Self-management of patients with type 2 diabetes in Chaoyang District, Beijing, and challenges in utilizing family and community resources: a mixed-methods study

BACKGROUND: The prevalence of type 2 diabetes mellitus (T2DM) in China has been steadily increasing, making it a major public health concern. Effective self-management, along with family and community support, is critical for disease control and the prevention of complications. However, many patients continue to face challenges in disease management. In addition to requiring proactive and standardized diabetes care from health service providers, patients also need to strengthen their self-management skills and mobilize family/community support resources. Further investigation into these challenges and potential solutions is warranted. This study aims to systematically evaluate the self-management behaviors of patients with T2DM and the collaborative management capacity of family caregivers in Chaoyang District, Beijing. It also intends to explore the practical challenges faced by community-based T2DM patients in long-term disease management with respect to self-management, family support, and community support. In addition, it seeks to identify optimization pathways for health management models based on family support systems, thereby providing both theoretical grounding and practical reference for developing comprehensive intervention strategies under the concept of proactive health. METHODS: An explanatory sequential design was employed in mixed methods research. This study first conducted a cross-sectional survey to assess the self-management status of T2DM patients and their caregivers attending medical institutions. Subsequently, qualitative research was employed to explore the specific challenges faced by community-based T2DM patients in long-term disease management, particularly regarding self-management, family support, and community support. A cross-sectional survey of T2DM patients and their caregivers was conducted in four healthcare institutions in Chaoyang District, Beijing, using standardized self-management questionnaires, and quantitative data were collected from June to October 2024. Semi-structured interviews were carried out with purposively selected patients, and qualitative interviews were conducted between April and June 2025. Quantitative data were analyzed descriptively, and qualitative data were thematically analyzed using Colaizzi's method. Methodological triangulation was adopted to cross-validate findings obtained from the cross-sectional survey and semi-structured interviews. RESULTS: Among 206 T2DM patients, attitude scores were highest, knowledge moderate, and practice lowest. The highest mean score of patient's knowledge dimension was observed for blood pressure and blood glucose knowledge (88.84 ± 27.93), while the lowest was basic knowledge (60.68 ± 32.29), At the practice level, foot care had only a moderate score (69.12 ± 21.33), only 22.33% performing it regularly. Exercise scored lowest (67.48 ± 29.85), with 38.35% of patients exercising regularly. Among 125 caregivers, attitudes were favorable, but notable deficiencies persisted across diabetes-related knowledge and other domains. The highest mean scores of knowledge dimension were observed for blood pressure/glucose knowledge (93.87 ± 17.65), While the lowest scores were for basic knowledge (74.93 ± 29.83). Qualitative findings from 25 patients revealed barriers including weak self-management beliefs, poor self-control, and limited knowledge, as well as inadequate family support and gaps in individualized, continuous, and effective community services. Qualitative data further revealed emotional and stress-related challenges that affected patients' adherence and coping capacity. CONCLUSION: Patients with T2DM in Chaoyang District, Beijing demonstrated notable deficiencies in disease management knowledge and low adherence to key self-management behaviors. Although caregivers performed better overall, their capacity for support also requires strengthening. Barriers at multiple levels may hinder effective glycemic control and make achievement of management goals challenging.