Provider perspectives on family support in diabetes self management in rural Adamawa Nigeria

Diabetes mellitus is rapidly increasing across low- and middle-income countries, yet rural communities face persistent inequities in chronic disease care. In Northeastern Nigeria, family members often provide essential support for diabetes self-management, but their role is influenced by poverty, cultural beliefs, and fragmented primary healthcare systems. This study examined healthcare providers’ perspectives on how family dynamics, socioeconomic conditions, and community resources shape diabetes care in rural Adamawa State. A descriptive qualitative design was used across five Local Government Areas. Twenty-five healthcare providers were purposively sampled based on their direct involvement in diabetes care. Semi-structured interviews were conducted in English or Hausa, audio-recorded, transcribed, and analyzed through inductive content analysis with triangulation across sites. Six themes emerged. Providers emphasized that poverty constrained access to medications, glucose monitoring, and recommended diets. Food insecurity and limited local substitutions made dietary adherence challenging. Knowledge gaps, spiritual interpretations of disease, and reliance on herbal treatments influenced care-seeking behaviors. Families served as frontline caregivers, assisting with transportation, food preparation, and medication adherence, although their capacity varied. Stigma and neglect were context-dependent, shaped by gender norms and misconceptions. Community support was described as sporadic and dependent on individual or religious leaders rather than structured systems. Diabetes care in rural Nigeria is shaped by intertwined socioeconomic, cultural, and structural determinants. Strengthening primary care platforms with family-centered diabetes education, culturally tailored outreach, community led home support, and affordability measures could reduce inequities and enhance self-management. Policies that institutionalize sustained community partnerships are essential for improving outcomes in low-resource settings.