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Mortality and morbidity aspects of self-care and barriers to accessing healthcare among Type 2 Diabetes Mellitus: novel applications in the Saudi and Swedish context

Research project
Active research
Project size
Project period
2020 - 2024
Project owner
Institute of Medicine, School of Public Health and Community Medicine

Short description

This research is a result of a collaboration between academic institutes in Saudi Arabia and University of Gothenburg (GU). The research work is performed by a GU-based PhD student including field visits and data collection in Saudi Arabia. The overarching aim of this research is to identify the morbidity and mortality aspects of self-care and barriers to accessing healthcare among T2DM in Saudi Arabia. This research will employ novel verbal autopsy methods to explore the community perception of causes of deaths due to T2DM and to investigate social and health system causes of death, as informed by the deceased relatives, as a form of monitoring barriers to access T2DM health care services in Saudi Arabia. This tool has potential for scaling up to national level as it can be easily integrated into the national civil registration system.


There is a huge demand on the Saudi healthcare system to provide better healthcare facilities to the rapidly increasing Saudi population, as well as the growing elderly population. The amount of literature addressing the self-care practices of T2DM patients and barriers to access care is scarce and is limited in evaluating the extent and impact of these practices on the patients’ lives. Unlike other countries in the Gulf region, unpublished reports suggest gaps in causes of mortality and morbidity and the MOH has potential to implement systematic tools for population health measurement of which the novel verbal autopsy concept (COMCAT) proposed in this project, is one tool likely to address the national agenda.

Aim of the project

The project aims to explore the community perception of causes of deaths due to T2DM and to identify circumstances (social and health system) causes of death barriers to access T2DM health care services in rural Saudi Arabia, using standardised international VA method. Furthermore, it will validate and adopt a Swedish-quality of life tool for assessing the impact of self-care activities on patients’ reported outcomes in rural Saudi Arabia and to compare patients’ perspectives on self-care activities between newly-diagnosed patients and patients with more than 10 years of T2DM in rural Saudi Arabia.


The VA WHO-2016 questionnaire will be used to collect information from the deceased relatives, conducted by the research (the PhD student) and two local research assistants, and aided with special digital pads which can reduce the process of interview to only 15 minutes and directly feed data into the data hub. The open-source InterVA-5 tool, which is fully compliant with the WHO 2016 VA standard, will be used for processing and interpreting the data into probabilities of causes of death (both medical and circumstantial) - InterVA-5 tool is a Bayesian-based model using a probability matrix that generates an estimate of the most likely cause of death.