivity, and transparency of the research presented.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable\u0026nbsp;request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to the Department of Community Medicine, MGIMS, Sevagram, India, for providing the necessary resources and field support. Special thanks to Bharambhe Sir, Mr. Praveen Bhusari, Nalini Sister, Mr. Jayprakash More, Sarika Sister, Bhavana Sister, and Alka Tai for their dedicated support in identifying participants and accompanying the team during data collection. We extend our heartfelt appreciation to ASHA workers, ANMs, and local healthcare providers for their invaluable assistance in facilitating data collection and engaging with the community. We also thankful to all the study participants for their valuable time and willingness to share their experiences, which contributed significantly to the findings.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGalicia-Garcia U, Benito-Vicente A, Jebari S, Larrea-Sebal A, Siddiqi H, Uribe KB, et al. Pathophysiology of type 2 diabetes mellitus. Vol. 21, International Journal of Molecular Sciences. MDPI AG; 2020. p. 1\u0026ndash;34. \u003c/li\u003e\n\u003cli\u003eDeFronzo RA, Ferrannini E, Groop L, Henry RR, Herman WH, Holst JJ, et al. Type 2 diabetes mellitus. Nat Rev Dis Primers. 2015 Jul 23;1. \u003c/li\u003e\n\u003cli\u003eMARIO COUTINHO HCGYWSY. The Relationship Between Glucose and incident cardiovascular events. 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India has over 100 mn diabetics \u0026amp; 136 mn pre-diabetics, says new ICMR study; Goa tops the list, UP records lowest prevalence. The Economic Times Panache [Internet]. 2025 Feb [cited 2025 Feb 22]; Available from: https://economictimes.indiatimes.com/magazines/panache/india-has-over-100-mn-diabetics-136-mn-pre-diabetics-says-new-icmr-study-goa-tops-the-list-up-records-lowest-prevalence/articleshow/100866686.cms?from=mdr\u003c/li\u003e\n\u003cli\u003ePowers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, et al. Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Educator. 2017 Feb 1;43(1):40\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eGao J, Wang J, Zheng P, Haard\u0026ouml;rfer R, Kegler MC, Zhu Y, et al. 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Endocrine Society; 2014. p. 648\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003eWorld Health Organization. WHO guideline on self-care interventions for health and well-being, 2022 revision [Internet]. 2022 [cited 2025 Feb 22]. Available from: https://iris.who.int/handle/10665/357828\u003c/li\u003e\n\u003cli\u003eCenters for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. 2024. On Your Way to Preventing Type 2 Diabetes. Available from: https://www.cdc.gov/prediabetes/takethetest/\u003c/li\u003e\n\u003cli\u003eCentres for Disease Control and Prevention. Participant Guide: Introduction to the Program Prevent T2: A Proven Program to Prevent or Delay Type 2 Diabetes [Internet]. U.S. Department of Health and Human Services; [cited 2025 Mar 16]. 1\u0026ndash;200 p. Available from: https://www.cdc.gov/diabetes-prevention/media/pdfs/T2-Participants-Combined.pdf\u003c/li\u003e\n\u003cli\u003eCentre for Disease Control and Prevention. 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Available from: www.aafp.org/afp.\u003c/li\u003e\n\u003cli\u003eKelly J, Karlsen M, Steinke G. Type 2 Diabetes Remission and Lifestyle Medicine: A Position Statement From the American College of Lifestyle Medicine. Vol. 14, American Journal of Lifestyle Medicine. SAGE Publications Inc.; 2020. p. 406\u0026ndash;19. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"50715b9d-f030-4b8b-9db7-7504f2286057","identifier":"10.13039/501100001411","name":"Indian Council of Medical Research","awardNumber":"File No: HRD-Head/PG thesis-program/2023-2024(30)","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Indian Council of Medical Research","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"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":"Co-Design Strategy, Diabetes Self-Care, Context-Specific Intervention, Indigenous Health Practices, Qualitative Research, Lifestyle Modification, Patient-Centered Care, Community-Based Intervention, Participatory Research","lastPublishedDoi":"10.21203/rs.3.rs-6329292/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6329292/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAims: \u003c/strong\u003eDiabetes is a growing challenge in rural India, where limited healthcare and cultural beliefs hinder self-care. A structured, culturally relevant self-care package is crucial to improve management and reduce complications. This study explores self-care practices in rural Maharashtra to develop a community-driven package.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis formative phase is part of a larger study using a stepped wedge cluster randomized feasibility trial with a closed cohort to assess the self-care package’s impact on glycemic control and well-being. Conducted in rural central Maharashtra (Nov 2023–March 2024), it explored diabetes self-care practices through a literature review, free listing, pile sorting, and in-depth interviews. Sample size was guided by data saturation to ensure richness and feasibility. Thematic analysis revealed key themes, with data triangulation ensuring culturally relevant insights.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe most salient practices included reducing sugar intake, regular walking, medication adherence, and dietary modifications. The study identified key components of diabetes self-care lifestyle, disease management, stress and addiction, diet and hydration, physical activity, and social well-being—highlighting community-driven strategies for a culturally relevant diabetes care framework.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eA structured, community-driven diabetes self-care package is essential for effective management in rural settings. Integrating cultural practices with evidence-based care enhances adherence and glycemic control.\u003c/p\u003e","manuscriptTitle":"What does self-care mean to us? Self-care Package for Type-2 diabetes mellitus patients in rural area: findings from a Formative Research Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-01 12:16:03","doi":"10.21203/rs.3.rs-6329292/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":"5dfd28b9-935b-4755-bba1-772eb51de747","owner":[],"postedDate":"April 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":46371068,"name":"Preventive Medicine"}],"tags":[],"updatedAt":"2025-04-01T12:16:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-01 12:16:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6329292","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6329292","identity":"rs-6329292","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}