A cultural adaptation of a diabetes self-management programme for patients with type 2 diabetes attending a primary health care centre in Saudi Arabia

Abstract

Background: Self-management is an integral part of chronic disease management. Diabetes self-management programmes have shown to be effective. However, they are not standard practice in all high prevalence settings. For example, although the prevalence of Type 2 Diabetes in Saudi Arabia is 23%, such programmes have yet to be developed and deployed to serve this population. Self-management programmes are highly culturally and context specific, requiring substantial research and refinement to make them effective. Aim: To culturally adapt the Stanford Diabetes Self-Management Programme to be more relevant to patients with type 2 diabetes attending a primary health care centre in Saudi Arabia. Methods: A total of 39 participants were recruited from clinic settings to attend a six-week programme and their feedback was used to inform the adaptation. A qualitative study of this process and the experiences of diabetes was built into the programme. This consisted of non-participatory observations in a chronic disease clinic, informal meetings with a team of health care professional and a series of focus groups with participating patients to explore perceptions of the programme and barriers to self-management. These were audio-recorded, transcribed verbatim and thematically analysed. Results: Gender and social norms and roles, religion and reliance on Allah were the main themes emerging from the data. Conclusion: Adapting the evidence-based intervention through using a cultural adaptation framework was not fully successful. This is due to complexity of incorporating findings such as gender and gender roles into the adaptation and at the same time maintain fidelity of the original programme. The finding of this study suggests that content and messages of behaviour change intervention may benefit from being gender-specific, especially in Saudi Arabia. The study contributes to more understanding of barriers to self-management among Saudi patients.