Willingness to pay for National Health Insurance Services and Associated Factors in Africa and Asia: a systematic review and meta-analysis.

Background: Universal health coverage (UHC) is crucial for public health, poverty eradication, and economic growth. However, 97% of low- and middle-income countries (LMICs), particularly Africa and Asia, lack it, relying on out-of-pocket (OOP) expenditure. National Health Insurance (NHI) guarantees equity and priorities aligned with medical needs, for which we aimed to determine the pooled willingness to pay (WTP) and its influencing factors from the available literature in Africa and Asia. Methods: Database searches were conducted on Scopus, HINARI, PubMed, Google Scholar, and Semantic Scholar from March 31 to April 4, 2023. The Joanna Briggs Institute's (JBI's) tools and the "preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement" were used to evaluate bias and frame the review, respectively. The data were analyzed using Stata 17. To assess heterogeneity, we conducted sensitivity and subgroup analyses, calculated the Luis Furuya-Kanamori (LFK) index, and used a random model to determine the effect estimates (proportions and odds ratios) with a p value less than 0.05 and a 95% CI. Results: Nineteen studies were included in the review. The pooled WTP on the continents was 66.0% (95% CI, 54.0-77.0%) before outlier studies were not excluded, but increased to 71.0% (95% CI, 68-75%) after excluding them. The factors influencing the WTP were categorized as socio-demographic factors, income and economic issues, information level and sources, illness and illness expenditure, health service factors, factors related to financing schemes, as well as social capital and solidarity. Age has been found to be consistently and negatively related to the WTP for NHI, while income level was an almost consistent positive predictor of it. Conclusion: The WTP for NHI was moderate, while it was slightly higher in Africa than Asia and was found to be affected by various factors, with age being reported to be consistently and negatively related to it, while an increase in income level was almost a positive determinant of it.

Prevalence and predictors of medication adherence among adolescents and adults with asthma in Ethiopia: a systematic review and meta-analysis.

OBJECTIVE: This review aimed to estimate the pooled prevalence and predictors of medication adherence among adolescents and adults with asthma in Ethiopia. DATA SOURCES: Primary studies were searched from PubMed, Scopus, HINARI, and Google Scholar from January 1, 2010 to December 10, 2023. In addition, we have used citation tracking. STUDY SELECTIONS: Observational studies (cross sectional, case control, and cohort) conducted among asthmatic patients ≥15 years old in Ethiopia, published in English language were included. After screening, the studies were assessed using Joanna Briggs Institute (JBI) critical appraisal tool and data were extracted using a checklist. Heterogeneity was assessed using forest plot, Q-statistics and I2. RESULTS: The review was performed among 13 institution-based studies with a total of 2901 participants with asthma. About 1058 participants had comorbid disease and 354 were cigarette smokers. The pooled prevalence of adherence to medications among patients with asthma was 40.50% (95% CI: 28.05, 52.96; p value < 0.001) with high heterogeneity (I2 = 98.25%, p < 0.001). Getting health education about asthma and having comorbid disease were predictors of medication adherence among adolescents and adults with asthma in Ethiopia. CONCLUSIONS: The pooled prevalence of medication adherence among adolescents and adults with asthma in Ethiopia is low and indicated that three out of five adolescents and adults with asthma were non-adherent to medications. This implies the Ministry of Health should develop different strategies to improve medication adherence including patient education and strengthening the health care system. Multicenter longitudinal studies should be further conducted by using objective methods of adherence measurement and large sample size.

Prevalence of medication adherence among adult asthmatic patients in four African countries: A systematic review and meta-analysis.

Non-adherence to medications has many deleterious effects including poor treatment outcomes, increased economic burden, increased morbidity, hospitalization rate, health care utilization, productivity loss, and mortality. Therefore, this review aimed to estimate the pooled prevalence of medication adherence among asthmatic adults in 4 African countries. Primary studies were extensively searched from databases such as PubMed, HINARI, Cochrane Library, CINHALand, Google Scholar, and Google search engines. After screening and assessing the quality of studies, data were extracted using a checklist. Heterogeneity was assessed using forest plot, Chocran's Q Test and I2. The random effects meta-analysis model was employed to pool the prevalence of medication adherence among adult asthmatic patients in Africa. Sub-group analysis and meta-regression were performed to identify the sources of heterogeneity. Publication bias was assessed using funnel plots with Egger's test. A sensitivity analysis was performed to assess the influence of individual studies on the overall estimate. The review was performed among 16 studies of which 14 were cross-sectional with a total of 4019 participants. The pooled random effects prevalence of adherence to medications among adult patients with asthma in Africa was 39% (95% CI: 32, 47; p < 0.001) with a heterogeneity (I2 = 94.82, p < 0.001). The pooled prevalence of medication adherence among adult asthmatic patients in Africa is low. Researchers should conduct further multicenter longitudinal studies by using objective methods of adherence measurement.

Dropout rate and associated factors of community-based health insurance beneficiaries in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Ethiopia aims to achieve universal healthcare using health insurance. To do so, it has been implementing community-based health insurance since 2011. However, the retention of members by the scheme has not yet been evaluated nationally. The systematic review and meta-analysis aimed to evaluate the dropout rate and associated factors among the scheme's beneficiaries in Ethiopia. METHODS: On December 19, 2022, searches were conducted in Scopus, Hinari, PubMed, Semantic Scholar, and Google Scholar. Searches were also conducted on the general web and electronic repositories, including the Ethiopian Health Insurance Service, the International Institute for Primary Health Care-Ethiopia, and various higher education institutions. The Joanna Briggs Institute's tools and the "preferred reporting items for systematic reviews and meta-analyses 2020 statement" were used to evaluate bias and frame the review, respectively. Data were analyzed using Stata 17 and RevMan 5. To assess heterogeneity, we conducted subgroup analysis and used a random model to calculate odds ratios with a p value less than 0.05 and a 95% CI. RESULTS: In total, 14 articles were included in the qualitative synthesis, of which 12 were selected for the quantitative analysis. The pooled estimate revealed that the dropout rate of beneficiaries from the scheme was 34.0% (95% CI: 23-44%), provided that the renewal rate was 66.0%, and was found to be influenced by socio-demographic, health status, length of enrolment, knowledge, attitude, the scheme, and health service-related variables. The southern and Oromia regions reported the lowest and highest dropout rates, with 27.0% (95% CI: 24-29%) and 48.0% (95% CI: 18-78%), respectively. The dropout rates increased from 12.3% in 2012-2015 to 34.4% in 2020-2021. CONCLUSION: More than one-third of the scheme's beneficiaries were found to have dropped out, and this has been found to increase over time, dictating that a community-based strategy and intervention, from the supply, insurer, and demand sides, seem indispensable in minimizing this huge dropout rate.

Pharmacy professionals' perceptions of their professional duties in the Ethiopian health care system: a mixed methods study.

BACKGROUND: Pharmacy professionals are experts in therapeutic knowledge, experience, and skills that are used to ensure desired patient outcomes, utilizing the best available clinical evidence and interventions in collaboration with the health care team. They perceive themselves as a provider of technical, standardized, and individualized advice. The objective of this study was thus to assess the perception of pharmacy professionals towards their current professional roles in the health care system in Dessie, a city in the north-east Ethiopian region. METHODS: A mixed-methods sequential explanatory study was used to assess the perception of pharmacy professionals towards their professional roles in Dessie city administration from December 15-30, 2019. The study participants were all pharmacy professionals working at health facilities in Dessie. Self-administered questionnaires were used to collect quantitative data, and face-to-face key informant interviews were used for qualitative data collection. Data were entered, processed, and analyzed using SPSS 25.0 statistical software, and thematic analysis was used for the qualitative exploration using QDA Miner Lite software (v2.0.7, free edition version). RESULT: The study had a 97.7% response rate. Of the 301 participants, 173 (57.5%) were male. Most of the participants had a positive perception, while 38 (12.6%) had a poor perception of their current professional roles. Lack of physical access, poor initiatives, poor communication skills, and a lack of administrative support for pharmaceutical care were statistically significant at a p value of 0.05 and a 95% confidence interval. From the qualitative data, two major themes emerged: perceived roles and determinants (perceived facilitators and barriers). CONCLUSION: Pharmacy professionals' roles were found to be influenced by a lack of physical access, poor initiatives, poor communication skills, and poor administrator support. Pharmaceutical care requires everyone's involvement in addressing these factors for successful performance and a better outcome and in considering perceived facilitators and barriers.

Corrigendum: Willingness to pay for social health insurance in Ethiopia: a systematic review and meta-analysis.

[This corrects the article DOI: 10.3389/fpubh.2023.1089019.].

Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study.

Background: The fundamental concept of community-based health insurance is to strengthen the healthcare financing system to access universal healthcare by reducing costly risk-coping strategies. The scheme's sustainability and the quality of services provided by it are highly dependent on the satisfaction of its beneficiaries. Despite beneficiaries' satisfaction being the key determinant for providing evidence for policy revision and decision-making, it has often been neglected. Therefore, the study investigated the community-based health insurance beneficiaries' satisfaction and associated factors in Legambo district, North-East Ethiopia. Methods: The study was conducted in the Legambo district with a community-based cross-sectional study design from October to November 2019. The data were collected from 838 households that had been the beneficiaries of the scheme using multi-stage and systematic random sampling. Twelve trained data collectors were employed and gathered the data using a pre-tested, structured questionnaire. We ran descriptive, bivariate, and logistic regression analyses. A value of p less than 0.05 with a 95% CI was used in multivariate logistic regression to determine the association of variables with the beneficiaries' satisfaction. Results: The overall satisfaction level of the beneficiaries of the scheme was 58.6% and was associated with the following factors: merchandize (AOR = 1.92, 95% CI = 1.02-3.63), living in rural areas (AOR = 1.52, 95% CI = 1.02-2.27), an early office opening time (AOR = 3.81, 95% CI = 2.04-7.10), a short time interval to use benefit packages (AOR = 4.85, 95% CI = 2.08-11.31), an inexpensive membership premium (AOR =10.58, 95% CI = 3.56-31.44), availability of laboratory services (AOR =2.95, 95% CI = 1.71-5.09), presence of referral services (AOR =1.93, 95% CI = 1.33-2.80), having immediate care at health facilities (AOR = 1.73, 95% CI = 1.01-2.97) and non-compulsory enrolment (AOR = 6.31, 95% CI = 1.64-24.20). Conclusion: The beneficiaries' satisfaction with the scheme was suboptimal and found to be determined by occupation, residence, laboratory and referral services, immediate care, office opening time, time interval to use benefit packages, premium amount, and situation of enrollment, most of which are service-related variables. Thus, to improve the satisfaction level, the stakeholders that should work hard seem to be the health insurance agency (the insurer) and the health facilities (the provider or supplier).

Hepatitis B virus infection and associated factors among antenatal care attendees in Dessie City Administration, North-East Ethiopia: a case-control study.

The hepatitis B virus remains a major public health problem due to a variety of risk factors, which we aimed to investigate in Dessie City Administration, Ethiopia. Unmatched case-control study was conducted from February to May 2021 using systematic random sampling. The data were collected using an interviewer-administered questionnaire, then cleaned using EpiData version 4.6.0 and exported to SPSS version 25.0 for analysis. The odds ratio with a 95 percent CI was used to determine the association between the independent and outcome variables. A total of 421 participants (105 cases and 316 controls) were enrolled. A history of having multiple sexual partners (AOR = 4.64; 95 percent CI: 2.64-8.14); a history of abortion (AOR = 3.18; 95 percent CI: 1.78-5.66); the presence of a hepatitis B carrier in the family (AOR = 8.70; 95 percent CI: 4.26-17.77); a history of hospitalization (AOR = 2.98; 95 percent CI: 1.56-5.69); and retroviral seropositivity (AOR = 3.68; 95 percent CI: 1.55-8.74) were independent risk factors for having hepatitis B virus infection. In conclusion, antenatal infection with the virus was found to be determined by the number of sexual partners, abortion and hospitalization, hepatitis B carriers in the family, and retroviral seropositivity, which dictates the need for integrated community-wide intervention.

Willingness to pay for social health insurance in Ethiopia: A systematic review and meta-analysis.

Background: Ethiopia plans to introduce social health insurance with the aim of giving recipients high-quality, long-term universal health care. It was anticipated to be fully operational in 2014. However, due to strong opposition from public employees, the implementation has been delayed multiple times. As a result, more and more studies have been conducted to collect evidence about the issue. However, there is no national pooled evidence regarding the willingness to pay for the scheme. Thus, this review aimed to evaluate the willingness to pay for social health insurance and associated factors in Ethiopia. Methods: On September 1, 2022, database searches were conducted on Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Based on this search, 19 studies were included in the review. The risk of bias for the included studies was assessed using Joana Briggs Institute checklists. The data were extracted using Microsoft Excel. RevMan-5 was used to conduct the meta-analysis. The effect estimates assessed were the odds ratios at a p-value <0.05 with a 95% CI using the random effect model. Results: The pooled willingness to pay for social health insurance was 42.25% and was found to be affected by sociodemographic, health and illness status, health service related factors, awareness or knowledge level, perception or attitude toward the scheme, and factors related to the scheme. The pooled result showed that the willingness of participants to pay for the scheme was 16% less likely (OR = 0.84; 95% CI: 0.52-1.36). When the outlier was unchecked, the willingness to pay became 42% less likely (OR = 0.58; 95% CI: 0.37-0.91). The lowest willingness to pay for the scheme was in the Oromia region, while the highest was in Harar. Professionally, teachers were 3.22 times more likely to pay for the scheme (OR = 3.22; 95% CI: 1.80-5.76) than health professionals. Conclusion: The willingness to pay for social health insurance was low, <50%, particularly among health professionals, which urges the Ethiopian health insurance service to deeply look into the issue.

The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Ideally health insurance aims to provide financial security, promote social inclusion, and ensure equitable access to quality healthcare services for all households. Community-based health insurance has been operating in Ethiopia since 2011. However, its nationwide impact on universal health coverage has not yet been evaluated despite several studies being conducted. OBJECTIVE: We evaluated the impact of Ethiopia's community-based health insurance (2012-2021) on universal health coverage. METHODS: On 27 August 2022, searches were conducted in Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Twenty-three studies were included. We used the Joana Briggs Institute checklists to assess the risk of bias. We included cross-sectional and mixed studies with low and medium risk. The data were processed in Microsoft Excel and analyzed using RevMan-5. The impact was measured first on insured households and then on insured versus uninsured households. We used a random model to measure the effect estimates (odds ratios) with a p value < 0.05 and a 95% CI. RESULTS: The universal health coverage provided by the scheme was 45.6% (OR = 1.92, 95% CI: 1.44-2.58). Being a member of the scheme increased universal health coverage by 24.8%. The healthcare service utilization of the beneficiaries was 64.5% (OR = 1.95, 95% CI: 1.29-2.93). The scheme reduced catastrophic health expenditure by 79.4% (OR = 4.99, 95% CI: 1.27-19.67). It yielded a 92% (OR = 11.58, 95% CI: 8.12-16.51) perception of health service quality. The health-related quality of life provided by it was 63% (OR = 1.71, 95% CI: 1.50-1.94). Its population coverage was 40.1% (OR = 0.64, 95% CI: 0.41-1.02). CONCLUSION: Although the scheme had positive impacts on health service issues by reducing catastrophic costs, the low universal health coverage on a limited population indicates that Ethiopia should move to a broader national scheme that covers the entire population.

Quality of life and associated factors among patients with cancer receiving chemotherapy at Dessie Comprehensive Specialized Hospital, North-East Ethiopia: a cross-sectional study.

Background: Cancer is a major public health problem around the world. Cancer by itself and its treatment modalities affect the quality of life (QoL) of patients with it. However, there were a paucity of studies about the QoL of patients receiving chemotherapeutic treatment in Ethiopia. This study was aimed at addressing such a gap. Accordingly, we investigated QoL and associated factors among cancer patients receiving chemotherapy at Dessie Comprehensive Specialized Hospital (DCSH), North East Ethiopia, in 2023. Methods: We employed a cross-sectional study from April 1 to May 30, 2023. The data was collected using the European Organization for Research and Treatment of Cancer Core QoL Questionnaire, version 3.0 (EORTC QLQ-C30). The data was entered and cleaned using EpiData version 4.6 and exported to Statistical Package for Social Sciences (SPSS) version 27 for analysis. The association between the dependent and independent variables was determined using Odds Ratios (ORs) at a p value < 0.05 with a 95% CI. Results: Data was collected from 394 patients. Their mean summary QoL score was 36.3 ± 9.0. About 39.3% demonstrated a good QoL summary score, whereas 60.7% were impacted by symptoms. A good functional QoL score was observed in 42.6% of the participants. About 54.8% and 31.7% reported good overall health status and good overall QoL, respectively. The most impacted functional domain was social functioning, affecting 64.5% of participants. The most common symptom was diarrhea, affecting 65.5% of the participants. Secondary school education level (Adjusted Odds Ratio-AOR = 3.16, 95% CI: 1.14-8.81), diploma and above education level (AOR = 4.90, 95% CI: 1.29-18.62), and urban residency (AOR = 1.74, 95% CI: 1.07-2.82) had a significant positive association with QoL, while being a civil servant (AOR = 0.13, 95% CI: 0.04-0.49), having stage III cancer (AOR = 0.14, 95% CI: 0.05-0.39), and stage IV cancer (AOR = 0.16, 95% 0.06-0.44) had a significant negative association with it. Conclusion: The QoL for cancer patients undergoing chemotherapy was significantly low and associated with their level of education, occupational status, area of residence, and stage of cancer. Incorporating psychosocial support is thus crucial in their treatment plans.

Willingness to pay for social health insurance among public civil servants: A cross-sectional study in Dessie City Administration, North-East Ethiopia.

Background: The readiness to pay for health insurance has an impact on universal health care. This study investigated the willingness of public civil servants in Dessie City Administration, North-East Ethiopia, to pay for social health insurance and associated factors. Methods: From April to May 2021, a cross-sectional study was undertaken. The sectors from which the samples were proportionately allocated were chosen using a multistage sampling procedure. Using their payroll list as a sampling frame, simple random sampling was done to recruit them. A semi-structured self-administered questionnaire was used to collect data. Epi Data version 3.1 was used to enter, code, and clean the data, which was then exported to SPSS version 23 for analysis. To determine relationships, bi-variable and multivariable analyses were utilized. Candidates for multivariable analysis were variables with a p-value ≤ 0.3 in bi-variable analysis. AOR with a 95% CI was used to determine the strength and direction of association. Statistical significance was defined at p-value < 0.05. Results: A total of 796 employees took part in the study, with a 94.42% response rate. Overall, 29.60% of them were willing to pay for the scheme (95% CI: 26.4, 33%). The decision to pay was influenced by favorable perception (AOR = 2.43, 95% CI: 1.72, 3.44), household income < Birr 5,000 (AOR = 0.26, 95% CI: 0.14, 0.48), acute illness (AOR = 0.48, 95% CI: 0.32, 0.72), bachelor level education (AOR = 0.44, 95% CI: 0.28, 0.70), master and above level education (AOR = 0.26, 95% CI: 0.14, 0.49), and age 25-29 years (AOR = 1.97, 95 % CI: 1.08, 3.57). Conclusion: The willingness of the civil servants to pay for social health insurance was low, and it was influenced by their attitudes toward the scheme, the occurrence of severe illness, income level, educational status, and age.

Barriers and facilitators to insulin treatment: a phenomenological inquiry.

BACKGROUND: Despite being the most effective treatment for advanced type 2 diabetes, the choice to start and maintain insulin therapy is based on a variety of criteria, including the patients' acceptance and willingness to adhere to it. The patients' beliefs and experiences, on the other hand, could not be revealed without a thorough exploration. OBJECTIVES: This study investigated the barriers and facilitators to insulin treatment from the perspectives of patients with type 2 diabetes following treatment at Dessie Comprehensive Specialized Hospital, North-East Ethiopia. METHODS: A phenomenological study was conducted from July 2019 to January 2020. Twenty-four (11 males and 13 females) participants were recruited purposively. Data were collected through face-to-face in-depth interviews, lasted about 23 to 71 min, until theoretical saturation was reached, and then organized using QDA Miner Lite v2.0.9. The transcripts were thematically analyzed using narrative strategies and the themes that arose were discussed in detail. RESULTS: The most common facilitator of insulin treatment was its relative effectiveness, which was followed by its convenience (fewer gastrointestinal side effects, small needle size and ease of use), the concept of it is life, faith in doctors' decisions, family support, and health insurance membership. The most common impediments, on the other hand, were market failures (expensiveness and supply shortages), followed by its properties and patients' circumstances. CONCLUSIONS: Market failures due to supply shortages and associated costs were identified to be the most significant barriers to insulin treatment, necessitating the availability of an effective pharmaceutical supply management strategy that targets on insulin supply and affordability. It is also strongly recommended that health insurance coverage be increased.

Patients' perceptions, associations, and justifications for the causes of diabetes in North-East Ethiopia: A qualitative study.

BACKGROUND AND AIMS: Diabetes management is strongly influenced by patients' beliefs about its causes. The study examined type 2 diabetes patients' perceptions of the causes of their illness in North-East Ethiopia. METHODS: The study used a phenomenological approach triangulated with modified grounded theory based on the Causative Dimension of Self-Regulated Model, and was conducted from July 2019 to January 2020. Purposive sampling was used to select the participants. Semi-structured in-depth face-to-face interviews with twenty-four (11 males and 13 females) participants were used to collect data until saturation. QDA Miner Lite v2.0.8 was used to perform analysis, which was then discussed based on the themes that emerged. RESULTS: The patients expressed and justified the causes of their illness by evidencing the temporal proximity of the onset of symptoms or indicators and specific misfortune. As such, diabetes has been attributed to emotional reactions, psycho-economic situations, supernatural evil spirits, substance use, nutritional problems, and other illness; emotional reactions, with psycho-economic and supernatural spirits being the most common. These causes were justified by referring to a specific earlier misfortune that related to the onset of the indicators. CONCLUSION: Patients' perceptions for attributing their illness were linked with emotional, psycho-economic, and supernatural evil spirits and justified by a specific life calamity by establishing the temporal association of symptoms with that adversity; which entails culture-specific psycho-social and educational interventions in diabetes care. Moreover, the finding necessitates that the causality justifications and linkages to misfortunes be included in the Causality Dimension of the Self-Regulated Model.

Sufferings of its consequences; patients with Type 2 diabetes mellitus in North-East Ethiopia, A qualitative investigation.

BACKGROUND: The burden of diabetes in Ethiopia is exponentially increasing with more than 68% of people with it being undiagnosed and a death rate of 32%. It is a disease impacting patients with negative somatic, psychological, social, and economic consequences. Patients in Ethiopia have very low awareness about chronic complications, which is very worrying. The study aimed to explore the consequences of their disease experienced by type 2 diabetes patients in North-East Ethiopia. METHODS: The study employed a phenomenological approach informed by the consequences dimension of the Common-Sense Model. It was conducted from July 2019 to January 2020 using purposive sampling with face-to-face in-depth interviews, for about three weeks, until reaching theoretical saturation. The data were collected from twenty-four type 2 diabetes patients, who were selected to include various socio-demographic characteristics. The data were organized by QDA Miner Lite v2.0.8 and analyzed thematically using narrative strategies. RESULTS: Using Common-Sense Model as a framework, the diabetes consequences experienced by the participants were categorized as complications and impacts. While the most common complications were cardiovascular disorders (hypertension, erectile dysfunction, heart and kidney problems, hyperlipidemia, edema, stroke, and fatigue) and ocular problems; the most common impacts were psychosocial (dread in life, suffering, family disruption, hopelessness, dependency, and craving), and economic (incapability and loss of productivity) problems. CONCLUSION: The patients here were bothered by diabetes complications as well as its psycho-social, economic and somatic consequences; being the psycho-social impacts the most common. As a result, the patients have been suffering in the dread of "what can come next?" This dictates that holistic care, based on Common-Sense Model, is needed in providing special emphasis to psycho-social issues.

Thirst for Information and Needs Reflections of Type 2 Diabetes Patients Receiving Insulin Treatment in North-East Ethiopia: A Qualitative Exploration.

OBJECTIVES: Ongoing, proactive, planned, and patient-centered diabetes education is the cornerstone of care for all persons with diabetes. Thus, the aim of this study was to explore the information needs of type 2 diabetes mellitus patients receiving insulin treatment in North-East Ethiopia. METHODS: The study was conducted from July 2019 to January 2020 using a qualitative enquiry (phenomenological approach) with purposive sampling. Face-to-face in-depth interviews were used to collect data until reaching theoretical saturation. The participants were type 2 diabetes patients receiving insulin treatment. They were identified from the diabetes patients' registration book at the diabetes clinic and interviewed at their appointment time, and were selected to include wide variations in terms of socio-demographic characteristics. Twenty-four participants (11 men and 13 women), with a median age of 57 years, were interviewed. The data were organized using QDA Miner Lite version 2.0.7 and analyzed thematically using narrative strategies. RESULTS: Most participants had not heard of diabetes before their diagnosis. They had limited knowledge of diabetes, but ascribed different connotations for it in the local language (Amharic). The needs reflections of patients were categorized into diabetes education and participants' recommendations. Diabetes education was totally absent at hospitals, and patients received education primarily from the Ethiopian Diabetes Association and broadcast and digital media. Thus, the major concern of patients was the availability of diabetes education programs at health institutions. CONCLUSIONS: Patients' main concern was the absence of routine diabetes education, which necessitates urgent action to implement diabetes education programs, especially at health institutions.