Determinants of Diabetes Self-Management Behaviours among Type2 Diabetes Patients in Kurdistan Region of Iraq: A Primary Care Study

Alan Muhamad Wsw and Kareem Fattah Azeez

Abstract

Type 2 diabetes mellitus (T2DM) represents a major public health challenge, with effective management fundamentally relying on patients' daily self-care behaviors. Despite the importance of health-related behaviors in diabetes management, limited evidence exists regarding determinants of these behaviors among T2DM patients in primary care settings in the Kurdistan Region of Iraq. A descriptive cross-sectional study was conducted among 200 adults with T2DM attending two primary health care centers in Rania City, Kurdistan Region, from January to April 2025. Data were collected through structured face-to-face interviews using a validated questionnaire (Cronbach's alpha = 0.85). Chi-square tests, correlation analyses, and multivariable regression models examined associations between sociodemographic, clinical, and psychosocial factors and self-management behaviors. Self-management behaviors were generally suboptimal, with low engagement in glucose monitoring, physical activity, dietary adherence, and foot care. Sociodemographic factors showed no significant associations with self-care behaviors. However, diabetes duration significantly predicted glucose monitoring (χ² = 26.51, p = .002) and medication adherence (χ² = 22.84, p = .007). Smoking status was associated with monitoring frequency and physical activity. Psychosocial determinants including diabetes-related stress, emotional well-being, support systems, and diabetes management confidence emerged as significant predictors. Risk stratification identified five distinct patient subgroups requiring tailored interventions. Comprehensive, multidisciplinary approaches addressing behavioral and psychosocial barriers are essential to optimize diabetes self-management in primary care settings in this population.