Barriers and facilitators to diabetes management among adults and healthcare providers in a peri-urban Ugandan health facility: A qualitative study
Diabetes mellitus is an increasing public health challenge in Uganda and other low- and middle-income countries, where health systems face growing demands for chronic disease care. Although quantitative studies have documented poor glycemic control and health system constraints, less is known about how patients and healthcare providers experience diabetes management in peri-urban public health settings. This study explored barriers and facilitators to diabetes management among adults with diabetes mellitus and healthcare providers at a peri-urban health facility in Uganda. We conducted a qualitative descriptive study at Kasangati Health Centre IV, Wakiso District, Uganda, between February and March 2025. Data were collected through 15 in-depth interviews with adults living with diabetes mellitus and 8 key informant interviews with healthcare providers involved in diabetes care. Participants were purposively selected based on their experience with diabetes management and service delivery. Interviews were audio-recorded, transcribed verbatim, translated where necessary, and analyzed using a hybrid inductive-deductive thematic approach informed by the Theoretical Domains Framework. Five interrelated themes were identified: (1) institutional and environmental factors influencing access to diabetes care; (2) cognitive and informational factors influencing medication adherence; (3) social influences on diabetes management; (4) emotional experiences of patients and healthcare providers; and (5) self-management strategies and continuity of care. Across these themes, participants identified barriers including resource limitations, communication challenges, medication management difficulties, stigma, emotional distress, and weak follow-up systems. Facilitators included peer support, religious and community networks, health education, provider flexibility, and patient-developed adherence strategies. Diabetes management was influenced by interacting health-system, social, informational, and behavioural factors. Resource constraints, limited health literacy, stigma, and weak follow-up systems hindered effective management, while social support, health education, and patient self-management strategies facilitated continued engagement in care. Interventions that strengthen chronic care services, patient education, and community support may improve diabetes outcomes in similar resource-constrained settings.