Exploring barriers and enablers to diabetes self-care practice in Ethiopia, 2025: A qualitative systematic review

Clinical Snapshot

Key Findings

• P Value: Not applicable for qualitative synthesis

• Effect Size: Not applicable for qualitative synthesis

• Primary Outcome: Six major barriers identified: health system limitations, individual-level challenges, socioeconomic constraints, behavioral/lifestyle factors, cultural/social norms, lack of social support

• Nnt Or Sensitivity: Five key facilitators: family/social support, health education/counselling, patient motivation/skills, culturally aligned practices, health system readiness

• Confidence Interval: Not applicable for qualitative synthesis

Clinical Application

Findings may inform culturally sensitive approaches for Ethiopian diaspora communities in Australia Limited relevance to Australian practice given established PBS diabetes medications access, RACGP diabetes management guidelines, and different cultural context. May inform care for Ethiopian immigrant populations Limited direct applicability to Australian diabetes patients due to significant cultural, socioeconomic, and health system differences

Abstract

INTRODUCTION: Diabetes mellitus is a growing public health concern in Ethiopia, with increasing prevalence and a high proportion of undiagnosed cases. Effective self-care is crucial for managing diabetes; however, many patients face challenges ranging from personal beliefs to systemic and sociocultural constraints. Although multiple qualitative studies have explored these challenges, a synthesized, context-specific understanding that incorporates broader social and health system factors remains limited. This review aimed to synthesize qualitative evidence on barriers and facilitators of diabetes self-care practice in Ethiopia. METHODS: A qualitative systematic review was conducted in accordance with PRISMA 2020 and PRISMA-QS guidelines. A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, Web of Science, and Google Scholar was performed using relevant keywords and Medical Subject Headings. Eligible studies included primary qualitative and mixed-methods studies with extractable qualitative findings that explored diabetes self-care barriers and facilitators among patients, caregivers, or healthcare providers in Ethiopia. Purely quantitative studies, reviews, editorials, and studies conducted outside Ethiopia were excluded. Thematic synthesis was employed to integrate findings, and the GRADE-CERQual approach was used to assess confidence in the review findings. RESULTS: Eleven studies were included, comprising qualitative and mixed-methods designs conducted across diverse urban and semi-urban healthcare settings in Ethiopia. Study participants included adults with type 1 and type 2 diabetes, as well as healthcare professionals and caregivers. Six major barriers to diabetes self-care were identified: health system limitations, individual-level challenges, socioeconomic constraints, behavioral and lifestyle factors, cultural and social norms, and lack of social support. Key facilitators included strong family and social support, health education and counseling, patient motivation and skills, culturally aligned practices, and signs of health system readiness. CONCLUSION AND RECOMMENDATION: Diabetes self-care in Ethiopia is shaped by interconnected individual, cultural, and systemic factors. While substantial barriers persist, important enablers, particularly family involvement and supportive healthcare interactions, offer opportunities for improvement. Interventions should be culturally sensitive, community-centered, and supported by strengthened health systems. Policy efforts should prioritize integration of diabetes care into primary healthcare services, capacity building of healthcare providers, and incorporation of patients' lived experiences into care planning. Prospero registration number CRD420251033692.

References

1. 1.Abdulwehab, Sadik, Kedir, Frezer. (2026). Exploring barriers and enablers to diabetes self-care practice in Ethiopia, 2025: A qualitative systematic review. PLoS One. https://doi.org/10.1371/journal.pone.0346867