1Faculty of Health Science, Bakti Tunas Husada University, West Java, Jawa Barat 46196, Indonesia
2Lincoln University College, Wisma Lincoln, 12-18, Jalan SS 6/12, 47301 Petaling Jaya, Selangor, Malaysia
*Corresponding Author’s Email: anihkurnia@universitas-bth.acid
Diabetes mellitus (DM) is a chronic condition characterised by hyperglycaemia resulting from the body’s inability to produce or effectively utilise insulin (Diane et al., 2022). The rising prevalence of DM, combined with increased mortality rates, imposes significant emotional, economic, and social burdens on individuals and societies. DM is linked to severe complications such as cardiovascular diseases, kidney failure, blindness, depression, and diabetic foot ulcers, which can lead to amputations if left unmanaged (Azeem, Khan & Liaquat, 2022; Seidu et al., 2022).
Lifestyle factors, including obesity, sedentary behaviour, and excessive consumption of processed, sugar-rich foods, exacerbate genetic predispositions towards DM. These interactions are particularly evident among adults (Celik et al., 2022). Effective DM management relies on patient education about medication adherence, dietary adjustments, increased physical activity, and other self-care behaviours, such as regular blood sugar monitoring and routine medical check-ups (Onyango et al., 2022). Collaboration among patients, families, and healthcare providers is critical to achieving better health outcomes and reducing diabetes-related complications and mortality (Mutyambizi et al., 2020).
Despite established treatment protocols, many patients struggle with medication adherence, a cornerstone of DM management. Barriers such as high costs, side effects, complex regimens, and inadequate education often hinder adherence, particularly in rural areas (Berkoh et al., 2022). Addressing these challenges in underserved settings can significantly reduce complications and hospitalisations (Bingham et al., 2021; Sabarathinam, 2023).
Self-management is fundamental to chronic disease care, encompassing behaviours like smoking cessation, alcohol moderation, regular monitoring of vital signs, and maintaining a balanced diet (Paudel et al., 2022). The American Association of Diabetes Educators (AADE) identifies seven key self-care behaviours: healthy eating, staying active, regular monitoring, medication adherence, problem solving, healthy coping, and risk reduction (Leslie Kolb, 2020; Paudel et al., 2022). However, individual self-care experiences vary widely, shaped by factors like cultural context, health literacy, social support, and access to healthcare services (Bogale et al., 2022). These factors significantly shape individuals' perspectives, priorities, and expectations regarding their condition and available support systems.
In rural areas, diabetes management requires a holistic approach. Nurses play a pivotal role as both care providers and educators, offering guidance on blood sugar monitoring, medication adherence, and lifestyle changes (Alshammari et al., 2021). Additionally, nurses offer psychosocial support, helping patients cope with emotional challenges related to their diagnosis. Nurses empower patients to manage their condition independently by teaching coping techniques and building self-efficacy. They also provide psychosocial support, empowering patients through culturally tailored interventions to maintain sustainable self-care practices (Huang, 2024). Limited access to healthcare information, financial constraints, and treatment adherence challenges further complicate diabetes care in rural areas. Poor glycaemic control, indicated by elevated HbA1C levels, often results from these systemic barriers (Sabarathinam, 2023). Additionally, socio-cultural factors and dietary misconceptions contribute to suboptimal self-management (Agidew et al., 2021).
Indonesia’s rich cultural diversity, with over 300 ethnic groups, significantly influences health attitudes and practices, including the use of alternative medicine (Lukman, Leibing & Merry, 2020). Religious beliefs also shape perceptions of health and illness, integrating faith into health management (Bayhakki & Thaniwatthananon, 2019; Indrayana et al., 2019). Educational disparities across regions affect health literacy, which in turn impacts health behaviour and treatment adherence (Eliza et al., 2022). Furthermore, Indonesia’s family- oriented society emphasises collective caregiving during health crises, fostering resilience but also presenting unique challenges (Atlas, 2019). However, geographic and economic inequalities create barriers to uniform healthcare access nationwide (Lukman, Leibing & Merry, 2020).
Support from the family and community enhances self-management behaviours and reduces complications, particularly in rural settings. This study explores the experiences and challenges of T2DM patients in rural Indonesian communities, highlighting the critical need for culturally sensitive approaches to improve self-care and healthcare delivery.
This study employed a qualitative design using semi-structured interviews to explore the self- care management experiences of individuals with Type 2 Diabetes Mellitus (T2DM) in rural Indonesia. A phenomenological framework, as described by Creely (2018), was adopted to gain an in-depth understanding of the participants' lived experiences.
Data were collected through semi-structured interviews, conducted by the researcher, who served as the primary instrument of the study. Each participant was interviewed twice, with each session lasting between 30 and 60 minutes. The interviews were audio-recorded and supplemented with observational field notes to enrich the contextual understanding of participants’ experiences. This method allowed for in-depth exploration of individual self-care practices related to T2DM.
Participants were selected through a snowball sampling, starting with referrals from the coordinator of a chronic disease control program. The inclusion criteria required participants to be between the ages of 35 and 70, have a T2DM diagnosis for at least six months, be capable of communicating in Indonesian, and be free from major speech, hearing, or cognitive impairments. Additionally, participants needed to express a willingness to engage in the study (Speziale, Streubert & Carpenter, 2011).
All interview recordings were transcribed verbatim and analysed using the Colaizzi method— a rigorous phenomenological analysis technique. This method enabled the identification of recurring themes and subthemes from the data (Creswell & Creswell, 2018; Creswell, 2013). NVivo 12 was used to manage and code the data, ensuring systematic and organised analysis.
To ensure the credibility and validity of the findings, triangulation was employed by cross- verifying data from interview transcripts, audio recordings, and field notes. This multi-source validation strengthened the consistency of the results. Member checking was conducted during the second round of interviews to validate the interpretations, thereby enhancing the trustworthiness of the study.
The researchers obtained ethical clearance from the Bakti Tunas Husada University with reference number 290/E.01/KEPK-BTH/XI/2023 on 24th November 2023.
Ethical considerations were rigorously upheld throughout the study, following the principles outlined in the Belmont Report (Polit & Beck, 2021). Informed consent was obtained from all participants before data collection, ensuring voluntary participation and a clear understanding of the study's objectives and procedures. To enhance the credibility of the findings, various methodological strategies were systematically employed. Triangulation was performed by comparing multiple data sources—including audio recordings, field notes, and interview transcripts—to ensure consistency. Member checking allowed participants to review and validate the findings, thereby enhancing accuracy. Peer debriefing with colleagues provided impartial insights and further reinforced the credibility of data interpretation. Additionally, thorough documentation and the maintenance of an audit trail supported the dependability and confirmability of the research process. These strategies, as guided by Creswell and Creswell(2018) and Creswell (2013), significantly contributed to the study’s overall credibility and reliability.
A total of 25 participants (15 females and 10 males) were included in the study. As shown in Table 1: Age distribution: 60% were aged 46–65 years, 32% were over 65, and 8% were aged 35–45 years; educational background: 80% completed senior high school, 12% held a bachelor's degree, and 8% completed only elementary or junior high school. Marital status: 88% were married. Duration of diabetes management: 84% had been managing diabetes for over 10 years.
Table 1: Respondent's Characteristic
No | Respondent's Characteristic | N (%) |
1 | Age | |
35-45 years old | 2 (8) | |
46-65 years old | 15 (60) | |
> 65 years old | 8 (32) | |
Mean ± SD | 52 ±0,657 | |
2 | Gender | |
Male | 10 (25) | |
Female | 15 (75) | |
3 | Education | |
Elementary-Junior High School | 2 (8) | |
Senior High School | 20 (80) | |
Bachelor's degrees | 3 (12) | |
4 | Status | |
Single | 1 (4) | |
Married | 22 (88) | |
Widow /widower | 2 (8) | |
5 | Ethnic Group | |
Sundanese | 24 (96) | |
Betawi | 1 (4) | |
6 | Live with Family | |
Live with children | 1 (4) | |
Lives with mother and family | 1 (4) | |
Live with partner | 23 (92) | |
6 | Long Suffering | |
a. 1-5 years | 0 (0) | |
b. 6- 10 years | 4 (16) | |
c. >10 years | 21 (84) | |
The demographic characteristics of the participants provide a comprehensive context for understanding their self-care management experiences. The findings indicate that the majority of participants were middle-aged women with a senior high school education who had been managing diabetes for over a decade. These characteristics suggest a population with substantial experience in diabetes self-management, coupled with a significant reliance on family and community support systems.
From the analysis, several key themes emerged that encapsulate the participants’ experiences with diabetes self-care management. These themes, systematically organised, underscore the complex dynamics and challenges participants face in managing their conditions effectively. As detailed in Table 2, the themes illustrate the diverse strategies and coping mechanisms employed by participants, offering valuable insights into the broader context of diabetes care in rural settings.
Table 2 summarises the main themes and subthemes related to diabetes self-care management, highlighting the complexities and influencing factors identified during the analysis. These findings provide a more profound understanding of the multifaceted nature of self-care management in rural communities and emphasise the need for tailored interventions that address these challenges.
Table 2: Themes and Subthemes in Diabetes Self-Care Management
Main Theme | Subthemes | Description |
Knowledge and Health Literacy |
| Participants demonstrated a limited understanding of diabetes, its potential complications, and necessary self-care practices. |
| Participants faced difficulties in comprehending medical instructions and health-related information, which hindered informed decision-making. | |
Emotional Impact |
| Participants experienced anxiety related to the progression of their condition and uncertainties about their future. |
| Emotional strain arising from managing diabetes, including frustrations with treatment regimens and perceived personal failures. | |
| Efforts to sustain a sense of normalcy and maintain positive mental health despite challenges in diabetes care. | |
Influencing Factors in Diabetes Self- Care Management |
| Challenges in consistently adhering to prescribed treatments due to side effects, forgetfulness, or lack of motivation. |
access | Issues such as long distances to healthcare facilities, financial constraints, and limited availability of healthcare professionals. | |
| Cultural beliefs and practices that affect dietary choices, medication adherence, and health-seeking behaviours. | |
Support | The role of family and community in providing emotional, informational, and practical assistance to support self-care. |
Knowledge and Health Literacy: Research indicates that low health literacy is a significant barrier to informed decision-making among diabetes patients.
Emotional Impact: Emotional challenges, including anxiety and diabetes-related stress, significantly affect patients' adherence to disease management routines.
Several influencing factors significantly impact the self-care management of diabetes patients. Treatment adherence is often hindered by barriers such as medication side effects, physical discomfort, and financial constraints, making it challenging for patients to follow prescribed regimens consistently. Barriers to healthcare access further exacerbate these challenges, particularly in rural areas, where limited accessibility to healthcare facilities contributes to inequities in diabetes management and leaves many patients underserved. Additionally, cultural influences play a critical role, as practices like dietary preferences and alternative medicine may conflict with medical recommendations, creating obstacles to effective disease management. Lastly, family and social support are vital in promoting better self-care behaviours, such as monitoring food intake and blood sugar levels.
This subtheme addresses participants' limited understanding of diabetes, its symptoms, and effective management practices. Many individuals only recognise basic symptoms, like thirst or fatigue, without understanding the necessary steps to control their conditions through medication, diet, and lifestyle modifications. For example:
"I know that diabetes affects my blood sugar, but I don’t understand how insulin works or why I need to adjust my diet."
"I sometimes feel confused about why I need to check my blood sugar levels so often, and I’m not sure how to interpret the results."
Low health literacy reflects participants' difficulties in accessing, understanding, and using health information effectively. This often results in confusion, particularly when healthcare providers offer conflicting advice, making it challenging for patients to make informed decisions about their care. For instance:
"The doctors tell me different things each time I visit, and I’m not sure which advice to follow, so I end up feeling lost."
"I have difficulty understanding the information in the pamphlets given to me, and I don’t always know what steps to take after reading them."
This theme delves into the emotional and psychological responses individuals experience while managing Type 2 Diabetes Mellitus (T2DM). It is broken down into three sub-themes: Anxiety, Diabetes Distress, and Maintaining Well-being.
Anxiety involves the fear, worry, and uncertainty that individuals feel when managing their diabetes. Patients often worry about their health outcomes, potential complications, and the social implications of their illness, which can hinder effective self-care and negatively impact their quality of life. Examples include:
“I’m afraid my blood sugar levels will never be under control, which makes me worry constantly.”
“I fear that if my condition gets worse, I might have to quit my job and become a burden to my family.”
Diabetic distress is the emotional burden and frustration directly related to managing diabetes. Such distress includes feeling overwhelmed by the daily demands of managing the condition and struggling to maintain motivation. Examples include:
“Sometimes, I feel overwhelmed with all the things I need to do, like taking medications, checking my blood sugar, and preparing special meals.”
“I get frustrated because no matter how much effort I put in; my condition doesn’t seem to improve.”
Despite these emotional challenges, some individuals actively strive to maintain their well-being by adopting coping strategies and staying positive. These efforts might include engaging in healthy habits, seeking social support, or participating in spiritual or stress-relief activities. Examples include:
“I try to maintain a balanced diet and go for daily walks to keep my body and mind in a positive state.”
“Praying and meditating help me manage my stress and accept my condition.”
This theme explores the various factors that influence individuals’ ability to manage their self- care in handling T2DM. These factors include adherence to treatment, barriers to healthcare access, cultural influence, and family and social support.
Treatment adherence encompasses how well patients follow the healthcare recommendations, including taking medication, following dietary guidelines, and engaging in physical activity. Poor adherence can hinder treatment outcomes and increase the risk of complications. Examples include:
“I always try to take my medication on time, but sometimes I forget.”
“I find it difficult to stick to the recommended diet, especially when I am outside the house.”
Barriers to healthcare access involve the challenges patients face in obtaining necessary care, such as geographical distance, financial limitations, and the complexity of healthcare processes. These barriers can prevent patients from accessing timely and quality care. Examples include:
“The nearest health center is too far from my home, and it is difficult for me to visit regularly.”
“The cost of consulting a doctor is too high, so I rarely check my condition.”
Cultural influence examines how cultural values and practices affect self-care behaviours. For instance, some patients might rely on traditional medicine or experience social pressure related to dietary habits that hinder effective diabetes management. Examples include:
“In our culture, rice is a staple food, and it is difficult for me to replace it with something healthier.”
“I prefer using herbal remedies over medication from the doctor because it is part of our family tradition.”
Family and social support play a crucial role in diabetes self-care management. Having support can motivate patients to adhere to treatment and maintain their care plans. Examples include:
“My husband always reminds me to take my medication and eat on time.”
“I feel more motivated to exercise because my friends support me and often exercise with me.”
Indonesia's diverse educational and healthcare experiences highlight significant variations in cultural perspectives and self-care practices among patients (Lukman, Leibing & Merry, 2020). For individuals with diabetes, self-efficacy—confidence in one’s ability to manage behaviours such as dietary adherence, physical activity, medication compliance, and blood glucose monitoring—is critical for effective disease management (Orem, Taylor & Renpenning, 2001). Enhancing health awareness can encourage active participation and foster more proactive self- care behaviours (Enggarwati, Dahlia & Maria, 2022).
However, Indonesia's cultural and social diversity presents challenges when generalising findings. With over 300 ethnic groups, each characterised by unique traditions and health beliefs, self-care practices for managing type 2 diabetes mellitus (T2DM) are deeply rooted in cultural contexts (Indrayana et al., 2019). While this study provides valuable insights into specific rural settings, its findings may not fully represent the broader spectrum of rural areas in Indonesia. Future comparative studies across different cultural backgrounds are necessary to capture the full extent of Indonesia's diversity and enhance the generalisability of these findings.
Self-care practices are influenced by various factors, including health literacy, emotional barriers, and social support. Many patients struggle to understand medical information and its implications for self-care management, which hinders their ability to effectively manage their condition (Pourhabibi et al., 2022). Limited health literacy can significantly hinder patients’ ability to access, understand, and apply health information, often resulting in suboptimal decision-making (van der Gaag et al., 2022). Furthermore, factors such as family history, health literacy, and recommendations from healthcare providers have been shown to significantly influence self-care behaviours (r = 0.22, p < 0.05) (Misra et al., 2022). Similarly, a study by Gupta et al. (2024) highlights that patients in rural areas often face limited access to healthcare services, financial constraints, and sociocultural beliefs that hinder diabetes self-care practices (Gupta et al., 2024). Additionally, Burleson, Stephens and Rimal (2025) emphasise that variations in adherence to self-care behaviours are influenced by multiple factors, including access to healthcare resources and differences in measurement methodologies (Burleson, Stephens & Rimal, 2025).
Frailty has been recognised as a significant complication of diabetes, particularly in older adults, leading to reduced muscle strength and an increased risk of adverse health outcomes. The presence of multimorbidity further exacerbates diabetes-related frailty, necessitating integrative management approaches that combine lifestyle interventions with pharmacological treatment. As diabetes increases the risk of frailty, addressing its impact through structured and holistic interventions is crucial for improving long-term health outcomes (Sinclair et al., 2025).
Emotional barriers, including depression and anxiety, exacerbate these challenges, with patients being 2–3 times more likely to experience these conditions. These psychological issues are often underdiagnosed yet closely associated with poor adherence and increased complications. Incorporating empathetic approaches in patient education can enhance emotional well-being and improve the effectiveness of self-care practices (Franquez, Souza & de Cássia, 2023). Interventions aimed at addressing these barriers have shown promise. For example, mindfulness-based programs have demonstrated efficacy in reducing stress, improving HbA1C levels, and enhancing self-management behaviours, highlighting their potential as effective strategies for improving diabetes outcomes (Lu et al., 2021).
The role of nurses in supporting T2DM self-management, particularly in rural settings, remains underexplored. Nurses act as facilitators by providing education, regular monitoring, and emotional support, empowering patients to overcome barriers such as diabetes-related distress and low health literacy (Yoon et al., 2022). In addition, family support plays a crucial role in diabetes self-care, particularly in ensuring adherence to dietary restrictions, medication intake, and regular check-ups. However, some patients report a lack of family support, which negatively impacts their ability to manage their condition effectively (Gupta et al., 2024). This support system not only provides practical assistance but also offers emotional reinforcement, significantly enhancing diabetes management outcomes (Molla et al., 2022). Burleson, Stephens and Rimal (2025) further highlight that adherence to diabetes treatment in rural settings is often complicated by variations in definitions and measurement modalities, making it difficult to standardise interventions across different populations (Burleson, Stephens & Rimal, 2025). Goins et al. (2022) identified various forms of support—emotional, instrumental, informational, and judgemental—that significantly influence self-care practices (Goins et al., 2022). Similarly, Molla et al. (2022) highlighted that 54.9% of patients in a cross-sectional study reported good social support, underscoring the critical role of family systems in diabetes management (Molla et al., 2022).
Diabetes self-care behaviours are influenced by environmental and social factors, including extreme weather conditions, time constraints, and cultural beliefs regarding alternative medicine (Gupta et al., 2024). These cultural traditions and socioeconomic constraints in rural areas significantly impact diabetes self-management, contributing to variations in adherence to treatment guidelines. Similarly, Burleson, Stephens and Rimal (2025) emphasise that a lack of standardised adherence measures complicates the evaluation of effective interventions, particularly in diverse rural populations. Collectively, these challenges underscore the need for tailored interventions that address both the clinical and sociocultural dimensions of diabetes care (Burleson, Stephens & Rimal, 2025).
Incorporating culturally sensitive nursing interventions tailored to Indonesia’s rural settings can further enhance diabetes management. Guided by frameworks such as Dorothea Orem’s Self-Care Deficit Nursing Theory, these interventions have the potential to significantly improve patient outcomes (Queirós, Vidinha & Almeida Filho, 2014). Community-based education programs and peer support groups led by nurses can help bridge gaps in healthcare access while aligning care with patients’ unique cultural and social needs.
Digital health tools, such as mHealth applications, offer significant opportunities to enhance self-management practices for individuals with diabetes. However, challenges such as low digital literacy and limited integration into existing healthcare systems continue to hinder their widespread adoption. In November 2024, the Indonesian Ministry of Health integrated the Digital Diabetes Diary (3D) feature from the PRIMAKU (Program Imunisasi Anakku meaning My Child’s Immunization Program) application into the SATUSEHAT (Satu Sehat meaning to One Health). This initiative enables real-time blood glucose monitoring for children with diabetes, highlighting the transformative potential of digital tools in improving disease management (Schubert, 2024). Additionally, non-invasive blood glucose monitoring technology using photoplethysmography (PPG) signals and artificial intelligence (AI) has demonstrated promising accuracy and clinical applicability, offering a transformative approach to patient-centred diabetes care (Zeynali et al., 2025). These technological advancements underscore the importance of collaborative approaches that integrate digital tools with traditional care methods to improve outcomes for rural patients.
A recent study reported that 89.5% of respondents experienced anxiety related to the financial burden of diabetes management, further emphasising the need for cost-effective and accessible healthcare solutions (Vitale, Wentzell & Laffel 2022). To address these challenges, multidisciplinary strategies that combine structured programmes, family and community support, and digital tools are essential. For instance, the Diabetes Online Community (DOC) provides psychological, informational, and self-management support, fostering empowerment and reducing isolation (Oser et al., 2020). Tailoring diabetes self-management programmes to the cultural, logistical, and behavioural needs of specific populations has been shown to effectively overcome barriers and improve patient outcomes. Liang et al. (2024) demonstrated that a culturally adapted, theory-driven, and structured self-management programme for insulin-treated adults significantly improved self-efficacy and self-care behaviours and reduced diabetes-related distress among Chinese participants.
Building on these successes, integrating culturally sensitive nursing training and community- based programmes can further enhance outcomes, particularly in underserved rural areas. Such strategies align with global best practices in diabetes care while addressing the unique challenges faced in Indonesia. In conclusion, improving self-management for T2DM requires a holistic approach that incorporates family and community support, culturally sensitive care, and innovative digital tools. Strengthening nursing education and adopting multidisciplinary strategies will foster sustainable improvements in diabetes care, especially in rural areas.
Effective self-care management is crucial for individuals with Type 2 Diabetes Mellitus (T2DM) in rural Indonesia to prevent complications and improve quality of life. This study identified several factors influencing self-care, including limited access to healthcare services, low health literacy, sociocultural influences, and the pivotal role of family and community support. Emotional barriers, such as anxiety, diabetes-related distress, and depression, further impede self-management and adherence to treatment.
To mitigate these challenges, integrating digital health solutions, such as telemedicine and remote monitoring applications, can bridge gaps in healthcare accessibility. Additionally, enhancing the role of diabetes care specialists and expanding community-based education programmes can significantly improve self-care behaviours among underserved populations. Interdisciplinary collaborations among healthcare providers, policymakers, and local communities are crucial for developing sustainable and accessible diabetes care models tailored to rural settings.
The findings of this study align with medium-range theories, emphasising the interplay between self-care experiences, healthcare accessibility, and social support systems in rural communities. To improve patient outcomes, healthcare professionals must adopt personalised, culturally sensitive care approaches that acknowledge the unique needs and beliefs of rural populations.
Future research should explore patient expectations and healthcare providers' perspectives to gain a more comprehensive understanding of self-care barriers and facilitators. Moreover, developing home-based management tools that facilitate real-time communication, monitoring, and patient education can help overcome geographic and logistical challenges, ensuring continuous and effective diabetes care in remote areas.
This study acknowledges certain limitations. The in-depth, context-rich insights provide valuable understanding of the self-care challenges faced by individuals with Type 2 Diabetes Mellitus in rural Indonesia. While cultural and socioeconomic diversity may affect broader applicability, these findings offer an important foundation for future research. To build on this work, larger, more representative studies using mixed-method approaches must be done to enhance relevance and deepen understanding of diabetes self-management in diverse rural settings.
The authors declare that they have no conflict of interests.
Gratitude is extended to all participants who contributed to this study, as well as to the healthcare professionals and local community leaders in rural Indonesia who supported the recruitment and data collection process. Appreciation is also directed to the Chronic Disease Control Program coordinators for their invaluable assistance in facilitating this research. Furthermore, acknowledgement is given to the academic supervisors and researchers for their significant contributions in refining the study’s methodology and ensuring its alignment with ethical and academic standards. Their expertise and guidance were instrumental in enhancing the quality of this study.
Agidew, E., Wale, M. Z., Kerebih, H., Yirsaw, M. T., Zewdie, T. H., Girma, M., & Miskir, A. (2021). Adherence to diabetes self-care management and associated factors among people with diabetes in Gamo Gofa Zone public health hospitals. SAGE Open Medicine, 9. https://doi.org/10.1177/20503121211053953
Alshammari, M., Windle, R., Bowskill, D., & Adams, G. (2021). The Role of nurses in diabetes care: a qualitative study. Open Journal of Nursing, 11(08), 682–695. https://doi.org/10.4236/ojn.2021.118058
Atlas, C. (2019). Indonesian Culture-Family. Repéré le, 2. Retrieved from: https://culturalatlas.sbs.com.au/indonesian-culture/indonesian-culturefamily. Accessed on 18th February, 2023.
Azeem, S., Khan, U., & Liaquat, A. (2022). The increasing rate of diabetes in Pakistan : A silent killer. Annals of Medicine and Surgery, 79. https://doi.org/10.1016/j.amsu.2022.103901
Bayhakki, Hatthakit, U., & Thaniwatthananon, P. (2019). Self-caring in islamic culture of muslim persons with esrd and hemodialysis: an ethnographic study. Enfermeria Clinica, 29(xx), 38–41. https://doi.org/10.1016/j.enfcli.2018.11.015
Berkoh, D. A., Owiredu, W. B. K. A., Gyasi, S. F., Donkoh, E. T., & Ngala, R. A. (2022). Factors associated with noncompliance to diabetes medication in a rapidly urbanizing region in Ghana : A mixed-methods study. Porto Biomedical Journal, 7(3), 1–6. https://doi.org/10.1097/j.pbj.0000000000000148
Bingham, J. M., Black, M., Anderson, E. J., Li, Y., Toselli, N., Fox, S., Martin, J. R., Axon, D. R., & Silva-Almodóvar, A. (2021). Impact of telehealth interventions on medication adherence for patients with type 2 diabetes, hypertension, and/or dyslipidemia: A systematic review. Annals of Pharmacotherapy, 55(5), 637–649. https://doi.org/10.1177/1060028020950726
Bogale, E. K., Wondiye, H., Debela, Y., Fentabil Anagaw, T., Worku, L., & Kebede, N. (2022). Self-care practice, lived experience of type 1 diabetes mellitus patients at Kemisse General Hospital, North Eastern Ethiopia: Phenomenological study. SAGE Open Medicine, 10. https://doi.org/10.1177/20503121221126862
Burleson, J., Stephens, D. E., & Rimal, R. N. (2025). Adherence definitions, measurement modalities, and psychometric properties in hiv, diabetes, and nutritional supplementation studies: a scoping review. Patient Preference and Adherence, 19, 319–344. https://doi.org/10.2147/PPA.S498537
Celik, S., Olgun, N., Yilmaz, F. T., Anataca, G., Ozsoy, I., Ciftci, N., Aykiz, E. F., Yasa, S., Karakiraz, E., Ulker, Y., Demirhan, Y. E., Celik, S. Y., Arpaci, I., Gunduz, F., Temel, D., Dincturk, C., Sefer, B. E., Bagdemir, E., Erdem, E., Sarimehmetoglu, E., … Cetin, N. (2022). Assessment the effect of diabetes education on self-care behaviors and glycemic control in the Turkey Nursing Diabetes Education Evaluating Project (TURNUDEP): a multi-center study. BMC Nursing 21,(1) 1–9. https://doi.org/10.1186/s12912-022-01001-1
Creswell, W. J., & Creswell, J. D. (2018). Research Design: Qualitative, Quantitative adn Mixed Methods Approaches, vol. 53, no. 9. 2018.[Online]. SAGE Publication, USA. Retrieved from: https://spada.uns.ac.id/pluginfile.php/510378/mod_resource/content/1/creswell.pdf . Accessed on 10th March, 2023.
Cresswell, J. (2013). Qualitative inquiry & research design: Choosing among five approaches. Retrieved from: https://revistapsicologia.org/public/formato/cuali2.pdf. Accessed on 17th July, 2023.
Creely, E. (2018). ‘Understanding things from within’. A husserlian phenomenological approach to doing educational research and inquiring about learning. International Journal of Research & Method in Education, 41(1), 104-122.https://doi.org/10.1080/1743727X.2016.1182482
Diane, A., Ali, N., Shukri, A., Bin, R., Mu, A., & Siddiqi, H. H. Al. (2022). β ‑ cell mitochondria in diabetes mellitus : A missing puzzle piece in the generation of hPSC ‑ derived pancreatic β ‑ cells ? Journal of Translational Medicine, 5, 1–10.https://doi.org/10.1186/s12967-022-03327-5
Eliza, E., Sumarman, S., Yunianto, A. E., & Fadly, D. (2022). Nutrition education regarding the glycemic index on the knowledge of patients with diabetes mellitus. Open Access Macedonian Journal of Medical Sciences, 10(E), 1174–1177.https://doi.org/10.3889/oamjms.2022.9986
Enggarwati, P., Dahlia, D., & Maria, R. (2022). Social support as a mediator between depressive symptoms and self-care activities in adults patient with type 2 diabetes mellitus. Journal of Public Health Research, 11(2), jphr-2021. https://doi.org/10.4081/jphr.2021.2734
Franquez, R. T., de Souza, I. M., & de Cássia Bergamaschi, C. (2023). Interventions for depression and anxiety among people with diabetes mellitus: Review of systematic reviews. PLoS One, 18(2 February), 1–13. https://doi.org/10.1371/journal.pone.0281376
Goins, R. T., Grant, M. K., Conte, K. P., & Lefler, L. (2022). Social support and diabetes management among Older American Indians. Front. Public Health, 10, 1–10.https://doi.org/10.3389/fpubh.2022.780851
Gupta, S., Fischer, J., Roy, S., & Bhattacharyya, A. (2024). Emotional regulation and suicidal ideation—Mediating roles of perceived social support and avoidant coping. Frontiers in Psychology, 15. https://doi.org/10.3389/fpsyg.2024.1377355
Huang, K. (2024). Nursing interventions of nurse-led health education for diabetes patients: To promote self-care (Bachelor’s thesis). Jamk University of Applied Sciences. Retrieved from: https://urn.fi/URN:NBN:fi:amk-202404197012, Accessed on 28th August, 2024.
Indrayana, S., Guo, S. E., Lin, C. L., & Fang, S. Y. (2019). Illness perception as a predictor of foot care behavior among people with type 2 diabetes mellitus in Indonesia. Journal of Transcultural Nursing, 30(1), 17–25. https://doi.org/10.1177/1043659618772347
Leslie Kolb, R. A. (2020). An effective model of diabetes care and education: revising the aade7 self-care behaviors®. Diabetes Educator, 46(2), 139–160.https://doi.org/10.1177/0145721719894903
Liang, W., Chow, K. M., Ni, X., Tola, Y. O., & Lo, S. H. S. (2024). Development, feasibility, and preliminary effects of a culturally adapted, evidence-based, and theory-driven diabetes self-management programme for Chinese adults with type 2 diabetes receiving insulin injection therapy. Primary Care Diabetes, 18(6), 649-659. https://doi.org/10.1016/j.pcd.2024.09.010
Lu, X., Yang, D., Liang, J., Xie, G., Li, X., Xu, C., Liao, H., Zhou, H., Xu, Z., Ye, C., Chen,H., Liang, M., Shen, Q., Sun, T., Hu, Y., Zhang, W., & Ning, Y. (2021). Effectiveness of intervention program on the change of glycaemic control in diabetes with depression patients: A meta-analysis of randomized controlled studies. Primary Care Diabetes, 15(3), 428–434. https://doi.org/10.1016/j.pcd.2021.01.006
Lukman, N. A., Leibing, A., & Merry, L. (2020). Self-care experiences of adults with chronic disease in indonesia: An integrative review. International Journal of Chronic Diseases, 2020, 1–17. https://doi.org/10.1155/2020/1379547
Misra, R., Adelman, M. M., Kirk, B., & Sambamoorthi, U. (2022). Relationship among diabetes distress, health literacy, diabetes education, patient-provider communication and diabetes self-care. American Journal of Health Behavior, 46(5), 528-540. https://doi.org/10.5993/AJHB.46.5.4
Molla, I. B., Berhie, M. A., Germossa, G. N., & Hailu, F. B. (2022). Perceived social supports and associated factors among diabetes mellitus patients. Journal of Diabetes & Metabolic Disorders, 21(2), 1651–1659. https://doi.org/10.1007/s40200-022-01116-x
Mutyambizi, C., Pavlova, M., Hongoro, C., & Groot, W. (2020). Inequalities and factors associated with adherence to diabetes self-care practices amongst patients at two public hospitals in Gauteng, South Africa. BMC Endocrine Disorders, 20(1), 1–10. https://doi.org/10.1186/s12902-020-0492-y
Orem, D. E., Taylor, S. G., & Renpenning, K. M. (2001). Nursing: Concepts of practice (6th ed). Mosby, St. Louis, United States. Retrived from: https://search.worldcat.org/title/Nursing-:- concepts-of-practice/oclc/45103042. Accessed on 28th August 2024.
Onyango, J. T., Namatovu, J. F., Besigye, I. K., Kaddumukasa, M., & Mbalinda, S. N. (2022). The relationship between perceived social support from family and diabetes self-management among patients in Uganda. Pan African Medical Journal, 41(1). https://doi.org/10.11604/pamj.2022.41.279.33723
Oser, T. K., Oser, S. M., Parascando, J. A., Hessler-jones, D., Sciamanna, C. N., Sparling, K., Jr, D. N., Litchman, M. L., Hessler-jones, D., & Sparling, K. (2020). Social media in the diabetes community : A novel way to assess psychosocial needs in people with diabetes and their caregivers. Current Diabetes Reports, 20(10), 1–10. https://doi.org/10.1007/s11892-020- 1294-3
Paudel, G., Dahal, K., Biswas, T., & Sugishita, T. (2022). Self-care behaviours among people with type 2 diabetes mellitus in South Asia : A systematic review and meta-analysis. 12. https://doi.org/10.7189/jogh.12.04056
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice. Wolters Kluwer. United States. Retrieved from: https://shorturl.at/GjLGv. Accessed on 28th August, 2024.
Pourhabibi, N., Mohebbi, B., Sadeghi, R., Shakibazadeh, E., Sanjari, M., Tol, A., & Yaseri, M. (2022). Determinants of Poor treatment adherence among patients with type 2 diabetes and limited health literacy: a scoping review. Journal of Diabetes Research, 2022. https://doi.org/10.1155/2022/2980250
Queirós, P. J. P., Vidinha, T. D. S., & Almeida Filho, A. J. (2014). Self-care: Orems theoretical contribution to the nursing discipline and profession. Revista de Enfermagem [internet], 4(3), 157-63. http://dx.doi.org/10.12707/RIV14081
Sabarathinam, S. (2023). A glycemic diet improves the understanding of glycemic control in diabetes patients during their follow-up. Future Science OA, 9(3). https://doi.org/10.2144/fsoa- 2022-0058
Schubert, K. H. (2024). Supporting patients with diabetes’ disease management through improved presentations of test results: A qualitative study (Master’s thesis). Aalborg University, Department of Planning. Rertieved from: https://vbn.aau.dk/ws/files/718956391/TAN10_KHS_FINAL.pdf, Accessed on 22nd July, 2024.
Seidu, S., Cos, X., Brunton, S., Harris, S. B., Jansson, S. P. O., Mata-Cases, M., Neijens, A.M. J., Topsever, P., & Khunti, K. (2022). 2022 update to the position statement by Primary Care Diabetes Europe: A disease state approach to the pharmacological management of type 2 diabetes in primary care. Primary Care Diabetes, 16(2), 223–244. https://doi.org/10.1016/j.pcd.2022.02.002
Sinclair, A. J., Abdelhafiz, A. H., Summerbell, A. M., Cukierman‐Yaffe, T., Wylie, S. L., Muzulu, S., ... & Si, P. E. H. (2025). Special Issues in old age: Frailty. Care of Older People with Diabetes: A Manual for Healthcare Practice, 241-403.https://doi.org/10.1002/9781394205066.ch16
Sinclair, A. J., Abdelhafiz, A. H., Summerbell, A. M., Cukierman‐Yaffe, T., Wylie, S. L., Muzulu, S., ... & Si, P. E. H. (2025). Special issues in old age: frailty. Care of Older People with Diabetes: A Manual for Healthcare Practice, 241-403.https://doi.org/10.1002/9781394205066.ch16
Speziale, H. S., Streubert, H. J., & Carpenter, D. R. (2011). Qualitative research in nursing: Advancing the humanistic imperative (5th ed.). Lippincott Williams & Wilkins, USA.
van der Gaag, M., Heijmans, M., Spoiala, C., & Rademakers, J. (2022). The importance of health literacy for self-management: a scoping review of reviews. Chronic Illness, 18(2), 234- 254. https://doi.org/10.1177/17423953211035472
Vitale, R. J., Wentzell, K., & Laffel, L. M. (2022). “Fear that one day i may not be able to afford insulin”: The emotional burden of diabetes costs during emerging adulthood. Diabetes Technology & Therapeutics, 24(12), 915-919. https://doi.org/10.1089/dia.2022.0170
Yoon, S., Kwan, Y. H., Phang, J. K., Tan, W. B., & Low, L. L. (2022). Personal goals, barriers to self-management and desired mhealth application features to improve self-care in multi- ethnic asian patients with type 2 diabetes: a qualitative study. International Journal of Environmental Research and Public Health, 19(22), 1–13.https://doi.org/10.3390/ijerph192215415
Zeynali, M., Alipour, K., Tarvirdizadeh, B., & Ghamari, M. (2025). Non-invasive blood glucose monitoring using PPG signals with various deep learning models and implementation using TinyML. Scientific Reports, 15(1), 1–23. https://doi.org/10.1038/s41598-024-84265-8