Background: A marked increase of type 2 diabetes and associated morbidity and mortality rate over the last 10 years has been recorded in Malaysia. Ineffective diabetes management and a lack of self-care practice among type 2 diabetic patients have been identified as the major reasons for this problem. Research in other countries has highlighted a range of factors influencing effective self-care of type 2 diabetes including patients' perspectives of diabetes, sociocultural issues, religious beliefs and support from healthcare. Nevertheless, there is paucity of research conducted in Malaysia. Therefore, the exploration of self-care practice and self-care support provision in patients with type 2 diabetes in Malaysia is needed to understand the problem. Aims: To understand the self-care practice of patients with type 2 diabetes in Malaysia and the factors that influence the patients' self-care practice. To understand the type 2 diabetes’ self-care support provision in Malaysia from the perspective of patients, healthcare professionals, and healthcare system. Methods: A qualitative, single embedded case study design was utilised. Eighteen patients with type 2 diabetes and 19 healthcare professionals (physicians, diabetes educators, nurse, pharmacist and dietician), involved in self-care support provision primary- and secondary-care settings in Kuala Lumpur and Putrajaya, Malaysia, participated in in-depth semi-structured interviews between November 2012 and June 2013. In addition, data were collected through participant-observation of clinic consultations, and analysis of relevant documents used in the provision of diabetes management in the respective clinics. The framework technique supported analysis of data. Data were stored and managed using Nvivo 9 software. Findings: The findings indicate that patients with type 2 diabetes had a good understanding of diabetes and self-care, but a lack of self-care support meant that effective self-care was difficult to sustain. Healthcare professionals’ (HCPs’) provision of self-care support was restricted due to several factors, including lack of opportunity to provide self-care support, unsuitable clinic environment and a fragmented management within primary and secondary care. Additionally, barriers in patient–HCP communication, a combination of the personal, interpersonal and inter-professional HCP factors, and a traditional medical model adopted by Malaysian healthcare system, seem to have influenced the practice and quality of the service delivered. Conclusion: It is clear that the increased incidence of uncontrolled type 2 diabetes is not merely due to poor self-care practice by patients, but also due to constraints in service delivery and underdevelopment of self-care support provision. The evidence generated can assist in the development of strategies to improve the quality of care and facilitate changes in the self-care support provision in Malaysia.

Background: Type 2 diabetes is among the fastest growing diseases in the world, especially in India where the prevalence is 9 percent and expected to rise significantly. Managing diabetes involves a substantial portion of self-care and lifestyle changes for the patient. Hence, the nursing care to patients needs to be focused on promoting self-care and empowerment. Objective: To describe the nursing care, focusing on self-care and empowerment, provided to patients with type 2 diabetes at a private diabetes clinic in India. Method: Eleven diabetes educators with specialist training were interviewed individually. Data was analysed using qualitative contents analysis. Results: One core category called Comprehensive approach was found. Additionally, the data was sorted into four main categories: Nursing care interventions, Counselling, Health education and Health protection. Conclusion: The participants had a comprehensive view of the patients, the disease and the role of health personnel involved in the care. This holistic approach permeated the nursing care performed by the participants, facilitated empowerment and the promotion of self-care to the patients. Clinical relevance: The study provides a widened perspective and understanding of the concepts of self-care and empowerment to patients with type 2 diabetes in different cultural contexts. The results can serve as an inspiration to new ways of promoting self-care and empowerment to patients with other health problems. / Bakgrund: Diabetes typ 2 är en av de snabbast ökande sjukdomarna i världen, särskilt i Indien. Där är prevalensen 9 procent och den befaras stiga betydligt. För att hantera sjukdomen behöver patienten genomföra livsstilsförändringar och behärska egenvård. Därför bör omvårdnaden inriktas på empowerment och att främja patientens förmåga till egenvård. Syfte: Att beskriva den omvårdnad, med fokus på egenvård och empowerment, som ges till patienter med diabetes typ 2 på en specialistklinik i Indien. Metod: Elva diabetesutbildare med specialistutbildning intervjuades individuellt. Materialet analyserades med hjälp av kvalitativ innehållsanalys. Resultat: En kärnkategori, kallad Helhetsperspektiv, hittades. Därutöver sorterades materialet in i fyra huvudkategorier: Omvårdnadsåtgärder, Rådgivning, Hälsoutbildning och Hälsoskyddande åtgärder. Slutsats: Respondenterna hade en helhetssyn på patienterna och sjukdomen, samt på den roll all hälsopersonal som var inblandad i vården hade. Denna helhetssyn genomsyrade omvårdnaden, hur respondenterna arbetade med empowerment till patienterna samt hur de stärkte patienternas kapacitet att utföra egenvård. Klinisk betydelse: Studien bidrar till en vidgad syn på och ökad förståelse för begreppen egenvård och empowerment när det gäller patienter med diabetes typ 2 i olika kulturella kontexter. Resultatet kan även inspirera till nya sätt att arbeta med empowerment och att främja egenvård bland andra patientgrupper.