Abstract

Background:
Diabetes self-care practices are essential for achieving glycemic control and preventing complications, yet many individuals fail to sustain consistent practices. Understanding both the magnitude of self-care behaviors and the contextual reasons behind poor adherence is necessary for designing effective interventions.

Aim:
This study assessed self-care practices among diabetic patients and explored facilitators and barriers influencing these behaviors in rural and urban Puducherry.

Methods:
An explanatory sequential mixed-method design was used. In the quantitative phase, 368 adults with diabetes were selected through cluster sampling from six rural and urban areas. Self-care practices were measured using the Summary of Diabetes Self-Care Activities (SDSCA) scale. Participants with poor self-care were invited for qualitative exploration. Four focus group discussions (FGDs) were conducted using a semi-structured guide across five domains: diet, physical activity, medication adherence, blood-glucose monitoring, and foot care. Data were analyzed descriptively and thematically.

Results:
Poor self-care was observed in 32% of rural and 29% of urban respondents. Rural participants showed significantly lower mean scores in blood-glucose monitoring, medication adherence, foot care, and exercise (p < 0.05). Qualitative findings revealed key facilitators such as fear of complications, family support, and use of reminders, while barriers included financial constraints, lack of motivation, limited awareness, time constraints, and misconceptions about medications. Foot-care and glucose-monitoring practices showed the widest knowledge–practice gaps.

Conclusion:
Despite reasonable awareness, self-care practices among diabetic patients remain suboptimal, particularly in rural areas. Addressing behavioral barriers through a context-specific, patient-centered diabetes self-care support module followed by training of diabetic patients may enhance adherence and improve long-term outcomes

Key words: Barriers; Diabetes; Facilitators; Self-care.