DETERMINANTS OF SELF-CARE IN TYPE 2 DIABETIC PATIENTS IN RAMALLAH PALESTINE: A HEALTH BELIEF MODEL (HBM) BASED STUDY

Abstract

Type 2 diabetes is a growing public health challenge in Palestine, with significant clinical, economic, and social consequences. Effective self-care is essential for improving glycemic control, preventing complications, and enhancing quality of life; however, it is often inadequately practiced among Palestinian patients. This study aimed to examine the psychological, social, and demographic factors influencing self-care behaviors among adults with type 2 diabetes in Ramallah, using a health beliefs model.

A cross-sectional design was used, including 383 adult patients diagnosed with type 2 diabetes for at least one year. Data were collected through structured interviews using a validated questionnaire that included: (1) demographic and clinical characteristics, (2) self-care behaviors (diet, physical activity, medication adherence, and glycemic control), and (3) elements of the health beliefs model (personal perception of predisposition, disease severity, benefits, and barriers). The mean age of participants was 55.5 years (range: 20–88 years), and 91.1% were married. Their educational attainment varied, with 7.8% being illiterate and 28.2% holding a university degree. Approximately one-third of participants had had diabetes for more than 10 years. Most participants lived in rural areas. Clinically, 97.9% experienced hyperglycemia, while 3.9% reported episodes of hypoglycemia. Contrary to expectations and international evidence, no statistically significant associations were observed between the components of the health beliefs model and self-care behaviors. Factors such as susceptibility, disease severity, benefits, and barriers did not predict self-care practices. In contrast, statistically significant relationships were identified between self-care and social factors. Higher levels of education were associated with improved self-care, highlighting the importance of health awareness. In addition, participants living in urban areas demonstrated better self-care practices compared to those living in rural areas and refugee camps, likely due to differences in access to healthcare, resources, and socioeconomic conditions. Other variables, including age, sex, marital status, duration of diabetes, and hyperglycemic episodes, did not show any statistically significant association with self-care behaviors. The findings suggest that self-care practices are more influenced by external social and environmental factors than by individual psychological beliefs. Therefore, improving diabetes management outcomes in Palestine requires a shift towards community-based and systemic interventions. Enhancing access to healthcare, particularly in rural and disadvantaged areas, and developing culturally appropriate educational programs are crucial. This study contributes to the limited literature on self-care for people with diabetes in Palestine and suggests that focusing on education, resource provision, and structural support may be more effective than targeting individual beliefs alone.