Qualitative systematic review of the socioeconomic factors affecting type 2 diabetes management in Pakistan

Table 1 Study characteristics

Ref.	Study	Study location	Participants and sampling	Methodology	Key findings/themes
Ansari et al[2], 2022	Experiences of diabetes self-management (study 1)	Rural Punjab	Middle-aged adults (n = 38) from low-income rural communities	Focus groups; thematic analysis	Low health literacy, poverty-induced dietary choices, strong reliance on family caregivers; fatalism and religious interpretations influenced self-care
Bukhsh et al[1], 2020	Perspectives and barriers of patients with T2DM (study 2)	Lahore and Multan	T2DM patients (n = 40), purposively selected from diabetes centers	Semi-structured interviews	Patients reported financial stress, limited awareness of glycemic control, dependence on informal care, and shame linked to insulin injections
Tariq et al[3], 2022	Living with diabetes: Role of culture and family (study 3)	Karachi	Urban females with T2DM (n = 25), recruited via clinics	Narrative interviews	Gender inequality limited female autonomy in diet/exercise. Family obligations, social restrictions on outdoor movement, and male gatekeeping were dominant themes
Ansari et al[13], 2019	Self-management in rural Pakistan (study 4)	Bahawalpur and Rahim Yar Khan	Patients (n = 22) from rural diabetes clinics	In-depth interviews	Accessibility challenges (distance, cost), low prioritization of diabetes, low self-efficacy, lack of culturally appropriate health messaging
Barolia et al[5], 2019	Motivators and deterrents to diet change (study 5)	Interior Sindh	Low-SES adults with T2DM (n = 15) with CVD	Ethnographic interviews	Religious motivation, fear of dependency, and family pride encouraged change; deterrents included food affordability, social gatherings, and denial
Bukhsh et al[1], 2020	CAM practices among patients with T2DM (study 6)	Urban Punjab	CAM users with T2DM (n = 35), interviewed from CAM clinics	Descriptive qualitative interviews	Patients chose CAM due to economic constraints, mistrust in biomedical systems, and beliefs in natural healing; affordability a critical driver
Ansari et al[12], 2021	Healthcare providers’ perspectives (study 7)	Dera Ghazi Khan	Rural HCPs (n = 18): Doctors, nurses, educators	Thematic framework analysis	HCPs cited lack of diabetes-specific training, poor community health-seeking behavior, and absence of referral systems; females more neglected
Gillani et al[8], 2018	KAP of diabetes in general population (study 8)	Nationwide Pakistan	Mixed community sample (n = 90) across provinces	Focus groups with diverse SES groups	Major knowledge gaps on diet/exercise; misconceptions about heredity and stigma; financial burden deterred routine monitoring
Othman et al[9], 2022	Perspectives of diabetes self-management (study 9)	Multan	Patients attending public clinic (n = 30)	Focus group interviews	Stress from unemployment, peer influence on noncompliance, lack of social support, and limited trust in primary care were noted
Siddique et al[10], 2021	Diabetes education in low-income Punjab (study 10)	Southern Punjab	Older adults (n = 20) in low-income diabetic households	Grounded theory approach	Participants faced conflicting medical advice, inadequate public health information, poor dietary infrastructure, and high food inflation
Jamil et al[11], 2025	Social determinants of diabetes in Pakistan (study 11)	National (urban and semi-urban)	Multi-level policy and community participants	Key informant interviews, stakeholders and patients	Diabetes risk embedded in systemic poverty, fragile health systems, and urban food deserts. Participants emphasized intergenerational cycle of poor education and disease

CVD: Cardiovascular diseases; CAM: Camera; T2DM: Type 2 diabetes mellitus; HCPs: Healthcare providers; KAP: Knowledge, attitude, and perception; SES: Socioeconomic status.