Restrictors of the effectiveness of diabetes self-management education: A qualitative content analysis

BACKGROUND: A key step for improving the effectiveness of diabetes self-management education (DSME) is to identify its restrictors. OBJECTIVES: The aim of this study was to explore the restrictors of the effectiveness of DSME. METHODS: This descriptive qualitative study was conducted in March 2016–2017. Participants were 16 DSME providers (viz., physicians, nurses, nutritionists, and psychologists) and nine DSME receivers (viz., patients and their family members) – 25 in total. Semi-structured interviews were held for data collection. Interviews were transcribed word by word and analyzed through conventional content analysis approach proposed by Graneheim and Lundman. RESULTS: The restrictors of the effectiveness of DSME were categorized into three main categories and 11 subcategories, namely patients' limited welcoming of DSME classes (allocating limited time for participation in DSME classes, inadequate knowledge about diabetes mellitus [DM] importance, inappropriate educational environment, and financial problems), unfavorable adherence to treatments: serious challenge (inattention to educations, poor motivation for adherence to medical recommendations, and inattention to the psychological aspects of DM), and the difficulty of adult education (the difficulty of changing health-related attitudes and behaviors, mere information delivery during education, adults' physical and perceptual limitations, and diabetes educators' limited competence in adult education). CONCLUSION: The findings of the present study provide an in-depth understanding about the restrictors of the effectiveness of DSME. DM management authorities and policymakers can use these findings to develop strategies for improving the effectiveness of DSME.