Three Lessons on diabetes for global health professionals, researchers and policy-makers from the people of Ga Mashie

Olutobi Adekunle Sanuade ^1* Lydia O Okoibhole ² Ernestina K Dankyi ³ Daniel Strachan ⁴ Leonard BAATIEMA ³ Sandra Boatemaa Kushitor ⁵ Raphael B Awuah ³ Mawuli K Kushitor ⁶ Samuel Amon ³ Irene Kretchy ³ Daniel Arhinful ⁷ Edward Fottrell ² Megan Vaughan ²

• ¹ The University of Utah, Salt Lake City, United States
• ² University College London, London, England, United Kingdom
• ³ University of Ghana, Accra, Greater Accra, Ghana
• ⁴ Nossal Institute for Global Health, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
• ⁵ Ensign Global College, Kpong, Ghana
• ⁶ University of Health and Allied Sciences, Ho, Volta, Ghana
• ⁷ Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana

Diabetes is a leading cause of death globally, with significant burdens in low-and middle-income countries (LMICs). However, knowledge of contextual factors associated with diabetes in LMICs are limited. This study highlights three important lessons on diabetes by identifying and interpreting contextual factors related to its prevention and management within a low-income urban community in Accra, Ghana.This was a qualitative study. Data were collected through four focus group discussions (FGDs) with elderly men and women (50+ years) and 18 in-depth interviews with community stakeholders, including traditional leaders, market women, and the Ga Mashie Development Agency. Thematic analysis was conducted to identify key insights on diabetes perceptions, challenges, and cultural practices.Three key themes emerged from the data: (1) Knowledge does not always translate to action. While participants had extensive knowledge of diabetes risk factors and management, they cited practical constraints that hindered their ability to make behavior changes; (2) Food is more than nutrition. Participants noted that food plays an important role in family, community, and emotional wellbeing, and (3) Diabetes carries dual meanings. Participants associated diabetes with both individual lifestyle behaviors (e.g. alcohol consumption and sexual activity) and broader environmental exposures (e.g. pollution and chemical contaminants in food).These results highlight the complexity of diabetes management in an urban poor community context, requiring more than knowledge on diabetes risk factors for behavior change. Addressing personal, communal, and environmental factors, alongside structural barriers, is essential for developing effective, sustainable diabetes management strategies in this setting.