Cultural Considerations for the Adaptation of a Diabetes Self-Management Education Program in Cotonou, Benin: Lessons Learned from a Qualitative Study

Abstract

Background: Type 2 diabetes (T2D) poses a disproportionate burden on Benin, West Africa. However, no diabetes intervention has yet been developed for Benin’s contexts. This study aimed to explore specific cultural beliefs, attitudes, behaviors, and environmental factors to help adapt a diabetes self-management program to patients with T2D from Cotonou, in southern Benin. Methods: Qualitative data were collected through focus group discussions (FDGs) involving 32 patients with T2D, 16 academic partners, and 12 community partners. The FDGs were audio-recorded, transcribed verbatim from French to English, and then analyzed thematically with MAXQDA 2020. Results: Healthy food was challenging to obtain due to costs, seasonality, and distance from markets. Other issues discussed were fruits and vegetables as commodities for the poor, perceptions and stigmas surrounding the disease, and the financial burden of medical equipment and treatment. Information about local food selections and recipes as well as social support, particularly for physical activity, were identified, among other needs. When adapting the curriculum, gender dynamics and spirituality were suggested. Conclusions: The study demonstrates the need for culturally sensitive interventions and a motivation-based approach to health (spiritual and emotional support). It also lays the groundwork for addressing T2D contextually in Benin and similar sub-Saharan African countries.