{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T08:15:33Z","timestamp":1788509733730,"version":"build-2803163510"},"reference-count":33,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Walailak University Research Fund","award":["CGS-RF-2024\/16"],"award-info":[{"award-number":["CGS-RF-2024\/16"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,5]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the behavioural and social determinants of type 2 diabetes mellitus (T2DM) self-care adherence in South Ethiopia using the integrated health belief model (HBM) and health-related quality-of-life (HRQoL) frameworks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Three public hospitals in South Ethiopia: Wolaita Sodo University Comprehensive Hospital, Humbo Primary Hospital and Boditi Primary Hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>404 systematically sampled adults aged 18\u201360 years with a confirmed diagnosis of T2DM who had been attending follow-up clinics for at least 12 months. Exclusion criteria included newly diagnosed T2DM, pregnancy, severe comorbidities or critical illness and unwillingness to participate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was adherence to diabetes self-care, assessed using the Summary of Diabetes Self-Care Activities scale across five domains: diet, physical activity, medication intake, blood glucose monitoring and foot care. Good adherence was defined as engagement in recommended behaviours on \u226550% of days per week. Secondary outcomes included socio-demographic factors, clinical variables, HBM constructs (perceived susceptibility, severity, benefits, barriers, cues to action and self-efficacy) and HRQoL domains (physical, psychological, social and environmental).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 404 participants, 58.4% demonstrated good adherence. In multivariable analysis, insulin-only treatment (AOR=3.0; p&lt;0.001), having comorbidities (AOR=2.02; p=0.007) and poor glycaemic control (AOR=3.6; p=0.003) were positively associated with adherence. Factors associated with poor adherence included low income (AOR=0.18; p=0.002), living alone (AOR=0.19; p=0.012), low self-efficacy (AOR=0.18; p&lt;0.001) and poor psychological health (AOR=0.53; p=0.024).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings challenge the direct application of standard behavioural models in low-resource settings. Structured factors, such as poverty, can overwhelm psychological mechanisms. Effective interventions must integrate economic support with psychological care to improve self-care adherence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-112143","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:55:25Z","timestamp":1785930925000},"page":"e112143","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Behavioural and social determinants of type 2 diabetes self-care adherence in a low-resource setting in South Ethiopia: a cross-sectional study using integrated health belief model and health-related quality-of-life frameworks"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9440-2622","authenticated-orcid":false,"given":"Temesgen Anjulo","family":"Ageru","sequence":"first","affiliation":[{"name":"Public Health Research Program, School of Public Health, Walailak University, Nakhon Si Thammarat, Thailand"},{"name":"Excellent Center for Public Health Research (EC for PHR), Walailak University, Nakhon Si Thammarat, Thailand"},{"name":"College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5634-7669","authenticated-orcid":false,"given":"Cua Ngoc","family":"Le","sequence":"additional","affiliation":[{"name":"Public Health Research Program, School of Public Health, Walailak University, Nakhon Si Thammarat, Thailand"},{"name":"Excellent Center for Public Health Research (EC for PHR), Walailak University, Nakhon Si Thammarat, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9537-8510","authenticated-orcid":false,"given":"Apichai","family":"Wattanapisit","sequence":"additional","affiliation":[{"name":"Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1720-7561","authenticated-orcid":false,"given":"Eskinder Wolka","family":"Woticha","sequence":"additional","affiliation":[{"name":"College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2318-4570","authenticated-orcid":false,"given":"Charuai","family":"Suwanbamrung","sequence":"additional","affiliation":[{"name":"Public Health Research Program, School of Public Health, Walailak University, Nakhon Si Thammarat, Thailand"},{"name":"Excellent Center for Public Health Research (EC for PHR), Walailak University, Nakhon Si Thammarat, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"2026090400400920000_16.8.e112143.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-021-00613-y"},{"key":"2026090400400920000_16.8.e112143.2","unstructured":"IDF, International Diabetes Federation . 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