What does self-care mean to us? Development of a Self-Care Package for Patients with Type-2 Diabetes Mellitus in Rural India: Findings from Formative Research

Abstract Background Diabetes self-care requires daily decisions influenced not only by medical advice but also by social norms, cultural beliefs, and economic realities. In rural India, these contextual factors are often underexplored, resulting in interventions that may not align with local needs or practices. This formative study aimed to explore self-care practices, barriers, and support needs among patients with type 2 diabetes mellitus in rural Maharashtra and to generate context-specific evidence to inform the development of a diabetes self-care package. Methods The current study is the formative phase of a larger project based on a stepped-wedge cluster randomized feasibility trial with a closed cohort. The study was conducted between November 2023 to March 2024, in rural central Maharashtra, India and used three qualitative techniques: free-listing (n = 30) to elicit everyday self-care practices, pile-sorting (5 groups; n = 30) to see how participants naturally grouped these practices, and in-depth interviews with adults living with type-2 diabetes (n = 12) to explore experiences, barriers, and supports. Participants were selected purposively, with recruitment continuing until data saturation was achieved to ensure richness and relevance. Findings from the qualitative methods were triangulated and integrated with evidence from a desk review and expert content validation to inform the development of the self-care package. Results The research emphasized important elements of diabetes self-care together with lifestyle practices, disease management and stress-addiction control while focusing on dietary patterns, hydration, physical activities and social well-being to create community-based strategies for cultural self-care frameworks. Participants most often named “reduce sugar” and “walking” (~ 63% each), followed by taking medicines (43%) and checking blood sugar (37%). Pile-sorting grouped practices into three clusters: lifestyle, diet, and medical adherence. Conclusion A structured diabetes self-care package is essential for effective management in rural settings. Locally grounded formative research clarified what “self-care” means to rural patients and why. Integrating cultural practices with evidence-based care enhances adherence and glycemic control.