Social determinants of health and diabetes self-care management in South Africa

Abstract

Objective: Diabetes is an incapacitating condition affecting millions of people in South Africa. Maintaining optimal glycaemic control is crucial in preventing diabetes complications, highlighting the importance of diabetes self-care. This study examined how Social Determinants of Health (SDoH) are associated with self-care management practices in individuals with diabetes in South Africa using the framework developed by the Healthy People 2020 initiative. Methods: This study utilised cross-sectional Project Mind baseline data collected in 2017. Self-care management was coded on a scale from ‘0’ (never) to ‘7’ (daily adherence). For analysis, this scale was dichotomised into two categories: low self-care (scores 0–5) and high self-care (scores 6–7). Furthermore, adherence with these daily self-care activities was categorised into three levels: no adherence, partial adherence (inconsistent or partial adherence to activities), and full adherence (consistent adherence to all self-care activities). Results: The analytical sample (n = 539) was predominantly female (76%), with a mean age of 54 years, urban residents (60%), unemployed (70%), and attained secondary education (11.3%). In determining the attainment of a higher scale of self-care, age (AOR = 1.02, CI=[0.99,1.05]) and secondary education (AOR = 1.13, CI=[1.02, 2.03]) were associated with an increase in the scale of self-care. Conversely, urban residency (AOR = 0.50, CI=[0.29,0.88]) and being obese (AOR = 0.43, CI=[0.19,1.00]) were associated with a lower scale of self-care. Although not statistically robust, food insecurity decreased while being a woman and having a stable house showed an increased association. Travelling longer distances to access healthcare was positively associated with no adherence, and urban residency has a negative association with full adherence relative to partial adherence. Conclusions: The associations between SDoH and diabetes self-care management within a South African context highlight the need for a more holistic understanding and approach to interventions. Future endeavours should examine these determinants more broadly and formulate integrative strategies to ameliorate diabetes self-care.