Knowledge and perspectives of primary care providers regarding prediabetes in rural India: a mixed-methods study

Abstract

With the current prevalence of 8%, recent studies have predicted a rising trend in prediabetes. Primary healthcare providers need to have a sufficient understanding of prediabetes to enable early detection and management at the community level. Therefore, this study aimed to assess the knowledge of prediabetes among primary healthcare providers and to explore the management strategies used by primary care physicians in rural South India. A cross-sectional mixed-methods study was conducted among primary healthcare providers, including accredited social health activists, auxiliary nurse midwives, staff nurses, and primary care physicians, in rural Bengaluru. Quantitative data were collected using a structured questionnaire assessing knowledge of prediabetes. Eight in-depth interviews were conducted among primary care physicians and analysed thematically. A total of 208 primary healthcare providers participated in the quantitative component. Of these, 107 (51.4%; 95% confidence interval [CI]: 44.4–58.4) had inadequate knowledge of prediabetes. Most participants incorrectly answered questions regarding its definition (n = 174; 83.6%) and symptoms (n = 187; 90.0%), while nearly two-thirds (n = 134; 64.4%) were unaware of the methods used to screen for prediabetes. Having less than five years of professional experience was significantly associated with inadequate knowledge (adjusted prevalence ratio [aPR] = 2.8; 95% CI: 1.10–6.9; p  = 0.029). The qualitative findings identified limited community awareness, absence of evident symptoms, reluctance to adopt dietary and physical activity changes, negligence towards the condition, and insufficient training on prediabetes as important barriers to its management. Context-specific training and decision-support interventions are needed to strengthen the early identification and management of prediabetes at the primary healthcare level.