In this study, about half of the clients (48.1%) were practiced diabetic self-care. The magnitude of this study was in line with studies conducted in Bangalore, India 47.6% [33], Gondar Hospital 48.1% [20], Hadiya Zone 43.1% [25], Benishangul Gumuz Hospital 45.7% [22] and Addis Ababa 52.3% [34]. This is might be due to, similarity in socio-cultural, lifestyle, inadequate access to glucose monitoring machines, and the level of education of the study participants particularly in Ethiopia.
But it was lower than the study done in Dila Hospital 76.8% [24], West Ethiopia 60.7% [35], Dessie Referral Hospital [28], West Ethiopia 60.7% [23], Dire Dawa, Dilchora Hospital 55.9% [21], outpatient patients in Arsi Zone 53.3% [26], and North-East Ethiopia 63.8% [36]. The possible variation could be attributed to the different measurement tools used and operationalization of self-care practices by the studies and lack of a self-glucose monitoring machine (nearly 70% of the respondents had no glucometer which contributes to a significant reduction in the magnitude of self-care practices in our case), and level of information education, and communications from the health professions.
It was also higher than the study conducted in Central Tigray 37.4% [37], Harari town 39% [11], Ayder Hospital, Mekelle 25.5% [17], and Bahir Dar 28.4% [18]. This discrepancy may be due to some improvements in the health care systems (related to the period gap) and variation of cutoff point to classify good and poor self-care, mean, and 50% of total self-care practices, respectively. Methodological and sample size variations may also account for this discrepancy.
In this study, several independent variables demonstrated a strong association with diabetes self-care. Numerous studies demonstrate that education improves a person's capacity to make decisions about their health, access, and use of health messages, and treatment of chronic conditions like diabetes mellitus. With better educational standing, one is more likely to practice diabetes self-care [11, 18, 23, 38–40]. The findings of the current study is supporting the hypothesis, showing that respondents with higher educational status were more likely to practice self-care than respondents with lower educational status. But a study conducted in Tigray hospitals [41] those with no formal education were more likely to have diabetes self-care practices.
Our findings showed that retired respondents engaged in fewer self-care practices than those who were in the workforce. This is consistent with the literatures, which shows that people who work will have the chance to meet new people, boosting their capacity to learn from coworkers. Retirement respondents may not have made long-lasting changes to their lifestyles or behaviors, which may make it difficult for them to practice diabetes self-care, in addition to having lower salaries than respondents who were still working [35, 39].
According to our research, respondents who were knowledgeable about diabetes care were more likely to engage in self-care. This result is in line with earlier studies [11, 35, 42]. Diabetes knowledge on self-care practice creates a clear understanding and eliminates confusion about the practice and the disease condition.
According to the HBM, for the behavior (self-care practice) to succeed, patients must feel threatened by their poor self-care practice [11, 13, 15]. Our finding is in line with this and revealed that patients with high perceived susceptibility to diabetic complications were more likely to participate in self-care practice compared with those with low perceived susceptibility.
Perceived severity was a promoting factor for self-care behaviors, such that the higher the perceived severity, the better the self-care practices. When patients are more aware of diabetes and its serious complications, they are more likely to recognize it as a health threat and consciously adopt healthy behaviors. Our findings and the findings by Daniel and Messer [12] and Ayele, T. et. al in Harar [11] are in line with this idea and revealed that respondents with a higher perceived severity were more likely to engage in self-care practice compared with those with less perceived severity.
The most effective predictor of whether people are inclined to engage in healthy activities is perceived hurdles to doing so, and these barriers might make it challenging to carry out advised actions [41]. Previous studies discovered a negative correlation between self-care practices and perceived barriers [10, 14, 16]. We also found that patients were less likely to practice diabetes self-care when they had higher perceived barriers. But, in a study by Ayele et. al, in Harar [11] respondents who had moderate perceived barriers to self-care were better to practice self-care.
However, perceived benefits had no significant associations with self-care behaviors, which may be due to differences in the study population, social culture, and the types of self-care behaviors assessed.
Half of the study participants were practiced good self-care. Based on the HBM, the study identified important factors for the occurrence of good self-care practice. Among other things, interventions aimed at changing (increasing) diabetes self-care practice-related behaviors in DM patients should aim to increase perceived susceptibility and perceived severity. Increased perceived susceptibility to and severity of DM complications can be achieved by educating the patient about the seriousness of the consequences of uncontrolled DM, as well as providing individualized risk estimates. Also, the perceived barriers to self-care should be evaluated, and patients should actively be involved in tailoring required modifications to their routines.
The study's scope and geographic coverage were limitation of this study. The limitations of cross-sectional research design and social desirability biases may also impede the plausibility of determining cause-and-effect relationships. For researchers, it is required to address the limitations of this study.