Dilemma of self-management among patients with diabetes in primary care settings in China: a qualitative study

Objective This qualitative study aimed to explore the self-management dilemmas faced by patients with diabetes in Chinese primary care and collect suggestions for improvement. Design Qualitative methods are used in this study. Thematic analysis was used to analyse the transcripts. Setting Four primary care communities in Beijing. The interviews were conducted between April and August 2025. Participants This qualitative study used face-to-face, semi-structured interviews with 32 patients with type 2 diabetes. Data collection continued until information saturation was reached. Results Four core themes and multiple subthemes were identified. The first theme, Inadequate Disease Cognition and Health Literacy, showed that patients had a limited understanding of diabetes, often delaying diagnosis and only learning about complications after they appeared. Misconceptions about diet and a lack of medication management knowledge were also common. The second theme, Suboptimal Daily Management, highlighted that physical activity was unstructured, glucose monitoring was irregular and emergency response capabilities were poor. The third theme, Fragmented Healthcare Resources and Inadequate Family Support, revealed systemic barriers such as limited primary care competencies, homogeneous health education formats that failed to meet patients needs and insufficient family support. The fourth theme, Limitations in Self-Management Decision-Making, demonstrated that patients decision-making processes were predominantly experience-driven, relying on personal or communal anecdotes rather than scientific medical evidence. Conclusions The self-management challenges among Chinese patients with diabetes in primary care are a complex interplay of inadequate individual cognition, suboptimal daily practices and fragmented support systems. The study suggests that future interventions should focus on enhancing general practitioner training, developing culturally sensitive health education and rebuilding family and community support networks to sustainably resolve these management dilemmas.