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Understanding barriers to type 2 diabetes self-management in excessive weight adults: A qualitative study of patient
Sirwan Khalid Ahmed1,2, Handren Wahid Murad3, Kochr Ali Mahmood4
1College of Nursing, University of Raparin, Rania, Sulaymaniyah, 46012 Kurdistan Region Iraq.
Background:
Diabetes management among excessive weight individuals remains a significant global health challenge, particularly in low- and middle-income regions such as Kurdistan Region, Iraq. Understanding the barriers from the patients' perspective is essential to designing effective, culturally sensitive interventions.
Aim:
To explore perceived barriers to type 2 diabetes self-management among excessive weight adults in the Kurdistan Region of Iraq.
Methods:
A qualitative descriptive study was conducted through semi-structured interviews with 20 excessive weight patients diagnosed with type 2 diabetes mellitus. Participants were purposively recruited from hospitals and primary care centers in Kurdistan Region, Iraq. Data were analyzed following Ahmed et al.'s (2025) six-phase thematic analysis process.
Results:
In this study, five major themes and nine subthemes were identified, reflecting the multifaceted barriers to diabetes management among excessive weight individuals. Emotional and psychological struggles included persistent depression, anxiety, and diminished motivation often rooted in self-blame. Knowledge gaps and health literacy encompassed confusion due to conflicting dietary advice and a lack of structured education on diabetes management. Structural and environmental constraints involved the unaffordability of healthy food and absence of safe spaces for exercise. Distrust and disconnect in healthcare relationships emerged through perceived judgment by healthcare providers and subsequent avoidance of appointments. Finally, internalized weight stigma was a cross-cutting theme, with participants expressing shame and self-stigmatization.
Conclusion:
Diabetes self-management among excessive weight patients in Kurdistan is hindered by a web of psychosocial, educational, systemic, and relational factors. Addressing these challenges requires multi-level, culturally tailored, patient-centered interventions that enhance education, reduce stigma, and foster trust between patients and providers.
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