Table 4. Recommendations to promote diabetes DSM related to barriers in the individual and community domain.

Barriers/Challenges	Recommendations for Policy, Practice or Future Research
Negative emotional states of persons living with diabetes	Diabetes care initiatives should focus on the family and community to promote psychological resilience and wellbeing of persons living with diabetes. Healthcare professionals should provide emotional and psychological support to patients at different stages of their disease through effective dialogue
Patients combining herbal and biomedical medicines to treat diabetes	More empirical work is needed to determine the potential effectiveness (or harm) of herbal medicine in diabetes management. Research work is also required to explore the potential for diabetes care algorithms to incorporate the use of clinically effective herbal preparations in order to give patients greater choice over potential treatment options
Poor financial situation of persons living with diabetes	Clinicians should identify and introduce patients to less expensive local foods and other means of exercising other than expensive formal gyms.
Patients poor knowledge on diabetes as a chronic lifelong disease	Culturally appropriate health education strategies for patient and family on diabetes should be done by health promotion officials.
Unhelpful cultural and superstitious beliefs	Patient and family education required to demystify diabetes
Social and family connectivity/or ties	Persons with diabetes should not be managed in isolation of their social networks, but that significant others should be involved as an integral part of health promotion intervention. This is particularly important to achieving dietary restrictions