“Everyone's situation with diabetes is different, so are individual needs and circumstances”: Lived Experiences and Management Routines of Type 2 Diabetes Mellitus in Southern Nigeria

“Everyone's situation with diabetes is different, so are individual needs and circumstances”: Lived Experiences and Management Routines of Type 2 Diabetes Mellitus in Southern Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article “Everyone's situation with diabetes is different, so are individual needs and circumstances”: Lived Experiences and Management Routines of Type 2 Diabetes Mellitus in Southern Nigeria Kenneth Ndidi Onyejose, Antor Odu Ndep, Precious Chidozie Azubuike, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8253163/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 Background Diabetes mellitus is a major public health concern that contributes to the global burden of disease. In Nigeria, nearly 4 million adults are living with diabetes, which has a significant risk of co-morbidities and mortality. There are several studies exploring causality and management, yet there is a paucity of information on the lived experiences of people diagnosed with diabetes, particularly in the southern part of the country, where cultural, socioeconomic, and healthcare dynamics may uniquely shape disease management practices. The objective of this study was to explore the lived experiences and management practices of T2DM patients at the University of Calabar Teaching Hospital, Nigeria. Methods This grounded theory qualitative study explored the lived experiences of people living with T2DM and their approaches to disease management. Four participants receiving treatment at the University of Calabar Teaching Hospital (UCTH), Cross River State, Nigeria, were purposively selected for key informant interviews, while fifteen participants were recruited for the focus group discussions. The data collected were transcribed and inductively analyzed manually. Results Six themes emerged from the data: Type 2 diabetes awareness, dietary control, risk perceptions, cultural influences, support systems, and coping strategies. Participants recognized the importance of reliable information sources about type 2 diabetes, including healthcare professionals, reputable websites, and scientific literature. Overall, addressing misconceptions emerged as a crucial aspect of diabetes education and advocacy efforts within the community. Conclusion Based on the study’s findings, a multifaceted approach to T2DM management, such as the integration of healthcare, cultural, structural, and behavioral methods, is pertinent. Incorporation of behavioral support strategies (goal setting and meal-prepping education) into routine T2DM care arises as a necessity, which would enhance dietary compliance and self-efficacy. Diabetes Mellitus T2DM Lived experience Management Cultural influences Misconception Figures Figure 1 Introduction Diabetes mellitus is a significant non-communicable condition that contributes substantially to the global burden of disease [ 1 ]. It is associated with a wide range of complications, severe microvascular and macrovascular disorders, which contribute to escalating healthcare costs, declining quality of life, and increased morbidity and mortality [ 2 , 3 ]. According to the International Diabetes Federation (IDF), an estimated 463 million adults [ 4 ], approximately 9.3% of the global population, were living with diabetes in 2019, and this number is expected to rise to around 800 million (10.9%) by 2045 [ 5 , 6 ]. Notably, 79% of individuals with diabetes reside in low- and middle-income countries (LMICs) [ 5 , 7 ]. In sub-Saharan Africa, diabetes prevalence is projected to increase significantly, with cases expected to grow by 149% over the next two decades from 19 million in 2019 to 47 million by 2045 [ 8 ]. In 2019, an estimated 3.9 million adults in Nigeria were living with diabetes, and this figure is expected to nearly double to approximately six million by 2045 [ 8 ]. Among the geopolitical zones in Nigeria, the South–South region recorded the highest pooled prevalence of type 2 diabetes mellitus (T2DM) at 8.5% [ 9 ]. This was followed by the North–East region (4.6%) and the South–East region (3.7%) [ 9 ]. These regional disparities highlight significant geographic variation in the T2DM burden across the country. According to previous research, contributing factors include poor dietary practices, sedentary lifestyles, healthcare access issues, urbanization, physical inactivity, and advancing age, with the latter two being particularly influential [ 10 – 12 ]. The gradual improvement in socioeconomic conditions in Nigeria over recent years has contributed to increased life expectancy and a progressively aging population [ 13 ]. Advancing age is associated with reduced insulin sensitivity, a key pathophysiological factor in the development of T2DM [ 14 ]. Furthermore, the rapid expansion of fast-food establishments across urban centers in Nigeria has led to greater consumption of energy-dense, high-fat meals [ 15 ]. This nutritional transition has significantly contributed to the rising burden of non-communicable diseases, including obesity, cardiovascular disorders, and T2DM, due to the sustained intake of diets rich in saturated fats, refined carbohydrates, and sodium [ 15 ]. To adequately manage T2DM, a holistic and cross-cutting approach is required. Beyond pharmacological interventions, lifestyle adaptations, sociocultural contexts, and psychosocial support must be considered [ 16 , 17 ]. Research has shown that adherence to specialized dietary routines, regular physical activity, and structured monitoring of blood glucose levels are essential components of T2DM care [ 18 ]. However, psychological factors such as anxiety, stress, and depression often negatively influence these self-care practices [ 19 – 21 ]. Moreover, societal belief systems regarding dietary practices, disease pathology, and treatment methods significantly influence patients’ decision-making and approaches to managing diabetes [ 22 , 23 ]. For instance, medical nutrition therapy recommendations often conflict with cultural food preferences, which can undermine adherence [ 24 ]. Similarly, social support systems play a crucial role in shaping patients’ attitudes toward disease management [ 25 , 26 ]. Friends, family, and community can either enable or hinder effective diabetes control. Studies have shown that patients with positive social support are more likely to adhere to medical recommendations and achieve better metabolic outcomes [ 27 ]. Despite the growing burden of diabetes, there is a scarcity of studies evaluating how patients in Nigeria manage and experience T2DM [ 28 , 29 ], particularly in Southern Nigeria. Furthermore, most existing studies fail to explore the sociocultural and personal aspects of T2DM management. This study, therefore, adds to this body of knowledge by exploring the lived experiences and management practices of T2DM patients at the University of Calabar Teaching Hospital, Nigeria. This approach enables a more comprehensive exploration, one that not only captures the realities on the ground but also incorporates patients’ personalized experiences and perspectives. Methods Study design This study was part of a larger mixed-methods study, comprising a descriptive cross-sectional design and a quasi-experimental design intervention, that sought to determine the effects of educational strategies on Type 2 diabetes management. As part of the formative phase of the larger study, this study employed a grounded theory qualitative approach to explore the lived experiences of people living with T2DM and their approaches to disease management. Our study leveraged the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist for the appropriate description and reporting of the study findings [ 30 ]. Study setting This study took place at the University of Calabar Teaching Hospital (UCTH), located in Calabar, Cross River State, Nigeria. UCTH is a Tertiary Health Institution, established in 1979, and is situated in the south-east of Calabar. The UCTH is bounded west by the University of Calabar Hotel, on the east by the Qua River (Esuk Atu), and on the north by Calabar International Airport. The University of Calabar Teaching Hospital has about 600 beds and a staff strength of over five hundred and fifty (550) workers. The hospital provides clinical services in all specialized medical areas such as Surgery, Internal Medicine, Pediatrics, Otorhinolaryngology, Anesthesiology, Obstetrics and Gynecology, Chemical Pathology, Family Medicine, Orthopedics/Traumatology, Dental and Maxillofacial Surgery, Ophthalmology, Hematology, Accident and Emergency, Psychiatry, Medical Social Work, and Medical Health Records. The Diabetes Clinic at the University of Calabar Teaching Hospital (UCTH) operates weekly, managing between 40 and 60 patients per week, which translates to approximately 240 patients monthly [ 31 , 32 ]. The clinic serves a diverse patient population, with most individuals aged between 41 and 50 years, and a majority being female (60%). Clinical care is provided through a multidisciplinary team including physicians, nurses, and support staff, as part of the hospital’s internal medicine department [ 31 , 32 ]. Study population This study employed adults aged 18 years and above who are receiving care for T2DM at the University of Calabar Teaching Hospital, Calabar. The population was drawn from all eligible patients irrespective of educational, religious, and ethnic affiliations. The accessible population was restricted to individuals who had recently been diagnosed with diabetes, regardless of the duration since diagnosis, provided they had not yet developed diabetes-related complications. Sampling procedure A purposive sampling technique was employed to select the study participants for the Key informant Interviews (KIIs) and Focus Group Discussion (FGDs). For the KIIs, four key informants were recruited in the selected health facility, comprising a Medical Doctor in charge of the outpatient department (OPD) for Type 2 diabetic patients (or their representatives), a Nurse, and two Pharmacists involved in dispensing drugs and attending to patients. In addition, a total of fifteen (15) adult Type 2 diabetic patients were recruited for the FGDs. Two discussion groups were formed, with one group comprising seven participants and the other comprising eight participants. These discussion groups were used for data triangulation with information collected through the KIIs. Instruments for data collection Two semi-structured guides were developed for the FGDs and KIIs. These guides were developed and designed to elicit in-depth information relevant to the study objectives. For the KIIs guide, the tool was divided into three sections: Section "A": the introduction of the study, which provides information about the research and the ethical considerations. Section "B": contained five to seven questions on key areas of interest, usually open-ended or closed-ended questions, designed to stimulate more revealing information about the issue of concern. Section "C" contained the closing remarks, request for recommendations for the study, and appreciation of interviewees. Additionally, the FGDs guide was structured into four sections: Section "A" focused on the introduction of the study and team, Section “B" encompasses the ground rules that guided the group and transformed individuals into an interactive group using icebreakers. Furthermore, Section "C" contained five to ten open-ended questions on the key topic of the study, while Section "D" contained closing remarks and appreciation of participants. Pre-testing of the instruments Upon the development and expert review of the study guides, a pre-testing exercise was conducted to ensure that the guides were appropriate, complied with, and covered the aims and objectives of the study. The KIIs guide was pre-tested among healthcare workers in the OPD department of the University of Uyo teaching hospital, while the FGDs guide was pre-tested among six patients and three healthcare workers in the University of Uyo teaching hospital, Akwa Ibom State. Findings and feedback from the pre-test exercise were incorporated to restructure and improve the quality of the guides before data collection. Data collection procedure Trained research assistants were recruited by the principal researcher to support the process of data collection. The research assistants received training on the KIIs and FGDs guides to ensure smooth and consistent data collection. The KIIs and FGDs were conducted in Efik and Pidgin languages and facilitated by the principal researcher, while research assistants were assigned the role of note-taker and observer, respectively. Two sessions of FGDs and all the KIIs were conducted in the two health facilities. Adequate and appropriate information about the research and research team, voluntary participation, confidentiality, and anonymity were provided to the participants, and informed consent was sought before the interview and discussion. A set of open-ended questions on the topic of study was asked, followed by probing questions to prompt further information and explore the participants' experiences related to the topic of discussion. The KIIs and FGDs were conducted in a serene environment selected in collaboration with the participants to avoid distraction. The interviews and discussions were recorded using a tape recorder, complemented by detailed note-taking. Data analysis and reporting The data from the KIIs and FGDs sessions were transcribed verbatim, translated, and back-translated into English by the principal researcher. The data were coded independently by the principal researcher with the support of other research assistants and analyzed inductively to derive themes associated with the study objectives in the University of Calabar Teaching Hospital (UCTH), Calabar. The data were analyzed thematically, leveraging Braun & Clarke, (2019), approach that involved familiarization with the data, searching for themes, reviewing and sorting themes, defining and naming themes, and producing report. Six themes emerged from data related to patients' knowledge and understanding of T2DM, as well as their experiences with disease management. Reflexivity, trustworthiness The Principal Investigator (KNO), a public health researcher with prior knowledge of diabetes prevention and management, acknowledges that this background may have influenced interactions with participants during the focus group discussions. To minimize bias, open-ended, participant-driven questions were employed, and a neutral, non-judgmental stance was maintained to encourage participants to share their personal experiences, perceptions, and beliefs freely. Furthermore, reflexive journaling and peer debriefing were integrated by PCA, AO, and ANO throughout data collection and analysis to enhance trustworthiness and ensure that the themes generated reflected participants’ voices rather than preconceived notions of the researchers. Results The thematic analysis of the study yielded six broad themes and twenty-two sub-themes related to patients' knowledge and understanding of T2DM, as well as their experiences with disease management. These themes and sub-themes were derived directly from the transcript, reflecting the discussants' experiences, perspectives, and discussions regarding Type 2 diabetes awareness, dietary control, risk perception, cultural influences, support systems, and coping strategies. Theme 1: Understanding of Type 2 Diabetes Participants exhibited a comprehensive understanding of type 2 diabetes. They identified its metabolic nature and the presence of elevated blood sugar levels as central characteristics. A clear distinction was made between type 2 and type 1 diabetes, with emphasis placed on the role of lifestyle factors such as diet and physical activity, in addition to genetic predispositions. Participants also indicated an awareness of the need to consult reliable sources for accurate information on type 2 diabetes. These sources included healthcare professionals, reputable health websites, and scientific literature. Definition and Characteristics Discussants demonstrated a nuanced understanding of type 2 diabetes, emphasizing its metabolic nature, insulin resistance, and the resultant elevated blood sugar levels as central features. "Type 2 diabetes is a condition where the body becomes resistant to insulin or doesn't produce enough insulin to regulate blood sugar levels effectively, leading to high blood sugar levels over time." - (Discussant 2) "It's basically a problem with how the body processes sugar. It's a metabolic disorder characterized by insulin resistance, meaning the body's cells don't respond effectively to insulin." - (Discussant 1) Differentiating Type 2 from Type 1 : Discussants focused on distinguishing between type 2 and type 1 diabetes, highlighting the role of lifestyle factors, such as diet and exercise, alongside genetic predispositions, in the development of type 2 diabetes. "It's important to note that type 2 diabetes differs from type 1 in that it's often linked to lifestyle factors like diet and exercise." - (Discussant 3) "Type 2 diabetes differs from type 1 in that it's often linked to lifestyle factors like diet and exercise. It occurs when the body's cells become resistant to insulin, causing glucose to build up in the bloodstream instead of being absorbed by cells for energy." - (Discussant 3) Awareness of Lifestyle Factors Discussants acknowledged the multifactorial nature of type 2 diabetes, recognizing the significant impact of lifestyle choices, including diet, exercise, stress, and genetic factors, on disease development and progression. "I mostly rely on information provided by healthcare professionals, but I also hear a lot from friends and family who have experience with diabetes, their endocrinologists, and diabetes specialists who provide expert insights and the latest developments in managing type 2 diabetes." - (Discussant 1) "As a nutrition student, I often refer to scientific journals and textbooks for accurate information about diabetes and diet. I also look into health organizations such as the American Diabetes Association and the World Health Organization for updated guidelines and information." - (Discussant 7) "Community events like health fairs or workshops, collaborating with local health organizations to host workshops and events focused on diabetes awareness, management, and support, could provide opportunities for people to learn about diabetes and ask questions." - (Discussant 5) Sources of Information Various sources, including healthcare professionals, reputable websites, scientific journals, and personal experiences, were cited as valuable sources of information about type 2 diabetes, reflecting a reliance on both expert knowledge and peer-based insights for understanding the condition. "I usually consult my doctor or search online for reputable websites like the American Diabetes Association. Medical journals and peer-reviewed research articles on diabetes management and treatment." - (Discussant 4) "I mostly rely on information provided by healthcare professionals, but I also hear a lot from friends and family who have experience with diabetes, their endocrinologists, and diabetes specialists who provide expert insights and the latest developments in managing type 2 diabetes." - (Discussant 6) Theme 2: Common Misconceptions about Type 2 Diabetes Discussions addressed prevalent misconceptions surrounding type 2 diabetes, including beliefs about weight, diet, the severity of the condition, and its curability. Participants debunked oversimplified views, emphasizing the multifactorial nature of type 2 diabetes and its potential to lead to severe complications if not properly managed. Moreover, they highlighted the importance of dispelling myths and promoting accurate information to improve community understanding and awareness of type 2 diabetes. Overall, addressing misconceptions emerged as a crucial aspect of diabetes education and advocacy efforts within the community. Weight-related Misconceptions Participants addressed misconceptions surrounding weight and type 2 diabetes, challenging the notion that only overweight individuals are at risk and highlighting the importance of genetic predispositions and other lifestyle factors. "I've come across the idea that only overweight people get type 2 diabetes. It's not true; thin people can develop it too." - (Discussant 2) "I've heard people say that diabetes isn't a serious condition, but that's definitely a misconception. It can lead to severe complications if not managed properly." - (Discussant 4) Simplistic Views on Diet Discussions centered on debunking oversimplified views of diabetes management through di et al one, emphasizing the complexities of disease management and the need for comprehensive lifestyle changes beyond sugar intake reduction. "Some people believe that type 2 diabetes can be cured by simply losing weight or following a specific diet. While lifestyle changes can help manage the condition, there is currently no known cure, and long-term management is essential." - (Discussant 3) "…That's true. Another misconception is that diabetes is only about sugar intake. People often overlook the importance of overall healthy eating and exercise habits." - (Discussant 3) Severity of the Condition Discussants corrected misconceptions regarding the seriousness of type 2 diabetes, highlighting its potential to lead to severe complications, including heart disease, stroke, kidney failure, and blindness, if not managed properly. "I've heard people say that diabetes isn't a serious condition, but that's definitely a misconception. It can lead to severe complications if not managed properly. In reality, it can lead to severe complications such as heart disease, stroke, kidney failure, and blindness if not properly managed." - (Discussant 4) "One common misconception I've come across is that only overweight or obese individuals develop type 2 diabetes, but genetics, lifestyle factors, and other health conditions also play significant roles." - (Discussant 2) Beliefs about Cure Misconceptions surrounding the curability of type 2 diabetes emphasized the chronic nature of the condition and the importance of long-term management strategies over quick-fix solutions. "Some people believe that type 2 diabetes can be cured by simply losing weight or following a specific diet. While lifestyle changes can help manage the condition, there is currently no known cure, and long-term management is essential." - (Discussant 3) "I've heard people say that diabetes isn't a serious condition, but that's definitely a misconception. It can lead to severe complications if not managed properly." - (Discussant 4) Theme 3: Awareness and Improvement Strategies Discussants proposed various strategies to enhance awareness and knowledge about type 2 diabetes within the community, including educational campaigns, accessible information dissemination, community engagement events, and collaborative efforts among stakeholders. Discussions emphasized the importance of targeted interventions tailored to diverse community needs and preferences, as well as the involvement of healthcare professionals, community leaders, and individuals living with diabetes. Moreover, they emphasized the significance of proactive initiatives in combating misconceptions, promoting healthy lifestyle choices, and fostering a supportive environment for diabetes management. Overall, improving awareness emerged as a collective endeavor aimed at empowering individuals, reducing stigma, and enhancing overall community health outcomes. Accessible Information Discussants emphasized the importance of making diabetes-related information accessible in multiple languages and formats, including free or low-cost screening programs and providing resources tailored to diverse community needs. "Providing personalized risk assessments could also be beneficial. Everyone's situation is different, so tailoring the information to each individual's needs and circumstances could make it more relevant and impactful." - (Discussant 2) "It's also important to make information accessible in multiple languages and formats to reach diverse communities." - (Discussant 4) "In addition to traditional educational materials, I also recommend reputable online resources and smartphone applications that provide valuable information and support for managing diabetes." (KII, Nurse) Community Engagement and Educational Campaigns Suggestions for improving awareness included targeted educational campaigns in schools and workplaces to promote healthy lifestyle choices and raise awareness about type 2 diabetes risk factors and prevention strategies. "I think education campaigns targeting schools and workplaces could help raise awareness about the importance of a healthy lifestyle in preventing type 2 diabetes." - (Discussant 3) Furthermore, strategies such as organizing community events, health fairs, and workshops in collaboration with local health organizations were proposed by discussants to foster community engagement, provide opportunities for education, and promote diabetes awareness and support. "Community events like health fairs or workshops, collaborating with local health organizations to host workshops and events focused on diabetes awareness, management, and support, could provide opportunities for people to learn about diabetes and ask questions." - (Discussant 5) "Peer support groups could be beneficial. Connecting with others who are going through support individuals with diabetes in our community." - (Discussant 6) "Involvement of support groups or peer networks for sharing experiences and coping strategies would aid in reducing the risk of complications." - (Discussant 3) Collaborative Efforts Discussants highlighted the need for collaborative efforts among stakeholders, including healthcare professionals, community leaders, and individuals living with diabetes, to combat misconceptions, promote accurate information, and improve diabetes education and awareness in the community. "Collaborating with local health organizations to host workshops and events focused on diabetes awareness, management, and support could provide opportunities for people to learn about diabetes and ask questions." - (Discussant 5) "Regular health screenings and check-ups to monitor early signs of complications." - (Discussant 2) "Educational workshops on exercise routines tailored to individuals with diabetes would also help ." - (Discussant 4) Theme 4: Dietary Control Measures Discussions revolved around dietary strategies for managing type 2 diabetes, emphasizing the role of balanced meals, portion control, and lifestyle modifications in regulating blood sugar levels. Discussants shared personal experiences and challenges related to dietary adherence, including dealing with cravings, finding healthy options, and navigating social situations. Moreover, effective strategies for sticking to a diabetic-friendly meal plan, such as meal preparation and seeking support from peers and healthcare professionals, were highlighted. Overall, the theme underscores the importance of practical, sustainable dietary approaches tailored to individual needs in promoting successful diabetes management and improving health outcomes. Understanding of Dietary Role Discussants discussed their understanding of the role of diet in managing type 2 diabetes, emphasizing the importance of balanced meals, portion control, and carbohydrate monitoring in regulating blood sugar levels. "My understanding is comprehensive, encompassing the importance of balanced meals, portion control, and carbohydrate monitoring in managing blood sugar levels for type 2 diabetes." - (Discussant 1) "My understanding is moderate. I've gathered some information over the years, but I'm still learning about how different foods affect blood sugar levels." - (Discussant 2) "I'm well-versed in the role of diet in type 2 diabetes management, including strategies like glycemic index awareness, meal timing, and the impact of dietary fats and proteins on insulin sensitivity." - (Discussant 3) Dietary Habit Changes Strategies for dietary habit changes included incorporating more leafy greens, limiting sugary beverages, and practicing portion control, reflecting a focus on whole, nutrient-dense foods and lifestyle modifications to support diabetes management. "I've made a conscious effort to incorporate more leafy greens and lean proteins into my meals while reducing my intake of refined carbohydrates." - (Discussant 1) "I've heard of the benefits of consuming foods with a low glycemic index, so I've been focusing on including more of those in my diet." - (Discussant 2) "Portion control has been crucial for me. I've learned to listen to my body and stop eating when I'm satisfied rather than stuffed." - (Discussant 3) Strategies for Adherence Effective strategies for sticking to a diabetic-friendly meal plan included meal prepping, setting achievable goals, and seeking support from friends and family, underscoring the value of practical, sustainable approaches to dietary adherence in diabetes management. "Planning and prepping my meals in advance has been a game-changer. It helps me stay organized and ensures that I always have healthy options available." - (Discussant 1) "I've found that setting small, achievable goals for myself has been helpful. It's less overwhelming than trying to make drastic changes all at once." - (Discussant 2) "Mindful eating has been key for me. Taking the time to savor each bite and listen to my body's hunger cues helps prevent overeating." - (Discussant 5) Theme 5: Cultural and Social Influences on Diet Discussions explored the cultural and social factors influencing dietary choices among individuals with type 2 diabetes, highlighting challenges related to traditional food practices, social gatherings, and access to healthy options. The theme emphasized the need for culturally sensitive interventions, peer support networks, and community resources to address barriers and promote diabetes-friendly dietary behaviors. Cultural Food Practices Discussants discussed cultural influences on dietary choices, highlighting challenges in adapting traditional dishes to meet diabetic dietary needs while preserving cultural identity and culinary heritage. "In my culture, food is deeply tied to social gatherings and celebrations. It can be difficult to resist indulging in traditional dishes, even if they're not the healthiest options." - (Discussant 1) "There's often a stigma around healthy eating in some communities. People might feel judged for making healthier choices or viewed as betraying their cultural heritage." - (Discussant 2) "Traditional foods in my community are often high in carbohydrates and sugars. It's challenging to find suitable alternatives without feeling like I'm giving up a part of my identity." - (Discussant 3) Social Stigma and Pressure Discussions addressed social stigma and pressure surrounding healthy eating, particularly in cultural contexts where certain foods are deeply rooted in social gatherings, traditions, and family dynamics, emphasizing the need for cultural sensitivity and support. "Social gatherings often revolve around food, making it harder to stick to dietary restrictions." - (Discussant 2) "Family dynamics and traditions may influence meal choices and portion sizes." - (Discussant 5) "There's often a stigma around healthy eating in some communities." - (Discussant 2) "People might feel judged for making healthier choices or viewed as betraying their cultural heritage." - (Discussant 2) "There's pressure to participate in these traditions, even if it means compromising on my health." - (Discussant 5) Accessibility of Healthy Foods Discussants identified access to healthy food options and affordability as challenges, particularly in underserved communities, emphasizing the importance of addressing structural barriers to healthy eating and promoting food equity. "Access to healthy food options can vary widely depending on where you live." - (Discussant 4) "Many people with diabetes struggle to afford nutritious foods, so finding ways to make healthy eating more accessible and affordable would be incredibly helpful." - (Discussant 3) "Lack of transportation can be a significant barrier to managing diabetes effectively." - (Discussant 4) Theme 6: Risk Perception of Developing Complications Discussants reiterated their concerns about the long-term complications associated with type 2 diabetes, highlighting varying levels of awareness and proactive management strategies. The theme underscored the importance of understanding the factors contributing to complications and the need for effective communication between healthcare providers and individuals with diabetes to mitigate risks. Complication Concerns Discussants expressed concerns about the long-term complications associated with type 2 diabetes, reflecting individual differences in risk perception and awareness of the potential consequences of poorly managed diabetes. "For me, I am quite concerned, as long-term complications can significantly impact quality of life ." - (Discussant 2) "See, it really bothers me, considering the potential impact on overall health and well-being." - (Discussant 4) "Recognizing the importance of lifelong vigilance and healthy habits, I am now very concerned as we all want to live long and well." - (Discussant 5) Food and lifestyle Discussants identified factors contributing to complications, including poor blood sugar control, lifestyle choices, genetics, access to healthcare, and mental health, highlighting the multifaceted nature of diabetes management and the importance of addressing modifiable risk factors. Poor blood sugar control is a major factor. If your blood sugar levels are consistently high, it can damage blood vessels and nerves over time." - (Discussant 7) "Lifestyle factors like diet and exercise play a significant role as well. If you're not eating well or staying active, it can exacerbate the risk of complications." - (Discussant 6) "I think genetics also plays a part. Some people may be more predisposed to developing certain complications than others, regardless of how well they manage their diabetes." - (Discussant 3) Personal Experiences with Complications Personal experiences or observations of complications among family and friends influenced discussants' perceptions of the condition and the importance of proactive management, emphasizing the role of lived experiences in shaping risk perception and health behaviors. "My grandmother had diabetes-related complications, including vision loss and kidney problems. Seeing what she went through definitely heightened my awareness of the seriousness of the condition." - (Discussant 4) "I've had some nerve damage in my feet, which was a scary experience. It made me realize that even seemingly minor complications can have a big impact on daily life." - (Discussant 7) "I haven't experienced complications personally, but I've seen how they've affected others in my community. It's reinforced the importance of taking proactive steps to manage my diabetes and reduce my risk." - (Discussant 5) Discussion The study respondents showed a high level of understanding of the concept of T2DM, indicating that it is a metabolic disorder marked by chronic hyperglycemia, resistance to insulin, and inadequate insulin synthesis. Remarkably, several of the participants differentiated T2DM from type 1 diabetes using the indices of risk factors and disease causation. They also highlighted that even though T2DM is mainly due to lifestyle, genetic predispositions play a role. Such a level of health awareness reflects literacy that is sufficient for adequate self-management [ 34 , 35 ]. Results from the study also showed that means of information retrieval were numerous, cutting across formal healthcare consultations and individual research in reputable medical journals such as the American Diabetes Association. The referencing of glycemic index concepts and the physiological impacts of insulin resistance by some of the participants with a background in health sciences underscored a deeper biomedical understanding [ 36 , 37 ]. These participants emphasized credible sources of information, and this demonstrates the increasing role of patient agency in the digital era. This is highlighted in review research by Bailey et al., who discovered that patients with higher levels of health knowledge generally exhibit better compliance with medical therapy [ 38 ]. Nonetheless, the study respondents also indicated the challenge of misinformation, which usually comes from non-expert personnel within their families and communities [ 39 , 40 ]. This, therefore, necessitates a synergistic health communication strategy comprising both professional guidance and community-based education, given the reliance of individuals on the two channels. Participants in the study pointed out and criticized prevalent misconceptions existing in their communities despite the widespread knowledge of the disease. Some of these include the beliefs that T2DM affects only overweight individuals, that it can be tackled by dietary adjustments and weight loss alone, and that it results only from high consumption of sugar [ 41 , 42 ]. Even though globally these misconceptions have been marked as significant hindrances to T2DM prevention and control, they remain pervasive across many communities [ 43 ]. The chronic and progressive nature of T2DM was also highlighted by the participants, who indicated that while lifestyle readjustments might reduce the need for medication, total cure of the disease is not feasible. Similar to previous studies, our participants emphasized that the influence of genetics and metabolic predisposition in the causation of diabetes has been undermined, citing cases of lean individuals suffering from the condition [ 44 , 45 ]. Importantly, participants in our study strongly questioned the notion that T2DM is a "mild" or "non-serious" disease. These findings align with previous studies in a review and cross-sectional study in Kenya, which reported that many participants described their experiences with T2DM both on a personal level and a family level citing complications such as neuropathy, retinopathy, and renal impairment as cumulative consequences of poor management [ 46 , 47 ]. These findings suggest that community enlightenment on public health must take the next step, advancing from basic awareness to addressing nuanced, culturally based misconceptions that affect health behavior. Participants in our study proposed various strategies to enhance awareness and engagement regarding T2DM within the community. A significant proposed strategy was the execution of specialized educational campaigns in schools, religious institutions, and workplaces. Mass campaigns are efficient tools in community sensitization [ 48 ], and this approach would drive awareness of the importance of preventive behaviors and early diagnosis in the management of T2DM within the study area. Another recommended strategy was increasing the accessibility of health information. The study participants advocated for educating the public in local languages and via simple communication methods to facilitate seamless assimilation by the masses. Poor levels of health awareness in some communities are a direct consequence of difficulties in communication [ 49 ]. To further improve accessibility to health information, the participants advocated for the dissemination of materials in various formats (print, visual aids, and radio). Additionally, strong support for frequent health screening programs was shown among the participants, as this helps in early disease detection and risk identification. Community engagement activities were also another emergent sub-theme from the study. These include workshops, health fairs, and support group meetings, which facilitate open dialogue and peer education. To ensure the sustainability and cultural relevance of these programs, synergistic efforts by NGOs, healthcare workers, and individuals with lived experiences of T2DM ought to be carried out regularly [ 50 ]. Diet emerged as a cornerstone of T2DM self-management. Discussions revolved around dietary strategies for managing type 2 diabetes, emphasizing the role of balanced meals, portion control, and lifestyle modifications in regulating blood sugar levels. Participants' experiences and challenges related to dietary adherence, including dealing with cravings, finding healthy options, and navigating social situations. Moreover, effective strategies for sticking to a diabetic-friendly meal plan, such as meal preparation and seeking support from peers and healthcare professionals, were highlighted. These findings, similar to those in Ethiopia, Iraq, and Iran, suggest a strong relationship between general health literacy and T2DM dietary management literacy levels [ 51 – 54 ]. More importantly, higher knowledge of T2DM management guarantees better health indices for diabetic patients. A study carried out among adults in Bangladesh showed that patients with higher knowledge of health nutrition had greater tendencies toward overall well-being than those with lower knowledge levels [ 55 ]. Behavioral adaptations to aid compliance with dietary routines were highlighted by the study participants as a means of curbing impulsive eating. Some strategies mentioned include portion estimation, meal planning, and the use of visual aids (such as the plate method). Generally, T2DM behavioral adaptations are crafted to drive empowerment and self-efficacy in patients while addressing social determinants of health and personal needs [ 56 ]. Out of the different approaches to behavioral adaptations in T2DM management (such as motivational interviewing [ 57 ], provision of concurrent education [ 58 ], and dietary strategies [ 59 ]), dietary strategies appeared to take a direct approach toward facilitating self-efficacy and consistency in T2DM management. This explains why most of the participants in our study indicated that meal prepping is a vital tool in achieving consistency in feeding routines. A meta-analytic study showed that dietary interventions were very potent in the management of T2DM [ 60 ]. In that study, however, the dietary interventions were mainly driven toward lowering carbohydrate consumption, eliciting ketosis [ 60 ]. Nevertheless, adherence to dietary recommendations posed some challenges as well. Some significant ones highlighted by the study participants include the affordability of healthy alternatives, family meal practices, and inconsistent availability of food. These factors often significantly affect the uptake of dietary recommendations, more notably for low-income patients, who may find it difficult to meet the demanding rigor of structured feeding. These challenges resonate with existing studies in Ghana and the United Arab Emirates that establish the relationship between socioeconomic factors and dietary adherence among diabetes patients [ 61 , 62 ]. To this effect, it is pertinent that nutrition interventions strongly consider cost-effectiveness in setting up meal plans. Dietary habits were also profoundly impacted by cultural identity and social dynamics. There was evidence of social stigma among T2DM patients, as participants indicated that opting for "diabetes-friendly" meals in communal spaces attracted perceptions of cultural rejection and sometimes culminated in social exclusion. As noted in other qualitative studies in Nepal and Israel, similar to ours, some individuals may break their food considerations in a bid to belong and avoid negative perceptions from their community [ 63 , 64 ]. This highlights how culture and society influence the feeding patterns of T2DM individuals. This influence was also shown in studies among a British South-Asian population, where food norms, stigma, and culturally inappropriate healthcare advice were major hindrances to adherence to T2DM dietary recommendations [ 65 ]. A similar pattern was also observed among the Mayan population, where wrong cultural conceptions about the cause of diabetes contributed to T2DM patients upholding cultural feeding practices that were detrimental to their well-being [ 66 ]. These factors pose significant but often overlooked challenges to adherence to dietary recommendations and hence underscore the need for culturally sensitive health promotion. Poor accessibility to healthy foods was another barrier to dietary recommendations, especially for individuals living with a low standard of living [ 10 , 67 ]. Difficulties in transportation, food unavailability in markets, and high costs served as obstacles in acquiring fresh and whole foods [ 68 ]. These structural deficiencies necessitate policy-driven interventions to enhance accessibility to healthy foods. Our findings echoed participants’ concerns regarding awareness and complications arising from T2DM. While some dreaded certain complications such as vision loss, amputations, kidney disease, and cardiovascular failure, others had little concern or uncertainty about these complications. This suggests gaps in provider–patient communication and calls for improvement in this area. Poor or no health enlightenment from healthcare providers to patients has resulted in detrimentally low health knowledge levels, which potentially leads to exacerbation of poor health conditions. Participants from this study called for more precise, individualized enlightenment from healthcare providers, employing tools such as visual aids, risk estimators, and analogies to facilitate better appreciation of abstract knowledge. Additionally, continuous follow-up was emphasized by the participants. Advocating for consistent engagement and support, they opined that one-time enlightenment programs proved ineffective and non-holistic. Opting for a continuous education system rather than a one-off program would allow for more sustainable learning and make room for more individualized care for patients [ 69 ]. Furthermore, this approach would potentially eliminate barriers such as limited-time consultations and the inability to communicate peculiar health challenges. Strengths and Limitations A key strength of this study is evident in its utilization of grounded theory, making room for a systematic exploration of multifaceted issues in T2DM management. The deployment of a qualitative approach in this study allows for an in-depth exploration of different individual perspectives. Additionally, the utilization of focus group discussions facilitated interactive dialogues that considered the collective voices, shared beliefs, and difficulties of participants. However, the results from this study may have reflected only data from the health-literate T2DM population, which would hinder the generalization of the findings to the entire T2DM community within the study area. Furthermore, biases stemming from social desirability could have influenced the responses of participants in group settings. This qualitative assessment of the lived experiences of T2DM individuals showcases an intertwined interaction between health knowledge, cultural context, and self-management principles. Prevalent misconceptions, sociocultural food practices, and systemic barriers continue to affect management outcomes despite a robust understanding of the condition by the participants. Findings from this study underscore the necessity for a multifaceted approach to T2DM management the integration of healthcare, cultural, structural, and behavioral methods. Conclusion This study reflects the need for the tailoring of educational interventions to highlight cultural food practices and social norms. Reputable local figures ought to be involved in the facilitation of community awareness campaigns, as this would increase uptake and compliance. Also, healthcare providers ought to be equipped with effective communication tools to enable the delivery of important healthcare information to the community in a clear and precise manner. Incorporation of behavioral support strategies (goal setting and meal-prepping education) into routine T2DM care arises as a necessity, which would enhance dietary compliance and self-efficacy. Declarations Ethical considerations A letter of introduction was obtained from the Head of Department, Public Health, University of Calabar, Cross River State, and ethical approval was obtained from the UCTH Research Ethics Committee Boards with approval number: NHREC/07/10/2012. We adhered to the principles of ethical research on human participants outlined in the Declaration of Helsinki [70]. Consent to Participate The purpose of conducting the study was explained to the hospital community members. Before commencement of the research interviews, informed consent was obtained from each study participant. During the data collection, the research team explained the essence of the study, the risks involved, and the potential benefits. They were informed that they had the liberty to discontinue with the interview should they feel uneasy. Participants were informed of their right to withdraw at any point without penalty, and all their information was treated with strict confidentiality, and the protection of respondents was maintained throughout the duration of the research, data analysis, and presentation of findings. Authors' contributions KNO conceptualized the study and led the development of the study methods and data collection. KNO and PCA contributed to the study design, methods, and the development of study materials. ASG contributed to data collection, development of guides, data analysis, and writing of results. KNO, PCA, PNT, TA, and CKC supported the development of manuscript and critical reviews. AJO and AON supervised and provided critical oversight of the project proposal, ethical approval application material, reviewed and contributed to result writing, discussion writing, and development of the manuscript. All authors read and approve the final manuscript. Acknowledgements The authors appreciate all our participants for their valuable contributions. Also, we wish to extend our appreciation to the staff of UCTH, Calabar, Cross Rivers, for their support throughout the study. Funding information The research was self-funded by the authors. Competing interests The authors declare no conflicts of interest. Data availability All data relevant to the study are included in the article. 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Diabetes structured self-management education programmes: a narrative review and current innovations. Lancet Diabetes Endocrinol. 2018;6:130–42. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–4. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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11:21:47","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":174680,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8253163/v1/1126bf09766b9a5fe7ff4dfb.html"},{"id":97894711,"identity":"d4ab8cd9-8e18-4e3b-b4d7-48526219b393","added_by":"auto","created_at":"2025-12-10 15:32:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":275764,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThematic map of major themes on the lived experiences and management practices of T2DM patients\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8253163/v1/833661d861cdb9b63ffd2c84.png"},{"id":103904055,"identity":"9249d077-ea9f-46cd-86cb-f999362b1308","added_by":"auto","created_at":"2026-03-04 10:27:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1443942,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8253163/v1/4f5f56be-68af-43a5-bb49-4d6908cb73a1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"“Everyone's situation with diabetes is different, so are individual needs and circumstances”: Lived Experiences and Management Routines of Type 2 Diabetes Mellitus in Southern Nigeria","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDiabetes mellitus is a significant non-communicable condition that contributes substantially to the global burden of disease [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is associated with a wide range of complications, severe microvascular and macrovascular disorders, which contribute to escalating healthcare costs, declining quality of life, and increased morbidity and mortality [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. According to the International Diabetes Federation (IDF), an estimated 463\u0026nbsp;million adults [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], approximately 9.3% of the global population, were living with diabetes in 2019, and this number is expected to rise to around 800\u0026nbsp;million (10.9%) by 2045 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Notably, 79% of individuals with diabetes reside in low- and middle-income countries (LMICs) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In sub-Saharan Africa, diabetes prevalence is projected to increase significantly, with cases expected to grow by 149% over the next two decades from 19\u0026nbsp;million in 2019 to 47\u0026nbsp;million by 2045 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn 2019, an estimated 3.9\u0026nbsp;million adults in Nigeria were living with diabetes, and this figure is expected to nearly double to approximately six million by 2045 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Among the geopolitical zones in Nigeria, the South\u0026ndash;South region recorded the highest pooled prevalence of type 2 diabetes mellitus (T2DM) at 8.5% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This was followed by the North\u0026ndash;East region (4.6%) and the South\u0026ndash;East region (3.7%) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These regional disparities highlight significant geographic variation in the T2DM burden across the country. According to previous research, contributing factors include poor dietary practices, sedentary lifestyles, healthcare access issues, urbanization, physical inactivity, and advancing age, with the latter two being particularly influential [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The gradual improvement in socioeconomic conditions in Nigeria over recent years has contributed to increased life expectancy and a progressively aging population [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Advancing age is associated with reduced insulin sensitivity, a key pathophysiological factor in the development of T2DM [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Furthermore, the rapid expansion of fast-food establishments across urban centers in Nigeria has led to greater consumption of energy-dense, high-fat meals [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This nutritional transition has significantly contributed to the rising burden of non-communicable diseases, including obesity, cardiovascular disorders, and T2DM, due to the sustained intake of diets rich in saturated fats, refined carbohydrates, and sodium [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo adequately manage T2DM, a holistic and cross-cutting approach is required. Beyond pharmacological interventions, lifestyle adaptations, sociocultural contexts, and psychosocial support must be considered [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Research has shown that adherence to specialized dietary routines, regular physical activity, and structured monitoring of blood glucose levels are essential components of T2DM care [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, psychological factors such as anxiety, stress, and depression often negatively influence these self-care practices [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Moreover, societal belief systems regarding dietary practices, disease pathology, and treatment methods significantly influence patients\u0026rsquo; decision-making and approaches to managing diabetes [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. For instance, medical nutrition therapy recommendations often conflict with cultural food preferences, which can undermine adherence [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Similarly, social support systems play a crucial role in shaping patients\u0026rsquo; attitudes toward disease management [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Friends, family, and community can either enable or hinder effective diabetes control. Studies have shown that patients with positive social support are more likely to adhere to medical recommendations and achieve better metabolic outcomes [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite the growing burden of diabetes, there is a scarcity of studies evaluating how patients in Nigeria manage and experience T2DM [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], particularly in Southern Nigeria. Furthermore, most existing studies fail to explore the sociocultural and personal aspects of T2DM management. This study, therefore, adds to this body of knowledge by exploring the lived experiences and management practices of T2DM patients at the University of Calabar Teaching Hospital, Nigeria. This approach enables a more comprehensive exploration, one that not only captures the realities on the ground but also incorporates patients\u0026rsquo; personalized experiences and perspectives.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eThis study was part of a larger mixed-methods study, comprising a descriptive cross-sectional design and a quasi-experimental design intervention, that sought to determine the effects of educational strategies on Type 2 diabetes management. As part of the formative phase of the larger study, this study employed a grounded theory qualitative approach to explore the lived experiences of people living with T2DM and their approaches to disease management. Our study leveraged the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist for the appropriate description and reporting of the study findings [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy setting\u003c/h3\u003e\n\u003cp\u003eThis study took place at the University of Calabar Teaching Hospital (UCTH), located in Calabar, Cross River State, Nigeria. UCTH is a Tertiary Health Institution, established in 1979, and is situated in the south-east of Calabar. The UCTH is bounded west by the University of Calabar Hotel, on the east by the Qua River (Esuk Atu), and on the north by Calabar International Airport. The University of Calabar Teaching Hospital has about 600 beds and a staff strength of over five hundred and fifty (550) workers. The hospital provides clinical services in all specialized medical areas such as Surgery, Internal Medicine, Pediatrics, Otorhinolaryngology, Anesthesiology, Obstetrics and Gynecology, Chemical Pathology, Family Medicine, Orthopedics/Traumatology, Dental and Maxillofacial Surgery, Ophthalmology, Hematology, Accident and Emergency, Psychiatry, Medical Social Work, and Medical Health Records. The Diabetes Clinic at the University of Calabar Teaching Hospital (UCTH) operates weekly, managing between 40 and 60 patients per week, which translates to approximately 240 patients monthly [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The clinic serves a diverse patient population, with most individuals aged between 41 and 50 years, and a majority being female (60%). Clinical care is provided through a multidisciplinary team including physicians, nurses, and support staff, as part of the hospital\u0026rsquo;s internal medicine department [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThis study employed adults aged 18 years and above who are receiving care for T2DM at the University of Calabar Teaching Hospital, Calabar. The population was drawn from all eligible patients irrespective of educational, religious, and ethnic affiliations. The accessible population was restricted to individuals who had recently been diagnosed with diabetes, regardless of the duration since diagnosis, provided they had not yet developed diabetes-related complications.\u003c/p\u003e\n\u003ch3\u003eSampling procedure\u003c/h3\u003e\n\u003cp\u003eA purposive sampling technique was employed to select the study participants for the Key informant Interviews (KIIs) and Focus Group Discussion (FGDs). For the KIIs, four key informants were recruited in the selected health facility, comprising a Medical Doctor in charge of the outpatient department (OPD) for Type 2 diabetic patients (or their representatives), a Nurse, and two Pharmacists involved in dispensing drugs and attending to patients. In addition, a total of fifteen (15) adult Type 2 diabetic patients were recruited for the FGDs. Two discussion groups were formed, with one group comprising seven participants and the other comprising eight participants. These discussion groups were used for data triangulation with information collected through the KIIs.\u003c/p\u003e\n\u003ch3\u003eInstruments for data collection\u003c/h3\u003e\n\u003cp\u003eTwo semi-structured guides were developed for the FGDs and KIIs. These guides were developed and designed to elicit in-depth information relevant to the study objectives. For the KIIs guide, the tool was divided into three sections: Section \"A\": the introduction of the study, which provides information about the research and the ethical considerations. Section \"B\": contained five to seven questions on key areas of interest, usually open-ended or closed-ended questions, designed to stimulate more revealing information about the issue of concern. Section \"C\" contained the closing remarks, request for recommendations for the study, and appreciation of interviewees. Additionally, the FGDs guide was structured into four sections: Section \"A\" focused on the introduction of the study and team, Section \u0026ldquo;B\" encompasses the ground rules that guided the group and transformed individuals into an interactive group using icebreakers. Furthermore, Section \"C\" contained five to ten open-ended questions on the key topic of the study, while Section \"D\" contained closing remarks and appreciation of participants.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003ePre-testing of the instruments\u003c/h2\u003e\u003cp\u003eUpon the development and expert review of the study guides, a pre-testing exercise was conducted to ensure that the guides were appropriate, complied with, and covered the aims and objectives of the study. The KIIs guide was pre-tested among healthcare workers in the OPD department of the University of Uyo teaching hospital, while the FGDs guide was pre-tested among six patients and three healthcare workers in the University of Uyo teaching hospital, Akwa Ibom State. Findings and feedback from the pre-test exercise were incorporated to restructure and improve the quality of the guides before data collection.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData collection procedure\u003c/h3\u003e\n\u003cp\u003eTrained research assistants were recruited by the principal researcher to support the process of data collection. The research assistants received training on the KIIs and FGDs guides to ensure smooth and consistent data collection. The KIIs and FGDs were conducted in Efik and Pidgin languages and facilitated by the principal researcher, while research assistants were assigned the role of note-taker and observer, respectively. Two sessions of FGDs and all the KIIs were conducted in the two health facilities. Adequate and appropriate information about the research and research team, voluntary participation, confidentiality, and anonymity were provided to the participants, and informed consent was sought before the interview and discussion. A set of open-ended questions on the topic of study was asked, followed by probing questions to prompt further information and explore the participants' experiences related to the topic of discussion. The KIIs and FGDs were conducted in a serene environment selected in collaboration with the participants to avoid distraction. The interviews and discussions were recorded using a tape recorder, complemented by detailed note-taking.\u003c/p\u003e\n\u003ch3\u003eData analysis and reporting\u003c/h3\u003e\n\u003cp\u003eThe data from the KIIs and FGDs sessions were transcribed verbatim, translated, and back-translated into English by the principal researcher. The data were coded independently by the principal researcher with the support of other research assistants and analyzed inductively to derive themes associated with the study objectives in the University of Calabar Teaching Hospital (UCTH), Calabar. The data were analyzed thematically, leveraging Braun \u0026amp; Clarke, (2019), approach that involved familiarization with the data, searching for themes, reviewing and sorting themes, defining and naming themes, and producing report. Six themes emerged from data related to patients' knowledge and understanding of T2DM, as well as their experiences with disease management.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eReflexivity, trustworthiness\u003c/h2\u003e\u003cp\u003eThe Principal Investigator (KNO), a public health researcher with prior knowledge of diabetes prevention and management, acknowledges that this background may have influenced interactions with participants during the focus group discussions. To minimize bias, open-ended, participant-driven questions were employed, and a neutral, non-judgmental stance was maintained to encourage participants to share their personal experiences, perceptions, and beliefs freely. Furthermore, reflexive journaling and peer debriefing were integrated by PCA, AO, and ANO throughout data collection and analysis to enhance trustworthiness and ensure that the themes generated reflected participants\u0026rsquo; voices rather than preconceived notions of the researchers.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe thematic analysis of the study yielded six broad themes and twenty-two sub-themes related to patients' knowledge and understanding of T2DM, as well as their experiences with disease management. These themes and sub-themes were derived directly from the transcript, reflecting the discussants' experiences, perspectives, and discussions regarding Type 2 diabetes awareness, dietary control, risk perception, cultural influences, support systems, and coping strategies.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eTheme 1: Understanding of Type 2 Diabetes\u003c/h2\u003e\u003cp\u003eParticipants exhibited a comprehensive understanding of type 2 diabetes. They identified its metabolic nature and the presence of elevated blood sugar levels as central characteristics. A clear distinction was made between type 2 and type 1 diabetes, with emphasis placed on the role of lifestyle factors such as diet and physical activity, in addition to genetic predispositions. Participants also indicated an awareness of the need to consult reliable sources for accurate information on type 2 diabetes. These sources included healthcare professionals, reputable health websites, and scientific literature.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eDefinition and Characteristics\u003c/h2\u003e\u003cp\u003eDiscussants demonstrated a nuanced understanding of type 2 diabetes, emphasizing its metabolic nature, insulin resistance, and the resultant elevated blood sugar levels as central features.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Type 2 diabetes is a condition where the body becomes resistant to insulin or doesn't produce enough insulin to regulate blood sugar levels effectively, leading to high blood sugar levels over time.\"\u003c/em\u003e - (Discussant 2)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"It's basically a problem with how the body processes sugar. It's a metabolic disorder characterized by insulin resistance, meaning the body's cells don't respond effectively to insulin.\"\u003c/em\u003e - (Discussant 1)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e\u003cb\u003eDifferentiating Type 2 from Type 1\u003c/b\u003e:\u003c/h2\u003e\u003cp\u003eDiscussants focused on distinguishing between type 2 and type 1 diabetes, highlighting the role of lifestyle factors, such as diet and exercise, alongside genetic predispositions, in the development of type 2 diabetes.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"It's important to note that type 2 diabetes differs from type 1 in that it's often linked to lifestyle factors like diet and exercise.\"\u003c/em\u003e - (Discussant 3)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Type 2 diabetes differs from type 1 in that it's often linked to lifestyle factors like diet and exercise. It occurs when the body's cells become resistant to insulin, causing glucose to build up in the bloodstream instead of being absorbed by cells for energy.\"\u003c/em\u003e - (Discussant 3)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eAwareness of Lifestyle Factors\u003c/h2\u003e\u003cp\u003eDiscussants acknowledged the multifactorial nature of type 2 diabetes, recognizing the significant impact of lifestyle choices, including diet, exercise, stress, and genetic factors, on disease development and progression.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I mostly rely on information provided by healthcare professionals, but I also hear a lot from friends and family who have experience with diabetes, their endocrinologists, and diabetes specialists who provide expert insights and the latest developments in managing type 2 diabetes.\"\u003c/em\u003e - (Discussant 1)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"As a nutrition student, I often refer to scientific journals and textbooks for accurate information about diabetes and diet. I also look into health organizations such as the American Diabetes Association and the World Health Organization for updated guidelines and information.\"\u003c/em\u003e - (Discussant 7)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Community events like health fairs or workshops, collaborating with local health organizations to host workshops and events focused on diabetes awareness, management, and support, could provide opportunities for people to learn about diabetes and ask questions.\"\u003c/em\u003e - (Discussant 5)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eSources of Information\u003c/h2\u003e\u003cp\u003eVarious sources, including healthcare professionals, reputable websites, scientific journals, and personal experiences, were cited as valuable sources of information about type 2 diabetes, reflecting a reliance on both expert knowledge and peer-based insights for understanding the condition.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I usually consult my doctor or search online for reputable websites like the American Diabetes Association. Medical journals and peer-reviewed research articles on diabetes management and treatment.\"\u003c/em\u003e - (Discussant 4)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I mostly rely on information provided by healthcare professionals, but I also hear a lot from friends and family who have experience with diabetes, their endocrinologists, and diabetes specialists who provide expert insights and the latest developments in managing type 2 diabetes.\"\u003c/em\u003e - (Discussant 6)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eTheme 2: Common Misconceptions about Type 2 Diabetes\u003c/h2\u003e\u003cp\u003eDiscussions addressed prevalent misconceptions surrounding type 2 diabetes, including beliefs about weight, diet, the severity of the condition, and its curability. Participants debunked oversimplified views, emphasizing the multifactorial nature of type 2 diabetes and its potential to lead to severe complications if not properly managed. Moreover, they highlighted the importance of dispelling myths and promoting accurate information to improve community understanding and awareness of type 2 diabetes. Overall, addressing misconceptions emerged as a crucial aspect of diabetes education and advocacy efforts within the community.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eWeight-related Misconceptions\u003c/h2\u003e\u003cp\u003eParticipants addressed misconceptions surrounding weight and type 2 diabetes, challenging the notion that only overweight individuals are at risk and highlighting the importance of genetic predispositions and other lifestyle factors.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I've come across the idea that only overweight people get type 2 diabetes. It's not true; thin people can develop it too.\"\u003c/em\u003e - (Discussant 2)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I've heard people say that diabetes isn't a serious condition, but that's definitely a misconception. It can lead to severe complications if not managed properly.\"\u003c/em\u003e - (Discussant 4)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eSimplistic Views on Diet\u003c/h2\u003e\u003cp\u003eDiscussions centered on debunking oversimplified views of diabetes management through di\u003cem\u003eet al\u003c/em\u003eone, emphasizing the complexities of disease management and the need for comprehensive lifestyle changes beyond sugar intake reduction.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Some people believe that type 2 diabetes can be cured by simply losing weight or following a specific diet. While lifestyle changes can help manage the condition, there is currently no known cure, and long-term management is essential.\" -\u003c/em\u003e (Discussant 3)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"\u0026hellip;That's true. Another misconception is that diabetes is only about sugar intake. People often overlook the importance of overall healthy eating and exercise habits.\" -\u003c/em\u003e (Discussant 3)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eSeverity of the Condition\u003c/h2\u003e\u003cp\u003eDiscussants corrected misconceptions regarding the seriousness of type 2 diabetes, highlighting its potential to lead to severe complications, including heart disease, stroke, kidney failure, and blindness, if not managed properly.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I've heard people say that diabetes isn't a serious condition, but that's definitely a misconception. It can lead to severe complications if not managed properly. In reality, it can lead to severe complications such as heart disease, stroke, kidney failure, and blindness if not properly managed.\"\u003c/em\u003e - (Discussant 4)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"One common misconception I've come across is that only overweight or obese individuals develop type 2 diabetes, but genetics, lifestyle factors, and other health conditions also play significant roles.\" -\u003c/em\u003e (Discussant 2)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eBeliefs about Cure\u003c/h2\u003e\u003cp\u003eMisconceptions surrounding the curability of type 2 diabetes emphasized the chronic nature of the condition and the importance of long-term management strategies over quick-fix solutions.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Some people believe that type 2 diabetes can be cured by simply losing weight or following a specific diet. While lifestyle changes can help manage the condition, there is currently no known cure, and long-term management is essential.\"\u003c/em\u003e - (Discussant 3)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I've heard people say that diabetes isn't a serious condition, but that's definitely a misconception. It can lead to severe complications if not managed properly.\"\u003c/em\u003e - (Discussant 4)\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eTheme 3: Awareness and Improvement Strategies\u003c/h2\u003e\u003cp\u003eDiscussants proposed various strategies to enhance awareness and knowledge about type 2 diabetes within the community, including educational campaigns, accessible information dissemination, community engagement events, and collaborative efforts among stakeholders. Discussions emphasized the importance of targeted interventions tailored to diverse community needs and preferences, as well as the involvement of healthcare professionals, community leaders, and individuals living with diabetes. Moreover, they emphasized the significance of proactive initiatives in combating misconceptions, promoting healthy lifestyle choices, and fostering a supportive environment for diabetes management. Overall, improving awareness emerged as a collective endeavor aimed at empowering individuals, reducing stigma, and enhancing overall community health outcomes.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eAccessible Information\u003c/h2\u003e\u003cp\u003eDiscussants emphasized the importance of making diabetes-related information accessible in multiple languages and formats, including free or low-cost screening programs and providing resources tailored to diverse community needs.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Providing personalized risk assessments could also be beneficial. Everyone's situation is different, so tailoring the information to each individual's needs and circumstances could make it more relevant and impactful.\"\u003c/em\u003e - (Discussant 2)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"It's also important to make information accessible in multiple languages and formats to reach diverse communities.\"\u003c/em\u003e - (Discussant 4)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"In addition to traditional educational materials, I also recommend reputable online resources and smartphone applications that provide valuable information and support for managing diabetes.\"\u003c/em\u003e (KII, Nurse)\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eCommunity Engagement and Educational Campaigns\u003c/h2\u003e\u003cp\u003eSuggestions for improving awareness included targeted educational campaigns in schools and workplaces to promote healthy lifestyle choices and raise awareness about type 2 diabetes risk factors and prevention strategies.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I think education campaigns targeting schools and workplaces could help raise awareness about the importance of a healthy lifestyle in preventing type 2 diabetes.\"\u003c/em\u003e - (Discussant 3)\u003c/p\u003e\u003cp\u003eFurthermore, strategies such as organizing community events, health fairs, and workshops in collaboration with local health organizations were proposed by discussants to foster community engagement, provide opportunities for education, and promote diabetes awareness and support.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Community events like health fairs or workshops, collaborating with local health organizations to host workshops and events focused on diabetes awareness, management, and support, could provide opportunities for people to learn about diabetes and ask questions.\"\u003c/em\u003e - (Discussant 5)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Peer support groups could be beneficial. Connecting with others who are going through support individuals with diabetes in our community.\"\u003c/em\u003e - (Discussant 6)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Involvement of support groups or peer networks for sharing experiences and coping strategies would aid in reducing the risk of complications.\"\u003c/em\u003e - (Discussant 3)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003eCollaborative Efforts\u003c/h2\u003e\u003cp\u003eDiscussants highlighted the need for collaborative efforts among stakeholders, including healthcare professionals, community leaders, and individuals living with diabetes, to combat misconceptions, promote accurate information, and improve diabetes education and awareness in the community.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Collaborating with local health organizations to host workshops and events focused on diabetes awareness, management, and support could provide opportunities for people to learn about diabetes and ask questions.\"\u003c/em\u003e - (Discussant 5)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Regular health screenings and check-ups to monitor early signs of complications.\"\u003c/em\u003e - (Discussant 2)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Educational workshops on exercise routines tailored to individuals with diabetes would also help\u003c/em\u003e.\" - (Discussant 4)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003eTheme 4: Dietary Control Measures\u003c/h2\u003e\u003cp\u003eDiscussions revolved around dietary strategies for managing type 2 diabetes, emphasizing the role of balanced meals, portion control, and lifestyle modifications in regulating blood sugar levels. Discussants shared personal experiences and challenges related to dietary adherence, including dealing with cravings, finding healthy options, and navigating social situations. Moreover, effective strategies for sticking to a diabetic-friendly meal plan, such as meal preparation and seeking support from peers and healthcare professionals, were highlighted. Overall, the theme underscores the importance of practical, sustainable dietary approaches tailored to individual needs in promoting successful diabetes management and improving health outcomes.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003eUnderstanding of Dietary Role\u003c/h2\u003e\u003cp\u003eDiscussants discussed their understanding of the role of diet in managing type 2 diabetes, emphasizing the importance of balanced meals, portion control, and carbohydrate monitoring in regulating blood sugar levels.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"My understanding is comprehensive, encompassing the importance of balanced meals, portion control, and carbohydrate monitoring in managing blood sugar levels for type 2 diabetes.\"\u003c/em\u003e - (Discussant 1)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"My understanding is moderate. I've gathered some information over the years, but I'm still learning about how different foods affect blood sugar levels.\"\u003c/em\u003e - (Discussant 2)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I'm well-versed in the role of diet in type 2 diabetes management, including strategies like glycemic index awareness, meal timing, and the impact of dietary fats and proteins on insulin sensitivity.\"\u003c/em\u003e - (Discussant 3)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003eDietary Habit Changes\u003c/h2\u003e\u003cp\u003eStrategies for dietary habit changes included incorporating more leafy greens, limiting sugary beverages, and practicing portion control, reflecting a focus on whole, nutrient-dense foods and lifestyle modifications to support diabetes management.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I've made a conscious effort to incorporate more leafy greens and lean proteins into my meals while reducing my intake of refined carbohydrates.\"\u003c/em\u003e - (Discussant 1)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I've heard of the benefits of consuming foods with a low glycemic index, so I've been focusing on including more of those in my diet.\"\u003c/em\u003e - (Discussant 2)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Portion control has been crucial for me. I've learned to listen to my body and stop eating when I'm satisfied rather than stuffed.\"\u003c/em\u003e - (Discussant 3)\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStrategies for Adherence\u003c/h3\u003e\n\u003cp\u003eEffective strategies for sticking to a diabetic-friendly meal plan included meal prepping, setting achievable goals, and seeking support from friends and family, underscoring the value of practical, sustainable approaches to dietary adherence in diabetes management.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Planning and prepping my meals in advance has been a game-changer. It helps me stay organized and ensures that I always have healthy options available.\"\u003c/em\u003e - (Discussant 1)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I've found that setting small, achievable goals for myself has been helpful. It's less overwhelming than trying to make drastic changes all at once.\"\u003c/em\u003e - (Discussant 2)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Mindful eating has been key for me. Taking the time to savor each bite and listen to my body's hunger cues helps prevent overeating.\"\u003c/em\u003e - (Discussant 5)\u003c/p\u003e\u003cdiv id=\"Sec31\" class=\"Section2\"\u003e\u003ch2\u003eTheme 5: Cultural and Social Influences on Diet\u003c/h2\u003e\u003cp\u003eDiscussions explored the cultural and social factors influencing dietary choices among individuals with type 2 diabetes, highlighting challenges related to traditional food practices, social gatherings, and access to healthy options. The theme emphasized the need for culturally sensitive interventions, peer support networks, and community resources to address barriers and promote diabetes-friendly dietary behaviors.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec32\" class=\"Section2\"\u003e\u003ch2\u003eCultural Food Practices\u003c/h2\u003e\u003cp\u003eDiscussants discussed cultural influences on dietary choices, highlighting challenges in adapting traditional dishes to meet diabetic dietary needs while preserving cultural identity and culinary heritage.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"In my culture, food is deeply tied to social gatherings and celebrations. It can be difficult to resist indulging in traditional dishes, even if they're not the healthiest options.\"\u003c/em\u003e - (Discussant 1)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"There's often a stigma around healthy eating in some communities. People might feel judged for making healthier choices or viewed as betraying their cultural heritage.\"\u003c/em\u003e - (Discussant 2)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Traditional foods in my community are often high in carbohydrates and sugars. It's challenging to find suitable alternatives without feeling like I'm giving up a part of my identity.\" - (Discussant 3)\u003c/em\u003e\u003c/p\u003e\u003cdiv id=\"Sec33\" class=\"Section3\"\u003e\u003ch2\u003eSocial Stigma and Pressure\u003c/h2\u003e\u003cp\u003eDiscussions addressed social stigma and pressure surrounding healthy eating, particularly in cultural contexts where certain foods are deeply rooted in social gatherings, traditions, and family dynamics, emphasizing the need for cultural sensitivity and support.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Social gatherings often revolve around food, making it harder to stick to dietary restrictions.\"\u003c/em\u003e - (Discussant 2)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Family dynamics and traditions may influence meal choices and portion sizes.\"\u003c/em\u003e - (Discussant 5)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"There's often a stigma around healthy eating in some communities.\"\u003c/em\u003e - (Discussant 2)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"People might feel judged for making healthier choices or viewed as betraying their cultural heritage.\"\u003c/em\u003e - (Discussant 2)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"There's pressure to participate in these traditions, even if it means compromising on my health.\" -\u003c/em\u003e (Discussant 5)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec34\" class=\"Section3\"\u003e\u003ch2\u003eAccessibility of Healthy Foods\u003c/h2\u003e\u003cp\u003eDiscussants identified access to healthy food options and affordability as challenges, particularly in underserved communities, emphasizing the importance of addressing structural barriers to healthy eating and promoting food equity.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Access to healthy food options can vary widely depending on where you live.\"\u003c/em\u003e - (Discussant 4)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Many people with diabetes struggle to afford nutritious foods, so finding ways to make healthy eating more accessible and affordable would be incredibly helpful.\"\u003c/em\u003e - (Discussant 3)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Lack of transportation can be a significant barrier to managing diabetes effectively.\"\u003c/em\u003e - (Discussant 4)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eTheme 6: Risk Perception of Developing Complications\u003c/h3\u003e\n\u003cp\u003eDiscussants reiterated their concerns about the long-term complications associated with type 2 diabetes, highlighting varying levels of awareness and proactive management strategies. The theme underscored the importance of understanding the factors contributing to complications and the need for effective communication between healthcare providers and individuals with diabetes to mitigate risks.\u003c/p\u003e\n\u003ch3\u003eComplication Concerns\u003c/h3\u003e\n\u003cp\u003eDiscussants expressed concerns about the long-term complications associated with type 2 diabetes, reflecting individual differences in risk perception and awareness of the potential consequences of poorly managed diabetes.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"For me, I am quite concerned, as long-term complications can significantly impact quality of life\u003c/em\u003e.\" - (Discussant 2)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"See, it really bothers me, considering the potential impact on overall health and well-being.\"\u003c/em\u003e - (Discussant 4)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Recognizing the importance of lifelong vigilance and healthy habits, I am now very concerned as we all want to live long and well.\"\u003c/em\u003e - (Discussant 5)\u003c/p\u003e\u003cdiv id=\"Sec37\" class=\"Section2\"\u003e\u003ch2\u003eFood and lifestyle\u003c/h2\u003e\u003cp\u003eDiscussants identified factors contributing to complications, including poor blood sugar control, lifestyle choices, genetics, access to healthcare, and mental health, highlighting the multifaceted nature of diabetes management and the importance of addressing modifiable risk factors.\u003c/p\u003e\u003cp\u003e\u003cem\u003ePoor blood sugar control is a major factor. If your blood sugar levels are consistently high, it can damage blood vessels and nerves over time.\"\u003c/em\u003e - (Discussant 7)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Lifestyle factors like diet and exercise play a significant role as well. If you're not eating well or staying active, it can exacerbate the risk of complications.\"\u003c/em\u003e - (Discussant 6)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I think genetics also plays a part. Some people may be more predisposed to developing certain complications than others, regardless of how well they manage their diabetes.\"\u003c/em\u003e - (Discussant 3)\u003c/p\u003e\u003cdiv id=\"Sec38\" class=\"Section3\"\u003e\u003ch2\u003ePersonal Experiences with Complications\u003c/h2\u003e\u003cp\u003ePersonal experiences or observations of complications among family and friends influenced discussants' perceptions of the condition and the importance of proactive management, emphasizing the role of lived experiences in shaping risk perception and health behaviors.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"My grandmother had diabetes-related complications, including vision loss and kidney problems. Seeing what she went through definitely heightened my awareness of the seriousness of the condition.\" -\u003c/em\u003e (Discussant 4)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I've had some nerve damage in my feet, which was a scary experience. It made me realize that even seemingly minor complications can have a big impact on daily life.\"\u003c/em\u003e - (Discussant 7)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I haven't experienced complications personally, but I've seen how they've affected others in my community. It's reinforced the importance of taking proactive steps to manage my diabetes and reduce my risk.\"\u003c/em\u003e - (Discussant 5)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study respondents showed a high level of understanding of the concept of T2DM, indicating that it is a metabolic disorder marked by chronic hyperglycemia, resistance to insulin, and inadequate insulin synthesis. Remarkably, several of the participants differentiated T2DM from type 1 diabetes using the indices of risk factors and disease causation. They also highlighted that even though T2DM is mainly due to lifestyle, genetic predispositions play a role. Such a level of health awareness reflects literacy that is sufficient for adequate self-management [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eResults from the study also showed that means of information retrieval were numerous, cutting across formal healthcare consultations and individual research in reputable medical journals such as the American Diabetes Association. The referencing of glycemic index concepts and the physiological impacts of insulin resistance by some of the participants with a background in health sciences underscored a deeper biomedical understanding [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. These participants emphasized credible sources of information, and this demonstrates the increasing role of patient agency in the digital era. This is highlighted in review research by Bailey et al., who discovered that patients with higher levels of health knowledge generally exhibit better compliance with medical therapy [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Nonetheless, the study respondents also indicated the challenge of misinformation, which usually comes from non-expert personnel within their families and communities [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. This, therefore, necessitates a synergistic health communication strategy comprising both professional guidance and community-based education, given the reliance of individuals on the two channels.\u003c/p\u003e\u003cp\u003eParticipants in the study pointed out and criticized prevalent misconceptions existing in their communities despite the widespread knowledge of the disease. Some of these include the beliefs that T2DM affects only overweight individuals, that it can be tackled by dietary adjustments and weight loss alone, and that it results only from high consumption of sugar [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Even though globally these misconceptions have been marked as significant hindrances to T2DM prevention and control, they remain pervasive across many communities [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe chronic and progressive nature of T2DM was also highlighted by the participants, who indicated that while lifestyle readjustments might reduce the need for medication, total cure of the disease is not feasible. Similar to previous studies, our participants emphasized that the influence of genetics and metabolic predisposition in the causation of diabetes has been undermined, citing cases of lean individuals suffering from the condition [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Importantly, participants in our study strongly questioned the notion that T2DM is a \"mild\" or \"non-serious\" disease. These findings align with previous studies in a review and cross-sectional study in Kenya, which reported that many participants described their experiences with T2DM both on a personal level and a family level citing complications such as neuropathy, retinopathy, and renal impairment as cumulative consequences of poor management [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. These findings suggest that community enlightenment on public health must take the next step, advancing from basic awareness to addressing nuanced, culturally based misconceptions that affect health behavior.\u003c/p\u003e\u003cp\u003e Participants in our study proposed various strategies to enhance awareness and engagement regarding T2DM within the community. A significant proposed strategy was the execution of specialized educational campaigns in schools, religious institutions, and workplaces. Mass campaigns are efficient tools in community sensitization [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], and this approach would drive awareness of the importance of preventive behaviors and early diagnosis in the management of T2DM within the study area. Another recommended strategy was increasing the accessibility of health information. The study participants advocated for educating the public in local languages and via simple communication methods to facilitate seamless assimilation by the masses. Poor levels of health awareness in some communities are a direct consequence of difficulties in communication [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. To further improve accessibility to health information, the participants advocated for the dissemination of materials in various formats (print, visual aids, and radio). Additionally, strong support for frequent health screening programs was shown among the participants, as this helps in early disease detection and risk identification. Community engagement activities were also another emergent sub-theme from the study. These include workshops, health fairs, and support group meetings, which facilitate open dialogue and peer education. To ensure the sustainability and cultural relevance of these programs, synergistic efforts by NGOs, healthcare workers, and individuals with lived experiences of T2DM ought to be carried out regularly [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDiet emerged as a cornerstone of T2DM self-management. Discussions revolved around dietary strategies for managing type 2 diabetes, emphasizing the role of balanced meals, portion control, and lifestyle modifications in regulating blood sugar levels. Participants' experiences and challenges related to dietary adherence, including dealing with cravings, finding healthy options, and navigating social situations. Moreover, effective strategies for sticking to a diabetic-friendly meal plan, such as meal preparation and seeking support from peers and healthcare professionals, were highlighted. These findings, similar to those in Ethiopia, Iraq, and Iran, suggest a strong relationship between general health literacy and T2DM dietary management literacy levels [\u003cspan additionalcitationids=\"CR52 CR53\" citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. More importantly, higher knowledge of T2DM management guarantees better health indices for diabetic patients. A study carried out among adults in Bangladesh showed that patients with higher knowledge of health nutrition had greater tendencies toward overall well-being than those with lower knowledge levels [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBehavioral adaptations to aid compliance with dietary routines were highlighted by the study participants as a means of curbing impulsive eating. Some strategies mentioned include portion estimation, meal planning, and the use of visual aids (such as the plate method). Generally, T2DM behavioral adaptations are crafted to drive empowerment and self-efficacy in patients while addressing social determinants of health and personal needs [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Out of the different approaches to behavioral adaptations in T2DM management (such as motivational interviewing [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e], provision of concurrent education [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e], and dietary strategies [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]), dietary strategies appeared to take a direct approach toward facilitating self-efficacy and consistency in T2DM management. This explains why most of the participants in our study indicated that meal prepping is a vital tool in achieving consistency in feeding routines. A meta-analytic study showed that dietary interventions were very potent in the management of T2DM [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. In that study, however, the dietary interventions were mainly driven toward lowering carbohydrate consumption, eliciting ketosis [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNevertheless, adherence to dietary recommendations posed some challenges as well. Some significant ones highlighted by the study participants include the affordability of healthy alternatives, family meal practices, and inconsistent availability of food. These factors often significantly affect the uptake of dietary recommendations, more notably for low-income patients, who may find it difficult to meet the demanding rigor of structured feeding. These challenges resonate with existing studies in Ghana and the United Arab Emirates that establish the relationship between socioeconomic factors and dietary adherence among diabetes patients [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. To this effect, it is pertinent that nutrition interventions strongly consider cost-effectiveness in setting up meal plans.\u003c/p\u003e\u003cp\u003eDietary habits were also profoundly impacted by cultural identity and social dynamics. There was evidence of social stigma among T2DM patients, as participants indicated that opting for \"diabetes-friendly\" meals in communal spaces attracted perceptions of cultural rejection and sometimes culminated in social exclusion. As noted in other qualitative studies in Nepal and Israel, similar to ours, some individuals may break their food considerations in a bid to belong and avoid negative perceptions from their community [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. This highlights how culture and society influence the feeding patterns of T2DM individuals. This influence was also shown in studies among a British South-Asian population, where food norms, stigma, and culturally inappropriate healthcare advice were major hindrances to adherence to T2DM dietary recommendations [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. A similar pattern was also observed among the Mayan population, where wrong cultural conceptions about the cause of diabetes contributed to T2DM patients upholding cultural feeding practices that were detrimental to their well-being [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. These factors pose significant but often overlooked challenges to adherence to dietary recommendations and hence underscore the need for culturally sensitive health promotion. Poor accessibility to healthy foods was another barrier to dietary recommendations, especially for individuals living with a low standard of living [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. Difficulties in transportation, food unavailability in markets, and high costs served as obstacles in acquiring fresh and whole foods [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. These structural deficiencies necessitate policy-driven interventions to enhance accessibility to healthy foods.\u003c/p\u003e\u003cp\u003eOur findings echoed participants\u0026rsquo; concerns regarding awareness and complications arising from T2DM. While some dreaded certain complications such as vision loss, amputations, kidney disease, and cardiovascular failure, others had little concern or uncertainty about these complications. This suggests gaps in provider\u0026ndash;patient communication and calls for improvement in this area. Poor or no health enlightenment from healthcare providers to patients has resulted in detrimentally low health knowledge levels, which potentially leads to exacerbation of poor health conditions. Participants from this study called for more precise, individualized enlightenment from healthcare providers, employing tools such as visual aids, risk estimators, and analogies to facilitate better appreciation of abstract knowledge. Additionally, continuous follow-up was emphasized by the participants. Advocating for consistent engagement and support, they opined that one-time enlightenment programs proved ineffective and non-holistic. Opting for a continuous education system rather than a one-off program would allow for more sustainable learning and make room for more individualized care for patients [\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. Furthermore, this approach would potentially eliminate barriers such as limited-time consultations and the inability to communicate peculiar health challenges.\u003c/p\u003e\u003cdiv id=\"Sec40\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and Limitations\u003c/h2\u003e\u003cp\u003eA key strength of this study is evident in its utilization of grounded theory, making room for a systematic exploration of multifaceted issues in T2DM management. The deployment of a qualitative approach in this study allows for an in-depth exploration of different individual perspectives. Additionally, the utilization of focus group discussions facilitated interactive dialogues that considered the collective voices, shared beliefs, and difficulties of participants. However, the results from this study may have reflected only data from the health-literate T2DM population, which would hinder the generalization of the findings to the entire T2DM community within the study area. Furthermore, biases stemming from social desirability could have influenced the responses of participants in group settings.\u003c/p\u003e\u003cp\u003eThis qualitative assessment of the lived experiences of T2DM individuals showcases an intertwined interaction between health knowledge, cultural context, and self-management principles. Prevalent misconceptions, sociocultural food practices, and systemic barriers continue to affect management outcomes despite a robust understanding of the condition by the participants. Findings from this study underscore the necessity for a multifaceted approach to T2DM management the integration of healthcare, cultural, structural, and behavioral methods.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study reflects the need for the tailoring of educational interventions to highlight cultural food practices and social norms. Reputable local figures ought to be involved in the facilitation of community awareness campaigns, as this would increase uptake and compliance. Also, healthcare providers ought to be equipped with effective communication tools to enable the delivery of important healthcare information to the community in a clear and precise manner. Incorporation of behavioral support strategies (goal setting and meal-prepping education) into routine T2DM care arises as a necessity, which would enhance dietary compliance and self-efficacy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA letter of introduction was obtained from the Head of Department, Public Health, University of Calabar, Cross River State, and ethical approval was obtained from the UCTH Research Ethics Committee Boards with approval number: NHREC/07/10/2012. We adhered to the principles of ethical research on human participants outlined in the Declaration of Helsinki [70].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe purpose of conducting the study was explained to the hospital community members. Before commencement of the research interviews, informed consent was obtained from each study participant. During the data collection, the research team explained the essence of the study, the risks involved, and the potential benefits. They were informed that they had the liberty to discontinue with the interview should they feel uneasy. Participants were informed of their right to withdraw at any point without penalty, and all their information was treated with strict confidentiality, and the protection of respondents was maintained throughout the duration of the research, data analysis, and presentation of findings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKNO conceptualized the study and led the development of the study methods and data collection. KNO and PCA contributed to the study design, methods, and the development of study materials. ASG contributed to data collection, development of guides, data analysis, and writing of results. KNO, PCA, PNT, TA, and CKC supported the development of manuscript and critical reviews. AJO and AON supervised and provided critical oversight of the project proposal, ethical approval application material, reviewed and contributed to result writing, discussion writing, and development of the manuscript. All authors read and approve the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors appreciate all our participants for their valuable contributions. Also, we wish to extend our appreciation to the staff of UCTH, Calabar, Cross Rivers, for their support throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was self-funded by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data relevant to the study are included in the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHossain MJ, Md A-M. 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World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Diabetes Mellitus, T2DM, Lived experience, Management, Cultural influences, Misconception","lastPublishedDoi":"10.21203/rs.3.rs-8253163/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8253163/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eDiabetes mellitus is a major public health concern that contributes to the global burden of disease. In Nigeria, nearly 4\u0026nbsp;million adults are living with diabetes, which has a significant risk of co-morbidities and mortality. There are several studies exploring causality and management, yet there is a paucity of information on the lived experiences of people diagnosed with diabetes, particularly in the southern part of the country, where cultural, socioeconomic, and healthcare dynamics may uniquely shape disease management practices. The objective of this study was to explore the lived experiences and management practices of T2DM patients at the University of Calabar Teaching Hospital, Nigeria.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis grounded theory qualitative study explored the lived experiences of people living with T2DM and their approaches to disease management. Four participants receiving treatment at the University of Calabar Teaching Hospital (UCTH), Cross River State, Nigeria, were purposively selected for key informant interviews, while fifteen participants were recruited for the focus group discussions. The data collected were transcribed and inductively analyzed manually.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSix themes emerged from the data: Type 2 diabetes awareness, dietary control, risk perceptions, cultural influences, support systems, and coping strategies. Participants recognized the importance of reliable information sources about type 2 diabetes, including healthcare professionals, reputable websites, and scientific literature. Overall, addressing misconceptions emerged as a crucial aspect of diabetes education and advocacy efforts within the community.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eBased on the study\u0026rsquo;s findings, a multifaceted approach to T2DM management, such as the integration of healthcare, cultural, structural, and behavioral methods, is pertinent. Incorporation of behavioral support strategies (goal setting and meal-prepping education) into routine T2DM care arises as a necessity, which would enhance dietary compliance and self-efficacy.\u003c/p\u003e","manuscriptTitle":"“Everyone's situation with diabetes is different, so are individual needs and circumstances”: Lived Experiences and Management Routines of Type 2 Diabetes Mellitus in Southern Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 11:21:42","doi":"10.21203/rs.3.rs-8253163/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"51d039ae-26e9-4089-867f-258a4afc2c64","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-04T10:24:02+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 11:21:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8253163","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8253163","identity":"rs-8253163","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}