BACKGROUND Self- management is vital to the control of diabetes. This study aims to assess the diabetes self-care behaviours of patients attending two tertiary hospitals in Gauteng, South Africa. The study also seeks to estimate the inequalities in adherence to diabetes self-care practices and associated factors. METHODS A unique health-facilities based cross-sectional survey was conducted amongst diabetes patients in 2017. Our study sample included 396 people living with diabetes. Face-to-face interviews were conducted using a structured questionnaire. Diabetes self-management practices considered in this study are dietary diversity, medication adherence, physical activity, self-monitoring of blood-glucose, avoiding smoking and limited alcohol consumption. Concentration indices (CIs) were used to estimate inequalities in adherence to diabetes self-care practices. Multiple logistic regressions were fitted to determine factors associated with diabetes self-care practices. RESULTS Approximately 99% of the sample did not consume alcohol or consumed alcohol moderately, 92% adhered to self-monitoring of blood-glucose, 85% did not smoke tobacco, 67% adhered to their medication, 62% had a diverse diet and 9% adhered to physical activity. Self-care practices of dietary diversity (CI = 0.1512) and exercise (CI = 0.1067) were all concentrated amongst patients with higher socio-economic status as indicated by the positive CIs, whilst not smoking (CI = - 0.0994) was concentrated amongst those of lower socio-economic status as indicated by the negative CI. Dietary diversity was associated with being female, being retired and higher wealth index. Medication adherence was found to be associated with older age groups. Physical activity was found to be associated with tertiary education, being a student and those within higher wealth index. Self-monitoring of blood glucose was associated with being married. Not smoking was associated with being female and being retired. CONCLUSION Adherence to exercising, dietary diversity and medication was found to be sub-optimal. Dietary diversity and exercise were more prevalent among patients with higher socio-economic status. Our findings suggest that efforts to improve self- management should focus on addressing socio-economic inequalities. It is critical to develop strategies that help those within low-socio-economic groups to adopt healthier diabetes self-care practices.

中文翻译：

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南非豪登省的两家公立医院患者坚持糖尿病自我护理行为的不平等和相关因素。

背景技术自我管理对控制糖尿病至关重要。这项研究旨在评估在南非豪登省的两家三级医院就诊的患者的糖尿病自我保健行为。该研究还试图评估坚持糖尿病自我护理行为和相关因素的不平等现象。方法2017年对糖尿病患者进行了独特的基于健康设施的横断面调查。我们的研究样本包括396名糖尿病患者。使用结构化问卷进行面对面访谈。本研究中考虑的糖尿病自我管理方法是饮食多样性，药物依从性，身体活动，自我监测血糖，避免吸烟和饮酒量有限。浓度指数（CIs）用于评估在遵守糖尿病自我护理实践中的不平等现象。拟合多元logistic回归以确定与糖尿病自我护理实践相关的因素。结果约有99％的样本未饮酒或中度饮酒，92％坚持自我血糖监测，85％禁止吸烟，67％坚持服药，62％饮食多样化和9 ％坚持体育锻炼。饮食习惯（CI = 0.1512）和运动（CI = 0.1067）的自我护理习惯都集中在社会经济地位较高的患者中，如阳性CI所示，而不吸烟（CI =-0.0994）则集中在这些人群中负面CI表示较低的社会经济地位。饮食多样性与女性有关，被退休和更高的财富指数。发现药物依从性与年龄较大的人群有关。人们发现，体育活动与大专教育有关，既是学生，又是财富指数较高的人。自我监测血糖与结婚有关。不吸烟与女性和退休有关。结论发现坚持锻炼，饮食多样化和药物治疗次优。具有较高社会经济地位的患者中饮食多样性和运动更为普遍。我们的发现表明，改善自我管理的努力应侧重于解决社会经济不平等问题。制定策略以帮助低社会经济群体的人们采用更健康的糖尿病自我护理方法至关重要。发现药物依从性与年龄较大的人群有关。人们发现，体育活动与大专教育有关，既是学生，又是财富指数较高的人。自我监测血糖与结婚有关。不吸烟与女性和退休有关。结论发现坚持锻炼，饮食多样化和药物治疗次优。具有较高社会经济地位的患者中饮食多样性和运动更为普遍。我们的发现表明，改善自我管理的努力应侧重于解决社会经济不平等问题。制定策略以帮助低社会经济群体的人们采用更健康的糖尿病自我护理方法至关重要。发现药物依从性与年龄较大的人群有关。人们发现，体育活动与大专教育有关，既是学生，又是财富指数较高的人。自我监测血糖与结婚有关。不吸烟与女性和退休有关。结论发现坚持锻炼，饮食多样化和药物治疗次优。具有较高社会经济地位的患者中饮食多样性和运动更为普遍。我们的发现表明，改善自我管理的努力应侧重于解决社会经济不平等问题。制定策略以帮助低社会经济群体的人们采用更健康的糖尿病自我护理方法至关重要。人们发现，体育活动与大专教育有关，既是学生，又是财富指数较高的人。自我监测血糖与结婚有关。不吸烟与女性和退休有关。结论发现坚持锻炼，饮食多样化和药物治疗次优。具有较高社会经济地位的患者中饮食多样性和运动更为普遍。我们的发现表明，改善自我管理的努力应侧重于解决社会经济不平等问题。制定策略以帮助低社会经济群体的人们采用更健康的糖尿病自我护理方法至关重要。人们发现，体育活动与大专教育有关，既是学生，又是财富指数较高的人。自我监测血糖与结婚有关。不吸烟与女性和退休有关。结论发现坚持锻炼，饮食多样性和药物治疗次优。具有较高社会经济地位的患者中饮食多样性和运动更为普遍。我们的发现表明，改善自我管理的努力应侧重于解决社会经济不平等问题。制定策略以帮助低社会经济群体的人们采用更健康的糖尿病自我护理方法至关重要。自我监测血糖与结婚有关。不吸烟与女性和退休有关。结论发现坚持锻炼，饮食多样化和药物治疗次优。具有较高社会经济地位的患者中饮食多样性和运动更为普遍。我们的发现表明，改善自我管理的努力应侧重于解决社会经济不平等问题。制定策略以帮助低社会经济群体的人们采用更健康的糖尿病自我护理方法至关重要。自我监测血糖与结婚有关。不吸烟与女性和退休有关。结论发现坚持锻炼，饮食多样化和药物治疗次优。具有较高社会经济地位的患者中饮食多样性和运动更为普遍。我们的发现表明，改善自我管理的努力应侧重于解决社会经济不平等问题。制定策略以帮助低社会经济群体的人们采用更健康的糖尿病自我护理方法至关重要。具有较高社会经济地位的患者中饮食多样性和运动更为普遍。我们的发现表明，改善自我管理的努力应侧重于解决社会经济不平等问题。制定策略以帮助低社会经济群体的人们采用更健康的糖尿病自我护理方法至关重要。具有较高社会经济地位的患者中饮食多样性和运动更为普遍。我们的研究结果表明，改善自我管理的努力应侧重于解决社会经济不平等问题。制定策略以帮助低社会经济群体的人们采用更健康的糖尿病自我护理方法至关重要。