Exploring diabetes self-management practices among people with TB in Eswatini: a qualitative analysis

Diabetes mellitus (DM), prevalent globally among individuals with tuberculosis (TB) and associated with suboptimal TB treatment outcomes, is a major concern in Eswatini, where high TB incidence and care gaps in screening for and managing pre-DM and DM exist. Understanding the feasibility and acceptability of DM self-management practices among individuals with TB and pre-DM/DM is key to improving both TB treatment success and glycaemic control in Eswatini and other resource-limited settings. To explore barriers and facilitators to adopting DM self-management practices, we conducted 26 in-depth interviews with individuals diagnosed with both TB and pre-DM/DM in Manzini, Eswatini. Our analyses were guided by the situated Information Motivation and Behavioural Skills model. While participants demonstrated substantial knowledge about the dietary and exercise changes needed to manage pre-DM/DM, many were unaware of the link between TB and DM. Some attributed their pre-DM/DM diagnosis to dietary habits or family history. Despite being well-informed and motivated to engage in self-management practices, structural barriers, especially financial constraints, frequently hindered their efforts. Participants suggested addressing these challenges by enhancing community education on DM, promoting home gardening initiatives, and offering financial assistance for transportation to clinics.