Content

end

Raji¹ AS and Okyere² S

Metadata

Highpoints

• Review of coping strategies by diabetic patients
• To update stakeholders on diabetes coping strategies
• The effects of physical, psychological, social, and financial coping strategies on diabetics are fully discussed

2. Citation: Raji AS and Okyere S. A review of the coping strategies adopted by diabetes patients in Ghana. Special Journal of Open Research and Reviews 2022, 2(2): 1-25. DOI: 10.61915/orr.456123.
3. DOI URL:  http://doi.org/10.61915/orr.456123
4. Address: 1. Department of Basic and Applied Biology, The University of Energy and Natural Resources, Post Office Box 214, Sunyani Ghana, Email: abdul.raji@uenr.edu.gh. Stephen Okyere, University Library, the University of Health and Allied Sciences, PMB 31. Ho, Ghana. Email: sokyere@uhas.edu.gh

4. Article history: Received: November 26, 2021, Accepted: January 6, 2022:  Published: February 12  

5. Correspondence: Abdul Sakibu Raji, Email: abdul.raji@uenr.edu.gh
6. Distribution and usage license: This open-access article is distributed by the terms and conditions of the Creative Commons Attribution 4.0 International License seen in this link (http://creativecommons.org/licenses/by/4.0/ ). You are free to use, distribute, and reproduce this article in any medium, provided you give correct credit to the original author(s) and the source, including the provision of a link to the Creative Commons license website. Pls show any modification’s

Abstract

Background: During the COVID-19 pandemic, reports have shown the devastating impact of Diabetes mellitus, with patients diagnosed with COVID-19 and having diabetes comorbidities having a high risk of mortality. Despite the predictability of mortality among COVID patients with diabetes, some diabetic patients survive. Diabetics use coping strategies, which are cognitive and behavioral maneuvers, to manage their condition, crises, and all of the demands that come with the condition.

Objective: To conduct a review of the literature on the coping mechanisms used by diabetic patients in Ghana.

Methodology: A systematic literature review technique was used for the study, and published articles and theses that addressed physical, social, and psychological coping mechanisms, as well as the financial ramifications of diabetes mellitus in Ghana, were taken into account.

Among the search engines used were Google Scholar, Scopus, Science Direct, and local University Repositories. The search was restricted to peer-reviewed published research and grey literature written in English and published in Ghana between 2010 and 2021. Out of 503 items, only 26 full-text papers were eventually used for the review process.

Results: Physical coping techniques included lifestyle adjustments, self-care practices, obtaining transportation assistance, collaboration and integration between traditional and orthodox healthcare systems, as well as seeking health care at health centers and health education.

Psychologically, patients participate in emotional self-efficacy, preferring to internalize parts of their views rather than communicating emotionally with their support network. Religion, strong psychological will, and confidence in diabetes control or cure-all positively influenced diabetes management.

Diabetic patients can receive social assistance from family and friends, religious organizations, psychologists, patient organizations of general health professionals, and non-governmental organizations. According to financial implications in diabetic management, the average monthly expenditure on a diabetic patient ranges between GHS150.00 and GHS 450.00, accounting for 60 to 90 percent of the overall cost as a direct cost.

Almost all diabetic patients reported that the NHIS was their primary source of diabetes treatment funding. To cover the cost of diabetic care, some people reportedly take less medication than recommended, sell their valuables, and work longer hours.

Conclusions and implications of key findings: Physical coping approaches include lifestyle changes, self-care practices, transportation support, teamwork, and integration between traditional healthcare systems. On a psychological level, patients engage in emotional self-efficacy. A support network, spirituality, psychological will, and belief in diabetes control or cure-all had a good impact on diabetes management.

Among the social support mechanisms were family and friends, religious groups, psychologists, general health professionals’ patient organizations, and non-governmental organizations. The financial implications of diabetes patient maintenance range from GHS150.00 to GHS 450.00 per diabetic patient per month, with 60 to 90 percent of the total cost as a direct expense.

More high-quality research is needed to correlate coping techniques with disease outcomes. There is also a need for the Ministry of Health and the Ghana Health Service to develop a strategy to incorporate these coping mechanisms into Ghana’s overall diabetes management.

Keywords: Diabetes, Diabetes mellitus, Coping Strategies, Coping Mechanisms, Ghana.

Introduction

Diabetes is a major public health concern with far-reaching consequences in people’s lives. Diabetes Mellitus (DM) is the most prevalent metabolic disorder, characterized by chronic hyperglycemia and insufficient peripheral tissue response to circulatory insulin or anomalies in insulin secretion (1, 2). Diabetes mellitus symptoms include thirst, polyuria, blurred vision, and weight loss (3, 4).

Ketoacidosis or a non-ketotic hyperosmolar state can develop in its most severe stages, culminating in a stupor, coma, and, in the absence of effective treatment, death (4). Chronic hyperglycemia has been associated with long-term damage, dysfunction, and failure of multiple organs, most notably the eyes, kidneys, nerves, heart, and blood vessels (3).

Diabetes prevalence has risen dramatically globally, with the latest estimates putting the number of adults with the disease at over 422 million, with a 1.5 million annual death rate attributed to the disease (5).  Diabetes is expected to become the seventh leading cause of death by 2030 (6), with over 600 million people affected by the disease by that time.

Diabetes prevalence is expected to rise by more than two-thirds in low- and middle-income countries, particularly in Sub-Saharan Africa. The disease’s burden has risen dramatically across Africa, from an estimated 7.1 million in the early 2000s to an estimated 18.6 million by 2030 (5). Diabetes prevalence patterns in Ghana are similar to those in other Sub-Saharan African countries. Previous studies estimated prevalence rates of less than 0.02 percent of the adult population, with current numbers ranging from 6.2 percent to 13.9 percent (5, 7).

This demonstrates the importance of diabetes in Ghana’s population for both the health system and the government. When the COVID-19 pandemic broke out, investigations revealed the devastating impact of Diabetes mellitus, with patients with COVID-19 and comorbidities having a high chance of fatality (8-10). Despite the inevitability of death among COVID patients with diabetes, some diabetics live.

Rationale

Diabetic individuals face a variety of challenges during their treatment. Seurng (11), Walker, and Garbe (12) discovered that diabetic patients face financial losses due to the high cost of medication and the inability to work full-time. According to the research, diabetic individuals face a variety of challenges during their treatment. Seuring, (11), Walker, and Garbe (12) discovered that diabetic patients face financial issues due to the high cost of medication and inability to work full-time.

Korsah (13) reported that diabetes patients suffer from low self-esteem as a result of body deformities caused by diabetic wounds and 65% have psychological symptoms such as depression, worry, and hopelessness. Werfalli and Kalula (14) identified a lack of social support from family, friends, church members, and organizations as the primary social stress experienced by diabetic patients. In a related article.

Objective:

To conduct a review of the literature on the coping mechanisms used by diabetic patients in Ghana

Materials and Methods

Literature Search Strategy (Search terms/algorithms)

Initially, a wide range of search phrases such as “diabetes”, “diabetes mellitus”, “coping mechanisms”, “physical coping mechanisms”, “psychological coping mechanisms”, “social support systems”, “financial implication”, and “Ghana” was used to capture the area of inquiry. The search statements were refined regularly to improve the search process and locate relevant content.

To search the databases, the following final statements were used: “diabetes mellitus” AND “coping mechanisms” AND “Ghana”; “diabetes mellitus” AND “physical coping mechanisms” AND “Ghana”; “diabetes mellitus” AND “psychological coping mechanisms” AND “Ghana”; “diabetes mellitus” AND “social support systems” AND “Ghana”

Database Search

We searched from the databases of Scientific Information (ISI), Cochrane, MEDLINE, Scopus, PubMed, ScienceDirect, Research gate, Google Scholar, Local University Databases such as UGSpace, KNUSTSpace, UCC Space, UDS Space, etc. The reference lists of identified studies were also screened to recover other articles.

Number of results found

In total, 503 records were found by searching databases and other sources. The relevant section of each selected article was then examined. After removing duplicates, the articles were entered into the EndNote software, and 431 references remained. The titles and abstract sections of the articles were checked, and 388 papers were excluded because their titles suggested that they did not fall within our study’s scope. As a result, 43 articles were available. Finally, twenty-six full-text papers were used in the review process.   

Inclusion and Exclusion Criteria

Twenty-six (26) papers were reviewed, which examined diabetic patients’ coping techniques in the form of psychological, physical, available social support networks, and financial implications in dealing with the disease. From 2010 to 2021, this included published quantitative, qualitative, and mixed studies, as well as observational studies on diabetic Mellitus coping, such as cross-sectional and cohort studies. Four hundred and seventy-seven (477) articles on non-communicable or non-diabetic diseases were excluded, as were brief reports, abstracts, editorials, comments, or discussion pieces.

Result of relevant Literature Reviewed

Physical coping strategies among diabetic patients

Diabetic patients cope in a variety of ways with physical challenges such as restricted physical energy, fatigue, and weight loss. Despite being aware of the importance of lifestyle in diabetes pathogenesis, the majority of diabetics engaged in diabetes-related high-risk behaviors such as inactivity, sedentary living, and poor diet.

In the current review, common self-care practices include following dietary recommendations, exercising, getting a blood sugar test (BST), caring for one’s feet, and taking medications; seeking transportation assistance, collaboration, and integration between traditional and orthodox healthcare systems; and seeking health care at health centers and health education primarily through various radio and television stations.

Vocational training

Participants who were vocationally trained were less likely to adhere to dietary recommendations (AOR=0.06; 95 percent CI=0.001-0.36; p0.001), but those who were aware of their disease were more likely to comply (AOR=38.8; 95 percent CI=3.01-49.25; p=0.016).

Ninety-six percent of those who took part ate the necessary three square meals per day. Diet and exercise adherence was found to be relatively low. Adherence to dietary recommendations was found to be influenced by the type of treatment and being on herb therapy. The vast majority of individuals were well-versed in their illness.

Assistance to the disable

Participants noted the necessity for assistance with their wheelchair and getting into an appropriate vehicle before being able to utilize a prosthetic limb, according to Palaya, Pearson (17). Some recounted how being in a plaster cast to cure a diabetic foot ulcer had limited their capacity to participate in events and provide reciprocal support to others.

Adulai (18) found that diabetes knowledge had a large positive influence on patients’ self-care practices, but diabetes beliefs had a significant detrimental effect on patients’ self-care. However, no statistically significant relationship was discovered between diabetic attitude and self-care activities.

Demography

Further investigation revealed that education, gender, marital status, and age all had a substantial impact on their self-care routines. Korsah (13) has claimed that more collaboration and integration between traditional and orthodox healthcare systems will provide the best potential to maximize patient care in Ghana. Asante (19) investigated diabetics’ perceptions of the causes of their diabetes.

Participants overwhelmingly believed that poor eating habits, excessive smoking, physical inactivity, excessive thinking, or worries were associated with an increased risk of diabetes, hypertension, and stroke, which could result in deformity or death. Poor eating habits, excessive smoking, physical inactivity, excessive thinking, or anxieties, according to the participants, were connected with an increased risk of diabetes, hypertension, and stroke, which could lead to deformity or death.

Dietary management

Hushie (20) reported that most participants experienced numerous hurdles to diet management, such as having to negotiate dietary recommendations with the dietician or having to make their own decisions on recommended parameters.  Most patients emphasized eating habitual Ghanaian foods (e.g., cassava, yam, plantain, cocoyam, sweet potatoes, and sauces, which are high in sugars, sodium, and fat; or low in protein and fiber) that contradicted recommended dietary guidelines, and they felt they had little or no self-control when it came to dietary choices.

Selfcare

Nam (21) discovered that total self-care habits were negatively linked with HbA1c in their study. Age, number of years living with diabetes, and total self-care all predicted 19.3 percent of the variation in glycated hemoglobin (HbA1c), with total self-care accounting for 35.5 percent of the predictive power. Self-care is useful in lowering glycemic levels (HbA1c) in diabetics.

Even while participants had a positive perspective of diabetes and its management, this did not translate into their self-care behaviors, resulting in high glucose levels. To ensure that patients adhere to self-care procedures, the author suggested a balance of oral health education on diabetes and monitoring of patients’ self-care activities.

Quality of life

According to Quaye (22), healthy individuals had a higher quality of life than hypertensives and diabetics, while diabetics had a lower quality of life than hypertensives. Patients with chronic illnesses who had a higher socioeconomic status had no better quality of life than those who had a lower socioeconomic status.

There was no significant difference in quality of life (p =.042) between chronically ill males (M = 62.43, SD = 12.75) and chronically ill females (M = 66.02, SD = 19.32). There was a positive association between sickness perception and quality of life (r =.619, p.01). Medication adherence demonstrated a favorable link with the quality of life (r =.412, p.01). Medication compliance influenced the link between sickness perception and quality of life (Z = 4.91, p.001).

Diagnosis of diabetes

Attuquaye (23) agrees that delayed diagnosis, diabetes complications, and the cost implications of diagnosis and diabetes management all necessitate more public education to raise awareness of the benefits of early diagnosis and management of the condition to prevent or reduce complications.

If the public understands and accepts this understanding, and the essential instructions are followed, the results may result in the reversal of diabetes disease development and associated costs. Because of rising obesity rates, the prevalence of Type 2 diabetes was high. Effective treatment techniques are also essential to postpone and avoid diabetic consequences such as cardiovascular disease.

Premorbid diabetes risk attenuator

Tabong, Bawontuo (24) discovered that respondents thought diabetes was a condition for the elderly and wealthy, which served as a premorbid risk attenuator. Despite their knowledge of the significance of lifestyle in diabetes pathogenesis, the majority of them engaged in diabetes-related high-risk behaviors such as lack of exercise, sedentary living, and unhealthy eating.

The study discovered that patients used moringa, noni, prekese, and garlic with conventional treatments. Adherence to dietary and exercise adjustments was difficult, with females reporting better adherence than males.

Diabetes control alternatives

The study also found that patients believed biological health facilities gave insufficient attention to psychosocial aspects of care, despite their importance in dealing with the condition. Furthermore, the study’s findings revealed that diabetic patients used local remedies (in addition to taking their medications) as part of their home-based management of the disease condition.

In this study, over 60% of diabetics used a combination of traditional and local therapies to control their disease at home. Moringa, precise, noni (Morinda citrifolia), and garlic were among the native cures highlighted in this study. Prekese is a Twi (language) term for the plant Tetrapleura tetraptera, whereas moringa is derived from the plant Moringa oleifera.

Combination of conventional medications and traditional alternatives

Other individuals reported combining conventional medicines with concoctions supplied to them by traditional healers. These home treatments may have the ability to lower blood sugar levels. Woode (25) discovered that 94.5 percent of people did not take any personal precautionary measures to prevent or reduce their risk of developing diabetes, whereas 16 (5.5 percent) made a few lifestyle modifications in an attempt to prevent or reduce their risk of developing diabetes.

According to their comments, restricting sugar intake was the most important effort performed by 12 (4.1 percent) individuals; 3 (1 percent) participated in physical workouts, and 1 (0.34 percent) decreased carbohydrate-rich based foods intake.

Adherence to diabetes control precautions

The majority of patients examined took their medications religiously but did not change their lifestyle to improve their treatment outcomes. Approximately 95.6 percent used glucometers accessible at diabetic clinics to measure their blood glucose levels at least once a month.

When the glucometer readings are high or other laboratory requests are involved, they report to the laboratories to have their glucose levels checked again with a lipid profile. Far more than half of the respondents, 93.9 percent, used both glucometers and laboratory tests to monitor their blood glucose levels, whereas 15 (5.1 percent) relied solely on laboratory testing.

Furthermore, 2.4 percent checked their blood glucose levels weekly, 5 (1.7 percent) quarterly, and 1 (0.3 percent) every three days. In contrast, 30% of individuals interviewed who did not possess glucometers reported that they visited pharmacy shops every two weeks to check their glucose level for 4-5GHC each test. Only 33.1 percent of all respondents used specific coping mechanisms, which included: 14.7 percent seeking traditional medicine/spiritual assistance; 5.8 percent using local herbs (such as dandelion and moringa); 2.7 percent exercising and dieting; 8.5 percent praying; and 1.4 percent using both prayers and traditional medicine.

Souces of diabetic information

Amponsah (26) discovered that the majority of respondents and participants selected the media as their primary source of diabetes knowledge. Respondents cite widespread awareness of tasting their pee and ants swarming around their urine as diabetic indicators and symptoms. The local nomenclature of these diseases, which are strongly linked to their believed causes, dominated respondents’ knowledge of diabetes. Diabetics face numerous problems, including daily medication, a change in lifestyle, and stigma (26).

Many people in the country listen to health programs on various radios and televisions, and they trust whatever information is offered on these media platforms, regardless of who is delivering it. As a result, researchers recommended that this health information be double-checked and screened by appropriate institutions such as the Ministry of Health and the Ghana Health Service to ensure that what is being told about the perceived causes, preventions, management, and medicines for diabetes is correct.

Quality of life

According to Acheampong (27), Type-2 diabetic patients have a lower quality of life than the healthy control group. Self-care activities increased the quality of life of type 2 diabetic patients substantially. Owiredua (28) discovered that a patient’s cognitive and emotional appraisal of their chronic illness is crucial in chronic illness management. As a result, patients have their own views and expectations about their illness, in addition to what health experts tell them.

Patients’ health beliefs and expectations are related to their adherence to prescribed medication and their level of psychological distress. The evidence from this study also suggests that health professionals should pay close attention to how patients represent their diabetes, as previous research has shown that patients’ illness representation is significantly related to their level of medication adherence. Salia (29) investigated diabetic patients with foot ulcers using an exploratory descriptive design.

Foot ulcer care

In-depth interviews were conducted, and the participants reported that diabetic foot ulcer treatments were difficult times in their lives. Despite the difficulties, participants used self-wound care, diet therapy, and medications as coping strategies, in addition to financial, emotional, psychological, and social support from their spouses, children, family members and friends, the church, community members, and health care professionals. The first stage of ulcer diagnosis was marked by pain and burning sensations, immobility, and a lack of exercise.

Diabetic patients’ psychological coping mechanisms

According to a study of publications on the psychological coping techniques used by diabetes, patients participate in emotional self-efficacy, preferring to internalize parts of their ideas rather than emotionally expressing them with their support network. Religion, a strong psychological will, and the conviction that diabetes can be controlled or cured all had a good impact on diabetes treatment.

Risk of post-traumatic stress disorder

Mensah Kubuga (30) investigated the impact of diabetes on food consumption and the psychological impact of living with diabetes in diabetics at the Tamale Teaching Hospital. The study discovered that all diabetic respondents were at risk of post-traumatic stress disorder (PTSD); four out of every six diabetic respondents had a 75% chance of being diagnosed with PTSD as a result of living with diabetes, while one out of every six diabetic respondents had the highest chance (above 75%).

Owusu (15) also investigated the life experiences of people living with type 2 diabetes mellitus in Accra by examining their psychosocial experiences and how they cope with their condition. She discovered that living with type 2 diabetes mellitus has been linked to severe negative psychological consequences for patients, the most common of which are depression and anxiety. Some patients did not mention signs of psychological issues since they claimed to be able to manage their disease.

Social repercussions

Patients have various unfavorable social repercussions as a result of their condition, such as social constraints, isolation, and stigmatization from community members due to substantial weight loss that is misinterpreted as HIV. Living with type 2 diabetes mellitus has severe negative psychosocial repercussions for patients, and healthcare providers should be on the lookout for these issues to provide the necessary support and treatment.

Again, Amankwah-Poku, Amoah (31) discovered a link between psychosocial distress, clinical factors, and self-management activities in type 2 diabetes management. The PAID allowed for the assessment of a broader range of emotional concerns (diabetes-related emotional distress), whereas the DDS allowed for the assessment of factors more closely related to diabetes self-management (diabetes distress).

Diabetes and psychological variables

Diabetes-related emotional distress, diabetes distress, and depressive symptoms were all found to be positively correlated, whereas non-supportive family behavior was found to be negatively correlated with these psychological variables. Diabetes-associated emotional discomfort was positively connected to systolic and diastolic blood pressure and adversely related to an exercise routine.

Diabetes distress was adversely associated with dietary and exercise routines and positively associated with glycemic levels, whereas depressive symptoms were positively associated with glycemic levels, diabetes complications, and systolic blood pressure.

Psychosocial care in diabetic management

The positive relationship between psychological variables and glycemic and blood pressure levels, as well as the positive relationship between non-supportive family behavior and self-management activities, suggests that psychosocial care should be included in the management of type 2 diabetes in Ghana. Patients can be screened for diabetes-related distress and depression symptoms, and if necessary, psychosocial care can be provided.

Emotional self-efficacy

Six of the eight individuals in Palaya and Pearson’s (17) interviews expressed a desire to engage in emotional self-efficacy regardless of the chronicity or severity of the ulceration. Some of their thoughts were internalized rather than shared emotionally with their support network. Three individuals expressed a strong desire for most self-sufficiency, and all of them mentioned being able to put their situation into perspective by seeing others as worse off. They described what appears to be the presence of depressive symptoms as well as a propensity to cope with their mental health problems on their own.

Self-help

One participant was especially hesitant to use psychology services. Researchers proposed that future approaches to mental health support services could include the health practitioner acknowledging and encouraging the individual to self-cope while also implying that self-help approaches are more successful if initiated, guided, maintained, and monitored by professionals.

This could result in a more proactive approach to the management of those experiencing a mental health crisis, such as Sophie. In this case, there is evidence to support the buffering hypothesis of social support because her sense of isolation, low self-efficacy, and reluctance to seek professional help all contributed to her being more affected by stressful situations like an infected diabetic foot ulcer.

Religious activities

Botchway and Davis (32) investigated whether the frequency of participation in religious activities and seeking care from spiritual and other traditional medicine (TM) practitioners, as well as their association with blood glucose (HbA1c) control, were associated with blood glucose (HbA1c) control in urban Ghanaians with type 2 diabetes mellitus (T2DM). Increased engagement in religious activities was shown to be strongly linked with lower HbA1c levels, whereas increased use of TM practitioners was found to be significantly associated with higher HbA1c levels.

Religious activities, according to the researchers, should be strategically integrated into disease management plans for Ghanaians with T2DM who identify as religious as a viable intervention. According to Hushie (20), patients’ hopes and fears have corresponding positive and negative emotional responses to the diagnosis, and they also serve as barriers to or facilitators of ongoing T2D self-management.

Combination of biomedicine, and religion

Hushie (20) discovered that patients relied on a combination of biomedicine, religion, and faith in God to help them manage their diabetes. This finding emphasizes the significance of religion and faith in God in diabetes management. These findings revealed that, depending on how one channel their faith, trust in God may be both a big source of support and a substantial barrier in diabetes self-care.

Diabetes fear made it difficult for patients to disclose the diagnosis to family members and/or pretend to be well, and adherence to dietary guidelines and medications was generally hampered by changes in dietary habits, adherence during social occasions, and adherence when with family and friends. The survey also found that people believed God would take care of them, so they didn’t have to worry about their diabetes.

In contrast, Nyarko, Kugbey (33) investigated the impact of diabetic patients’ perceptions of their condition and religion on their mental health problems at Korle-Bu Teaching and Tema General Hospitals. The results demonstrate that the religious tendency of diabetes patients did not substantially correlate with their mental health problems [r(192) =.09, >.05].

Illness perceptions and diabetes management

Illness perception is  significantly and positively related to their overall mental health problem (MHP) and particular ones such as somatization [r(192) =.20,.01], obsessive-compulsive disorder [r(192) =.13,.05], depression, anxiety [r(192) =.19,.01], and psychoticism [r (192) =.12,.05]. Multiple regression analyses demonstrate that the perception of sickness coherence [ = -.33, t = -4.92,.01], followed by perceptions of symptoms [ =.27, t = 3.89,.01] and perception of concern [ =.16, t = 2.46,.05] substantially predicted the level of general mental health problem (MHP). Similarly, among diabetic patients, perception of coherence was the most important predictor of both depression and anxiety.

Korsah (13) also reported that diabetes was associated with spiritual powers in several ways, and some respondents discussed the idea that diabetes may be contracted ‘spiritually,’ through food that one eats, in that an envious person, in some mystical way, can give the disease, in this case, diabetes, to another person (the target of the envy) through food.

It was odd to see a pastor of a Christian church retain the same beliefs as the general public about traditional beliefs and the existence of supernatural creatures, including witchcraft. It found that there were no differences in participants’ conceptions of spiritual reasons of diabetes, regardless of their background, including education, religion, age, and sexual orientations, since practically all participants strongly maintain this reported opinion.

Diabetes as a home disease

Korsah (13) goes on to say that family and friends or close allies educate the sick person that his or her disease is not a ‘hospital disease,’ but rather ‘efie yare,’ which translates to ‘home disease.’

‘Home diseases’ are thought to be caused by spiritual forces, and treatments for such conditions include spiritual activities such as invocations. The desire for a “cure” was evident in the narratives of five respondents, and this was linked to participants who either began medical treatment immediately upon diagnosis, later reverting to spiritual/herbal treatment, or participants who combined both medical and traditional treatments. Participants’ ultimate ‘cure seeking’ belief for diabetes mellitus, a chronic condition, was to seek hospital treatment, which was contrary to their initial belief in the supernatural as a source of cure for the condition.

The religious aspect of diabetes management

Their religious affiliation had no bearing on their decision to treat the condition with biomedicine or spiritual means. Some diabetics believe that God can cure diabetes because God is the Creator of humans and, as such, can identify what is wrong with the participants. Amponsah (26) in his analysis, reported that most of the respondents (56.6 percent) thought that witches and wizards may deliver diabetes or hypertension to any individual of their choice while 43.4 percent said it is not conceivable.

Diabetes self-management practices

Asante (34) discovered that the level of good diabetes self-management practices was 25.2 percent and that high satisfaction with how well health care providers help patients understand diabetes self-management was also associated with an increase in participant SDSCA (=3.47; 95 percent CI= 1.46-8.22). Other variables were not found to be significantly related to SDSCA. Diabetes self-management practices were found to be low among diabetes patients attending the Greater Accra Regional Hospital.

Illness perception and quality of life

As Quaye (22) discovered, the relationship between illness perception and quality of life was partially mediated by medication compliance. Highly religious chronically ill patients had higher quality of life than low religious chronically ill patients. In conclusion, the author proposed that health practitioners should pay more attention to patients’ quality of life and help them establish a positive view about their illness and comply with the treatment regimen.

Bawontuo, Tabong (24) According to the study, many people felt uneasy when they were told they had diabetes because it is a chronic condition that requires lifelong management and daily medication. Respondents were saddened and had to think about it for several days. When they started the treatment, however, this feeling gradually faded.

Respondents under the age of 40 originally rejected the ailment because they believed diabetes was exclusive for the elderly. Physicians also mentioned the importance of counseling and psychological support for patients for them to accept their condition. They advocated for psychologists to be stationed in hospitals so that persons suffering from chronic diseases that necessitate lifelong therapy may receive psychotherapy and assistance. Another physician specialist interviewed expressed his thoughts on diabetic patients’ psychotherapy.

Diabetes and depression

Woode (25) discovered that 12.6 percent had moderately severe depression and 17.7 percent had diabetes problems. Individuals in informal employment were 17 times more likely to have depressive symptoms than those in formal employment (aOR=17.0; 95 percent CI: 1.7-177.6; P=0.017).

Respondents who did not know how they got the disease were less likely to default in their clinic attendance (OR=O.4; 95 percent CI=-0.2-O.7; P=0.005) compared to those who did know how they got the disease, while those who did not know how they got the disease were 8 times more likely to be burdened by depressive symptoms (aOR=8.0; 95 percent CI: 1.9-32.8; P=0.004).

Respondents who did not have a family history of the disease were 4.5 times more likely to have depressive symptoms than those who did (aOR=4.5; 95 percent CI: 1.0-20.1; P= 0.049). While 73.4 percent of respondents believed the disease was caused by God, 93.5 percent were aware of religious coping strategies. Patients’ perceptions of how they had the disease were influenced by a variety of social, spiritual, and environmental factors, which influenced their coping strategies.

Diabetes and emotions

The emotions described by respondents have been accepted as a normal part of the process of being diagnosed with a disease, particularly a chronic condition. This explains why they should seek advice. Even though health care professionals stated that all diagnosed patients are counseled, 264 (85.4 percent) agreed they were counseled after being diagnosed. Accepting a chronic condition diagnosis is a process of adjustment that aids in the modification of lifestyle choices and influences better treatment outcomes. It is well known that functional disabilities, treatment costs, and reliance on others, particularly family members, can all have an impact on diabetic patients’ psychological well-being.

Diabetes and religious perceptions

Foot ulcers, excessive weariness, headaches, and recurrent stomach pains were all noted as problems. More than 93 percent of participants were aware of prayers, including the belief that diabetes is caused by God, while 6.5 percent believe prayers have little to do with diabetes. Nuworza (35) investigated the impact of diabetic patients’ perceptions of their illness and their levels of religiosity on their mental health problems at two major hospitals in Ghana’s Greater Accra Region (Korle-Bu Teaching and Tema General Hospitals). According to the findings of the study, the level of religiosity of diabetic patients did not have a significant relationship with their mental health problems.

Sickness perception and general mental health

However, sickness perception was strongly and positively connected to their general mental health problem (MHP) as well as particular ones such as degrees of Somatization, Obsessive-Compulsion, Depression, Anxiety, and Psychoticism. It is concluded that diabetic patients’ perception of their illness plays a significant role in their experience of mental health problems, and that sex and level of education also have a significant impact on their mental health problems, necessitating attention from health officials for holistic healthcare.

Religious coping and quality of life

Acheampong (27) also discovered that religious coping improved the quality of life of type 2 diabetic patients significantly. Stress was found to be a poor predictor of quality of life in type 2 diabetic patients, although depression and anxiety were not. There were five emerging themes on coping and quality of life in total. Prayer, strength, healing from God’s word, adjustment, protection, security, and healthy practices are examples of these. Among all the themes, prayer appears to be the most prominent. In general, participation in religious rituals and activities provided participants with a sense of security and solace. As a result, religiosity appears to be an efficient way for individuals to manage their sickness.

Medication adherence and diverse diabetes representations

Owiredua (28) investigated how patients’ representations of diabetes, psychological distress, and use of spiritual coping influence their medication adherence using a purposive sampling technique at Tema General Hospital. It was found that illness representation components such as illness consequence, personal control, and emotional representation predicted medication adherence.

The illness representation components that predicted psychological distress were a chronic timeline, illness coherence, emotional representation, and consequences. Medication adherence was not predicted by psychological distress, spiritual coping, or demographic variables. Spiritual coping did not, once again, mediate the relationship between illness representation and medication adherence.

Diabetes patients who mistrust their abilities to control their condition, have higher disease consequences, and have higher levels of negative feelings about the disease are less likely to stick to their recommended treatments (28). According to the author, interventions should thus be aimed at empowering patients to take maximum control over their illness, because their actions are expected to improve their conditions. While caring for diabetic patients, health practitioners must be holistic in their approach to healthcare, taking into account the importance of the patients’ portrayal of the condition.

Salia (29) claims that despite the challenges, participants used their religion in the form of praying and consulting with religious leaders; some aspects of the grieving process, such as denial, isolation, and acceptance, were used in coping with the disease using an exploratory descriptive design from Korle-Bu Teaching Hospital in Accra (KBTH) through in-depth interviews.

Social support mechanisms available at the diabetes clinics

Family and friends, religious groups, psychologists, general health professionals’ patient organizations, and non-governmental organizations were among the social support mechanisms available to diabetic patients. In a few studies, patients described family, friends, and social occasions such as weddings, funerals, naming ceremonies, and birthday celebrations, which are widespread in Ghana, as barriers rather than facilitators of diabetes management. They typically coped by avoiding attendance with a flimsy excuse, feigning eating, or requesting that the food be taken away.

Diabetic care and NGOs/Associations

Godman and Basu (36) found that patient associations and non-governmental organizations (NGOs), have increasingly played a vital role in African countries to enhance the care of diabetic patients, with a stronger emphasis on improving the management of patients with NCDs. Improved diabetes treatment is gaining traction across Africa and Ghana, as countries build and revise action plans to improve the care of people with NCDs as part of SDG goals.

Aikins and Boynton (37) investigated the fundamental differences between Ghana and Cameroon in the multiple-institutional and multi-faceted responses’ to chronic diseases and found that Ghana lacks a chronic disease policy but does have a national health insurance policy that covers drug treatment of some chronic diseases, a culture of patient advocacy for a wide range of chronic conditions, and mass media involvement in chronic disease education.

Churches in both countries (Ghana and Cameroon) educate people about serious chronic diseases. Neither country has carried out a systematic assessment of the impact of initiatives on health outcomes and cost-effectiveness. Palaya and Pearson (17) discovered that some of their study participants were extensively involved in community groups, charities, and parental or family obligations, whilst others were constrained to merely offering emotional support to others, owing to the high amount of care they require. Participants’ perceptions of communication and interactions with health providers suggest a role for collaborative decision-making processes in the management of diabetic foot ulcers.

Family support

According to Asante (19), family support was a common adaptation technique among study participants. Respondents responded that coping with the challenges of chronic diseases such as diabetes necessitates significant engagement between patients and their families to identify the best ways to collaborate. Family support was a common adaptation technique among participants in the study area, similar to the observed coping approach in most studies.

Diabetes and Religious/traditional medical alternatives

Botchway and Davis (32) investigated whether the frequency of participation in religious activities and seeking care from spiritual and other traditional medicine (TM) practitioners were associated with blood glucose (HbA1c) control among urban Ghanaians with type 2 diabetes mellitus (T2DM). They discovered that increased frequency of participation in religious activities was significantly associated with lower HbA1c levels, whereas increased use of TM practitioners was significantly associated with higher HbA1c levels.

These findings imply that strategically including religious activities into disease care programs for religious Ghanaians with T2DM may be a potential therapeutic technique. Hushie (20) also discovered three types of barriers or facilitators of diabetic self-care: 1) social functions, 2) familial and social ties, and 3) a lack of knowledge about the social components of diabetic self-care during counseling sessions. Weddings, funerals, naming ceremonies, and birthday parties, which are quite popular in Ghana and rooted in strong social and cultural norms, were described as barriers rather than facilitators of controlling T2D by patients.

Diabetes and social functions

Social functions were seen as significant hurdles because there was too much temptation available, combined with a lack of healthier or more acceptable meal options. As a result, patients evolved a variety of coping strategies and practices toward social gatherings, such as 1) avoiding attendance with a flimsy excuse; 2) faking eating; or 3) requesting that the food be taken away.

Most patients reported that family members helped them with a variety of management strategies, including adjusting to new diet regimes and roles dictated by the patient, assisting with the preparation of recommended meals, acting as checkpoints on patients when they were “tempted” to eat “unhealthy” foods or ate late – and serving as reminders to check their blood sugar levels.

Family members could sometimes be a barrier to patients controlling the illness since they persisted in eating their usual meals rather than conforming to the diabetes patient’s needs. Evidence from counseling sessions revealed that providers frequently focused primarily on clinical aspects of the disease, such as diet, physical activity, and glycemic control, with little emphasis on the social dimensions of the disease, such as how to disclose it to family members or mobilize social support from such family members for managing various aspects of the disease. This could be a serious impediment to patients’ day-to-day management of the disease.

From a different perspective, Korsah (13) says that sick persons face pressure from close family members, and friends, about where to seek treatment, especially if the problem is a chronic disease, such as hypertension, diabetes, or epilepsy. Tabong, Bawontuo (24) also demonstrated that diabetics used various health outlets before receiving a formal diagnosis of the ailment.

Biomedical practitioners, traditional medical practitioners, spiritualists, and homeopathic medicines are among them. Respondents (80%) were frequently pursued concurrently or in sequences depending on recommendations they obtained from other sources (24). Respondents were generally satisfied with their ability to manage the condition at home and were glad to take their drugs regularly with the assistance of a partner or family caregiver (24).

Diabetes and work capacity

According to Woode (25), respondents’ conditions have a detrimental impact on their work capability for reasons such as being too weak to work, becoming easily weary, feeling dizzy and at times unable to sleep at night, and accessing health treatment during clinic days.

Diabetics seek help from family, relatives, friends, neighbors, and, in some cases, their older children and supervisors at work. When asked how they schedule between work and coming to the hospital on clinic days, 32% said they leave work or school to attend clinic; 14% said they have relatives like their husbands, older children, or close relatives who stay with them to take care of the shops; 15.4% said they have apprentices, colleagues, or supervisors who assume their duties for them; and 38.9% said they have no problem scheduling because they work in the evenings, work on specific days, or are on call.

Diabetes and family support

Respondents also reported that their disease generates disagreements/quarrels among family members on occasion, and 2.0 percent stated that their condition creates a general climate of hostility/tension. The majority of respondents (85.7%) reported that their families were extremely supportive of them. The other 14.3 percent of respondents said their family was indifferent to them, 1.4 percent said they were neglected and were among those who said their disease produces an atmosphere of antagonism at home, and the rest (0.7 percent) said their families were unaware they had diabetes. All respondents said that they are not a member of any social group that identifies them as diabetic.

Diabetes and marriage

Surprisingly, Amponsah (26) discovered that participants in his study believed marital status played a significant impact in determining one’s diabetes/hypertension status. The most popular explanations revolved around the preparation of healthy foods and the timing of meals. The reason for this is that once a child leaves his or her parents to begin working, he or she has no choice but to purchase food from a store.

Diabetes and social support

As a result, Acheampong (27) discovered that social support had a considerable favorable effect on the quality of life of type 2 diabetic patients. Support from family was found to be much more beneficial to the quality of life than support from a significant other. Friends’ support, on the other hand, was not a significant predictor of quality of life in type 2 diabetic patients. Low quality of life was also caused by a lack of marital fulfillment. Most patients found that the provision of social support helped deal with the sickness. Church members and family members provided the majority of the social support.

Diabetes and negative social consequences

Owusu (15) investigated the life experiences of people living with type 2 diabetes mellitus in Accra and discovered that patients face some negative social consequences as a result of their illness, such as social restrictions, isolation, and stigmatization from community members due to severe weight loss that is misinterpreted as HIV.

The investigation also revealed that respondents use a variety of coping mechanisms, including support from their social networks, religion, and self-care activities. Owusu (15) also discovered that having type 2 diabetes mellitus has a significant detrimental impact on the patients’ economic lives in the form of job loss and a lack of employment opportunities.

Amankwah-Poku, Amoah (31) investigated the link between psychosocial distress, clinical factors, and self-management behaviors related to type 2 diabetes treatment and discovered that non-supportive family conduct connected negatively with these psychological variables. Salia (29), using an exploratory descriptive design on 12 participants from Korle-Bu Teaching Hospital, concluded that participants used coping strategies such as consulting religious leaders and receiving social support from their spouses, children, family members and friends, church, community members, and health care professionals.

Financial implications for adopting the various coping mechanism

Monthly budget

The average monthly expense on a diabetic patient ranges from GHS150.00 to GHS 450.00, with direct costs accounting for 60 to 90 percent of the overall cost (which comprises of cost of medications, cost of investigations, and cost of other treatments). Diabetics have developed a variety of coping mechanisms, including obtaining financial assistance from family, friends, or remittances, while some make out-of-pocket payments (self-financing) to fund diabetes treatment. Almost of diabetic patients mentioned the NHIS as their primary source of finances for diabetes treatment.

Private insurance was not employed by any of the diabetes patients. Some allegedly take less medication than advised, sell their valuables, and work more hours to help cover the cost of diabetic treatment. Annorbah-Sarpei (38) studied the cost of diabetes among diabetics and discovered that the total direct (medical and non-medical) and the indirect cost was GHS22,074.97 (USD4,165.09), with a mean or average cost of GHS183.96 (USD34.71) per diabetic patient and a median of GHS180.72 (USD34.71) (USD34.09).

The overall monthly direct cost for diabetes accounted for approximately 90% of the entire cost profile of diabetes treatment among diabetics at Ga South Municipal Hospital. Self-financing was mentioned by more than half of those polled as a treatment source. Diabetes treatment expenses continue to climb as drug costs rise, which is a key driving factor. Many diabetic people continue to make out-of-pocket expenses to support their diabetes care.

Diabetes and NHIS

 Even though practically all diabetic patients in the research cited NHIS as their primary source of funding for diabetes treatment, 55.8 percent still reported self-financing treatment costs. None of the diabetes patients reported receiving private insurance, and only 2.5 percent received financial assistance from friends, parents, or remittances.

Individual techniques were mentioned by 53% of respondents (64) as part of their financial coping mechanisms, with 28.4% of them reportedly taking less medication than prescribed and fewer than 1% selling their assets. In terms of public-based mechanisms, one-third of respondents said the NHIS was their financial coping mechanism, while 12% said market-based mechanisms were their financial coping technique. 9.6 percent of those polled said they worked extra hours to cover the cost of diabetic care.

The annual budget for the care of one diabetic patient in Ghana

 The study’s cost data – direct, indirect, and intangible costs – might be used as a funding advocacy tool by public health promoters and educators to support diabetes prevention and promotion programs. According to Attuquaye (23), the annual financial cost of caring for one diabetes patient is projected to be GH 541.35 (US$ 373.34). Service costs accounted for 21.7 percent of total costs, while direct medical costs accounted for 78.3 percent. The drug cost accounted for 69.2 percent of the total financial cost. Diabetes management was expected to cost GH 420,087.67 (US$ 289,715.63) in total.

This represented 8% of the Clinics’ total expenditure in the 2009 fiscal year. The study found that the kind of institution, type of diabetes, and comorbidities all greatly increased the cost of diabetes management to Cocoa clinics. Pei (39) discovered that the total cost of diabetes for 40 households was estimated to be 14,989 Cedi/month, of which 66.5 percent was direct cost and 30.2 percent was indirect cost, after investigating the economic burdens and financial protections of households with diabetes patient(s) in urban Ghana through cost-of-illness analysis and catastrophic health expenditure computation.

Diabetes and the burden on scarce private family fund

Unusual health expenses happened in 52.9 percent of the households that support members with a scarce private fund. Outpatient and inpatient expenditures were 136 and 418 Cedi each month, respectively. The NHIS had a positive financial protection effect on the economic burden of diabetes, although this effect was reduced by NHIS shortcomings.

The extended family served as the primary source of financial assistance for diabetes treatment and care. Diabetes has a large economic burden in urban Ghana, with unusual consequences for households that support members with a private fund. Except for NHIS, patients’ financial support is primarily derived from personal rather than public resources. To safeguard households with diabetes patients from financial hazards, social services and changes to the NHIS are required.

Diabetes and institutional or informal sources

Palaya and Pearson (17) examined situations in which diabetics required financial assistance from institutional or informal sources in their support network. Similarly, with only two participants not receiving a government pension or allowance payment, employment was minimal in this group. One participant identified a fundamental issue with the affordability of orthopedic footwear, stating that the devices that help prevent and maintain a healed ulcer were out of reach for the person who most needed them owing to a financial barrier. Hushie (20) also mentioned the expense of consultation as a key issue because patients must pay out-of-pocket.

After all, the private specialist hospital used in this study is not a licensed service provider under Ghana’s National Health Insurance Scheme (GNHIS), which was created to provide citizens with universal health coverage. These findings suggest that interventions to improve follow-up visits should focus on educating patients about the importance of regular check-ups and that strategies that address multiple barriers at the same time (e.g., lower out-of-pocket payments, faster consultations) may be more effective in reducing non-attendance than strategies that address only one barrier. Nam (21) also suggested that the cost of glucometers be heavily subsidized or factored into NHIS and made available to diabetes patients for free.

Diabetes and Ghana’s National Health Insurance Scheme (GNHIS)

Woode (25) reported that while the majority of respondents responded that their money does not influence their ability to seek medical treatment, 13.3 percent agreed that their economics do influence their ability to seek medical care. The NHIS has also helped to decrease the financial burden that most patients would have experienced otherwise, as it demonstrates that without health insurance, most respondents would not have obtained health care owing to a lack of funds.

Even while treatments such as insulin are rationed for patients, which means those on insulin will have to buy more to complement their monthly demand, out-of-pocket payments are still decreased, indicating that the condition imposes some sort of financial stress on its sufferers. Amponsah (26) also suggested that the NHIS include special packages for persons suffering from chronic conditions such as diabetes and hypertension, allowing them to pay a greater premium in exchange for better treatment.

Acheampong (27) conducted more interviews with diabetics who are unable to work as hard as they once did. There have been reports of poor financial management, and they have spent a lot of money on drugs and a special diet. Due to financial constraints, some people have been unable to strictly adhere to their medication and diet. Salia (29) also conducted an exploratory descriptive study on 12 participants from Korle-Bu Teaching Hospital in Accra, Ghana (KBTH), where participants identified the cost of managing diabetic foot ulcers as a challenge.

The cost of diabetes and DFUs management included the cost of medications, the cost of investigations, the cost of transportation, and the cost of other treatments, including plastic reconstructive surgery. The participants stated that the cost of treating the ulcers had rendered them penniless and that there were occasions when they were unable to have hospital dressings done because they could not afford the cost of transportation to the hospital. Participants expressed dissatisfaction with their inability to pay for several investigations ordered by their doctors. Despite the difficulties, individuals made an effort to overcome the difficulties associated with disease management by employing coping techniques.

Overall coping mechanisms from the reviewed literature

Participants employed self-wound care, nutrition therapy, and pharmaceuticals. Job loss was attributed to participants’ inability to work productively as a result of ulcer discomfort and frequent hospital visits. They had decreased work hours and were unable to work at times, resulting in a loss of income while they spent all of their money at the hospital treating the ulcers. As a result, the majority of self-employed people had to close their businesses. The majority of them became penniless as a result of the situation, particularly those who ran their enterprises.

Those who worked for the government were absent from work for an extended period. Participants reported receiving financial, emotional, psychological, and social support from their husbands, children, family members and friends, church, community members, and health care providers. Some participants stated that they relied on family and friends for financial assistance to cover the cost of dressing the ulcers at the time.

Discussion of authors viewpoints about reviewed literature

Physical coping mechanisms of Diabetic patients

Diabetic individuals confront physical issues such as reduced energy, exhaustion, weight loss, daily prescriptions, lifestyle modifications, and stigma. Despite their knowledge of the significance of lifestyle in diabetes pathogenesis, the majority of diabetics engaged in diabetes-related high-risk behaviors such as lack of exercise, sedentary living, and poor eating (19, 24). Diabetic difficulties are mostly caused by a delay in diagnosis and associated problems with financial consequences (23).

Physical coping strategies that assist diabetics in disease management include lifestyle changes such as adherence to dietary recommendations, physical exercise, blood sugar test (BST), foot care, and medication adherence, known as self-care practices; seeking support in transportation, collaboration, and integration between traditional healthcare systems and orthodox healthcare systems, seeking health care at health centers and health education, and limiting alcohol consumption (16, 17, 20, 21, 25, 27).

Even though Quaye (22) discovered that patients’ quality of life is unrelated to their socioeconomic status and gender; the type of treatment, vocation, socioeconomic status, diabetes knowledge, and being on herb therapy were found to influence patients’ adherence to physical coping recommendations (16, 18, 28, 29). Illness perception and medication adherence were found to have a positive association with quality of life (22). Tabong, Bawontuo (24) discovered that even though patients had difficulty following dietary adjustments and exercises, ladies reported higher adherence than males.

Korsah (13) has claimed that more collaboration and integration between traditional and orthodox healthcare systems will provide the best potential to maximize patient care in Ghana. Moringa (Moringa oleifera), Prekese (Tetrapleura tetraptera), noni (Morinda citrifolia), dandelion, and garlic were among the locally utilized traditional therapies (24, 25).

Diabetic patients’ psychological coping mechanisms

Post-traumatic stress disorder (PTSD) was among the psychological challenges presented by diabetics, with Kubuga and Mensah (30) discovering that approximately four out of every six diabetics had a 75 percent chance of being diagnosed with post-traumatic stress disorder as a result of living with diabetes; also included were depression, stress, and anxiety (15, 25, 27), psychosocial distress in the form of Diabetes-related emotional distress, diabetes distress, and depressive symptoms (31), (33).

Diabetic patients’ psychological coping mechanisms include emotional self-efficacy with a preference to internalize some of their thoughts rather than sharing emotionally with their support network (17), religiosity or spirituality, or belief in a Godly cure (13, 22, 25, 27, 29, 32), and strong psychological will and belief in diabetes control, acceptance, or cure (13, 22, 25, 27, 29, 32), and strong psychological will and belief in diabetes control, acceptance, or cure (13, 22, 25, 27, 29, 32). (20, 24, 28, 29).

Increased frequency of participation in religious activities was found to be significantly associated with lower HbA1c levels (32) and improved patient quality of life (27). Quaye (22) discovered that highly religious chronically ill patients had a higher quality of life than low religious chronically ill patients. While 73.4 percent of respondents believed that the condition was God-given, 93.5 percent believed in religious coping (25); nonetheless, Nyarko, Kugbey (33), and Nuworza (35) discovered that diabetes patients’ perspective of their illness and level of religiosity did not affect their mental health. According to Hushie (20), patients’ hopes and fears elicit positive and negative emotional responses that act as barriers to or facilitators of ongoing self-management.

According to Woode (25), those in informal work, those who did not know how they got the disease, and those who did not have a family history were more likely to be troubled by depressed symptoms than their counterparts.

Social support methods for diabetic clinic patients.

Patients have various unfavorable social repercussions as a result of their condition, such as social constraints, isolation, and stigmatization from community members due to substantial weight loss that is misinterpreted as HIV (15).

Support from family and friends (13, 17, 19, 20, 24-27, 29, 31), religious organizations (17, 27, 29, 32), healthcare professionals (29), patient associations (29), and non-governmental organizations (29) were among the social support systems available to diabetes patients (36). In a few studies (13, 20), patients described family, friends, and social occasions such as weddings, funerals, naming ceremonies, and birthday parties, which are very common in Ghana, as barriers rather than facilitators of managing diabetes, and they mostly coped by avoiding attendance by giving a flimsy excuse; faking eating, or asking for the food to be taken away.

Ghana does not have a chronic disease policy, but it does have a national health insurance policy that covers some chronic disease drug therapy, a culture of patient advocacy for a wide range of chronic disorders, and mass media involvement in chronic disease education (37).

The adoption of diverse coping mechanisms has financial ramifications.

Diabetes has a serious negative impact on patients’ economic lives in the form of job loss, a lack of employment options, and a burdening of self and social network on medical expenses such as medicine, special diet, clinic appointments, and many more (15, 26, 27, 29). The typical monthly spending on a diabetic patient ranges from GHS150.00 to GHS 450.00, with 60 to 90 percent of the entire cost as direct cost (which includes the cost of prescriptions, investigations, and other treatments such as the cost of glucometers) (21, 23, 38, 39).

These financial expenditures are covered by self-funding, family and friend assistance, and the National Health Insurance Scheme (NHIS) (23, 38, 39). Diabetics have evolved a variety of coping mechanisms, including obtaining financial support from family, friends, or remittances, while some make out-of-pocket payments (self-financing), or from official or informal sources in their support network (17), to help with diabetes care.

Almost all diabetic patients rely on NHIS as their primary source of finances for diabetes care, with none or few relying on private insurance (25, 26, 38, 39). Even though treatments such as insulin are rationed for patients, patients nevertheless purchase extra to supplement their monthly requirement, indicating that the disease places a financial burden on diabetics (25). Some patients claim to take less medication than prescribed, while others claim to have sold assets and/or worked more hours to cover the cost of their therapy (29). As for coping mechanisms, some people used nutrition therapy, self-wound care, and self-medication (29).

Conclusion

Physical coping mechanisms in the review include lifestyle changes such as adherence to dietary recommendations, physical exercise, blood sugar test (BST), foot care, and medication adherence known as self-care practices; seeking support in transportation, collaboration, and integration between traditional healthcare systems and orthodox healthcare systems or choosing one; and seeking health care at health centers and health education.

Psychologically, patients engage in emotional self-efficacy, preferring to internalize some of their thoughts rather than sharing emotionally with their support network. Religiosity, strong psychological will, and belief in diabetes control or cure-all positively influenced diabetes management.

Family and friends, religious groups, psychologists, general health professionals’ patient organizations, and non-governmental organizations were among the social support mechanisms available to diabetic patients.

According to financial implications in diabetic management, the average monthly expenditure on a diabetic patient ranges from GHS150.00 to GHS 450.00, with direct costs accounting for 60 to 90 percent of the total cost (which comprises of cost of medications, cost of investigations, and cost of other treatments).

Diabetics have developed a variety of coping mechanisms, including obtaining financial assistance from family, friends, or remittances, while some make out-of-pocket payments (self-financing) to fund diabetes treatment. Almost of diabetic patients mentioned the NHIS as their primary source of finances for diabetes treatment. Private insurance was not employed by any of the diabetes patients. Some allegedly take less medication than advised, sell their valuables, and work more hours to help cover the cost of diabetic treatment.

Implications

Nursing Investigations

A survey of the existing literature reveals that diabetes coping techniques have received little attention. Ghanaian researchers are encouraged to perform extensive and rigorous studies. This, presumably, will broaden our understanding of the subject and, as a result, improve the quality of care in healthcare facilities. This would also contribute to closing the research gap in terms of the various cultural approaches used to manage these chronic diseases.

Curriculum for Nursing Education

It is also critical that nursing education focuses on diabetic management practices during hospital visits. This would significantly improve diabetic care in diabetic clinics throughout the country.

Administration of Nursing

Nurses must be made aware of the importance of diabetic management education to the general population, particularly family and friends of diabetics, as well as the need for associations to help those suffering from these chronic diseases. This would help to improve understanding, attitudes, and practices about the subject.

Recommendations

The following recommendations were made based on the present review’s findings:

1. A mix of oral diabetes health education and monitoring of patients’ self-care activities to ensure patients adhere to self-care practices.
2. Health information on television and radio should be checked and screened by competent institutions such as the Ministry of Health and the Ghana Health Service to ensure that what is being conveyed about the perceived causes, preventions, management, and medications for diabetes is correct.
3. Counseling and psychological support are required to help patients accept their condition. As a result, psychologists should be assigned to hospitals so that persons with chronic diseases that necessitate lifelong therapy can receive psychotherapy and assistance. Patients can be examined for diabetes-related discomfort and depression symptoms, and if necessary, psychosocial care can be provided.
4. As a potential therapeutic strategy, religious activities should be deliberately included in disease management programs for diabetics who identify as religious. Perhaps a combination of biomedicine, religion, and faith in God to aid with diabetes self-management.
5. The Ghana Health Service should adopt a chronic disease policy to ensure that the NHIS offers particular packages for persons suffering from chronic diseases such as diabetes, allowing them to pay a higher premium in exchange for better treatment. The cost of glucometers might be subsidized by the government or incorporated into the NHIS and supplied to diabetic patients for free

Funding details: Not funded

Conflict of interest: None declared

References

1. Yaribeygi H, Sathyapalan T, Atkin SL, Sahebkar A. Molecular mechanisms linking oxidative stress and diabetes mellitus. Oxidative medicine cellular longevity. 2020;2020.
2. Association AD. Diagnosis and classification of diabetes mellitus. Diabetes careCare10;33(Supplement 1): S62-S9.
3. `Preiato VL, Salvagni S, Ricci C, Ardizzoni A, Pagotto U, Pelusi C. Diabetes mellitus induced by immune checkpoint inhibitors: Type 1 diabetes variant or new clinical entity? Review of the literature. Reviews in Endocrine Metabolic Disorders. 2021:1-13.
4. Haftu H, Gebrearegay H, Berhane AJD, Metabolic Syndrome. Malnutrition-Modulated Diabetes Mellitus in Children, Rare Disease with Atypical Presentation: Case Report. Diabetes, Metabolic Syndrome Obesity: Targets Therapy. 2020;13:3069.
5. Asamoah-Boaheng M, Sarfo-Kantanka O, Tuffour AB, Eghan B, Mbanya JC. Prevalence and risk factors for diabetes mellitus among adults in Ghana: a systematic review and meta-analysis. International health. 2019;11(2):83-92.
6. Salama MS, Isunju JB, David SK, Muneza F, Ssemanda S, Tumwesigye NM. Prevalence and factors associated with alcohol consumption among persons with diabetes in Kampala, Uganda: a cross-section study. BMC Public Health. 2021;21(1):1-10.
7. Sarfo-Kantank O, Owusu-Dabo E, Adomako-Boateng F, Eghan B, Dogbe J, Bedu-Addo G. An assessment of prevalence and risk factors for hypertension and diabetes during world diabetes day celebration in Kumasi, Ghana. East African Journal of Public Health. 2014;11(2):805-15.
8. Rubino F, Amiel SA, Zimmet P, Alberti G, Bornstein S, Eckel RH, et al. New-onset diabetes in Covid-19. New England Journal of Medicine. 2020;383(8):789-90.
9. Kumar A, Arora A, Sharma P, Anikhindi SA, Bansal N, Singla V, et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metabolic Syndrome: Clinical Research Reviews in Endocrine Metabolic Disorders. 2020;14(4):535-45.
10. Lim S, Bae JH, Kwon H-S, Nauck MA. COVID-19 and diabetes mellitus: from pathophysiology to clinical management. Nature Reviews Endocrinology. 2021;17(1):11-30.
11. Seuring T, Archangelidi O, Suhrcke M. The economic costs of type 2 diabetes: a global systematic review. Pharmacoeconomics. 2015;33(8):811-31.
12. Walker IF, Garbe F, Wright J, Newell I, Athiraman N, Khan N, et al. The economic costs of cardiovascular disease, diabetes mellitus, and associated complications in South Asia: a systematic review. Value in health regional issues. 2018;15:12-26.
13. Korsah KA. Coping strategies of newly diagnosed patients with type two Diabetes Mellitus at a Hospital in Ghana. 2015.
14. Werfalli MM, Kalula SZ, Manning K, Levitt NS. Does social support affect knowledge and diabetes self-management practices in older persons with Type 2 diabetes attending primary care clinics in Cape Town, South Africa? PloS One. 2020;15(3):e0230173.
15. Owusu Y. Psychosocial Experiences of Patients with Type-2 Diabetes Mellitus: A Study at the Korle-Bu Teaching Hospital [Masters Dissertation]. Balme Library: University of Ghana; 2016.
16. Wornyoh GD. Adherence to Diet and Exercise Regimen among Patients with Type 2 Diabetes Mellitus at the Tema General Hospital, Greater Accra, Ghana. Balme Library: University of Ghana; 2020.
17. Palaya J, Pearson S, Nash T. Perception of social support in individuals living with a diabetic foot: a qualitative study. Diabetes research clinical practice. 2018;146:267-77.
18. Adulai K. Patient’s Perception of Diabetes and Its Management among Patients at La General Hospital [MSc]. Balme Library: University of Ghana; 2015.
19. Asante KB. Aging and chronic diseases in Ghana: The case of Akim Oda. Balme Library: University of Ghana; 2018.
20. Hushie M. Exploring the barriers and facilitators of dietary self-care for type 2 diabetes: a qualitative study in Ghana. Health promotion perspectives. 2019;9(3):223.
21. Nam MA. Examining The Role Of Self-Care Management In Type 2 Diabetes Mellitus Patients At The Korle Bu Teaching Hospital. Balme Library: University of Ghana; 2017.
22. Quaye MG. Illness Perception and Quality of Life among Chronically Ill Patients: A Study of Diabetics and Hypertensives at Korle-Bu Teaching Hospital [Master of Philosophy]. University of Ghana Balme Library: METHODIST UNIVERSITY COLLEGE, GHANA; 2015.
23. Attuquaye QE. Financial Cost of Diabetes Management to Cocobod Clinics, Ghana. Balme Library: University of Ghana; 2010.
24. Tabong PT-N, Bawontuo V, Dumah DN, Kyilleh JM, Yempabe TJPo. Premorbid risk perception, lifestyle, adherence and coping strategies of people with diabetes mellitus: A phenomenological study in the Brong Ahafo Region of Ghana. 2018;13(6):e0198915.
25. Woode EB. PSYCHOSOCIAL BURDEN ON SUFFERERS OF DIABETES MELLITUS IN THE TAMALE METROPOLIS. UDS Space: University for Development Studies, Tamale; 2015.
26. Amponsah MK. Local Perceptions and Management of Diabetes and Hypertension in Shai-Osudoku District of Ghana [Doctor of Philosophy]. Balme Library: University Of Ghana; 2017.
27. Acheampong VO. Religious Coping, Psychosocial Factors And Quality Of Life Among Type–2 Diabetic Patients In Ghana [MPhil Thesis]. Balme Library: University of Ghana; 2017.
28. Owiredua C. Living With Diabetes: A Study of Illness Representation, Spiritual Coping, Psychological Distress and Medication Adherence [MPhil Thesis]. Balme Library: University Of Ghana; 2015.
29. Salia VOA. Experiences of Individuals Living With Diabetic Foot Ulcers at the Korle-Bu Teaching Hospital [Masters’ Thesis]. Balme Library: University of Ghana; 2014.
30. Kubuga CK, Mensah M, Osei G, Osei SO, Abugre D. Nutritional and Psychological Impact of Diabetes on Diabetics: Case Study in the Tamale Teaching Hospital-Ghana. European Scientific Journal. 2013;9(30):212 – 35.
31. Amankwah-Poku M, Amoah AG, Sefa-Dedeh A, Akpalu J. Psychosocial distress, clinical variables and self-management activities associated with type 2 diabetes: a study in Ghana. Clinical Diabetes Endocrinology. 2020;6(1):1-10.
32. Botchway M, Davis RE, Appiah LT, Moore S, Merchant ATJJoR, Health. The Influence of Religious Participation and Use of Traditional Medicine on Type 2 Diabetes Control in Urban Ghana. 2021:1-14.
33. Nyarko K, Kugbey N, Atindanbila S. Illness perception, religiosity and mental health of diabetic patients in Ghana. American Journal of Applied Psychology. 2014;3(1):12-21.
34. Asante NA. Factors Associated With Diabetes Self Management among Diabetes Patients Attending the Greater Accra Regional Hospital: University of Ghana; 2019.
35. Nuworza K. Illness Perception, Religiosity and Mental Health of Diabetic Patients in Ghana [MPhil Dissertation]. Balme Library: University of Ghana; 2013.
36. Godman B, Basu D, Pillay Y, Almeida PH, Mwita JC, Rwegerera GM, et al. Ongoing and planned activities to improve the management of patients with Type 1 diabetes across Africa; implications for the future. Hospital practice. 2020;48(2):51-67.
37. Aikins Ad-G, Boynton P, Atanga LL. Developing effective chronic disease interventions in Africa: insights from Ghana and Cameroon. Globalization Health Promotion Perspectives. 2010;6(1):1-15.
38. Annorbah-Sarpei N. Out-Of-Pocket Expenditure and Financial Coping Strategies for Management of Diabetes at Ga South Municipal Hospital. Balme Library: University of Ghana; 2019.
39. Pei F. Managing diabetes in urban Ghana: is it affordable? [MSc Thesis]. Duke University Library: Duke University; 2015.