Health literacy, cultural beliefs, and environmental barriers to diabetes self-management in older adults in Zabol, Iran: a qualitative study

Effective self-management is crucial for older adults with type 2 diabetes mellitus (T2DM), yet limited health literacy, socio-cultural factors, and resource constraints may hinder optimal care, especially in underserved regions. This study explored the lived experiences, barriers, and facilitators of diabetes self-management among older adults in Zabol, Iran. A qualitative descriptive design with an inductive, constructivist orientation was employed. Thirty-two older adults with T2DM (aged ≥ 60 years) were selected via purposive sampling with maximum variation from healthcare centers in Zabol. Semi-structured, in-depth interviews were conducted between February 2024 and August 2024. Data were analyzed using conventional content analysis following Graneheim and Lundman. Analysis revealed six major themes influencing diabetes self-management: (1) limited health literacy and communication barriers, compounded by hierarchical patient-provider power dynamics; (2) socioeconomic insecurity and food access challenges; (3) family dynamics and gender roles, including maternal altruism and limited emotional support; (4) cultural beliefs and fatalistic attitudes influencing adherence; (5) multimorbidity and physical limitations creating competing care demands; and (6) environmental and practical barriers, particularly harsh climatic conditions unique to Zabol. The findings extend existing qualitative evidence by describing how older adults in Zabol face a specific set of intersecting individual, cultural, and environmental barriers to diabetes self-management. Contextually responsive interventions addressing food insecurity, climatic barriers to physical activity, and hierarchical patient-provider dynamics are needed. Culturally tailored strategies may contribute to improved health outcomes in this vulnerable population.