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James O, Abbou-Abbas L, Vijayasingham L. Living with and managing type 1 diabetes in humanitarian settings: A qualitative synthesis of lived experience and stakeholder tacit knowledge. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003027. [PMID: 38905318 PMCID: PMC11192347 DOI: 10.1371/journal.pgph.0003027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/28/2024] [Indexed: 06/23/2024]
Abstract
Humanitarian health actors are beginning to better consider and manage non-communicable diseases, such as diabetes, in emergency and protracted crisis settings. However, a focus on the more globally prevalent type 2 diabetes (T2D) dominates. Blind spots prevail in the unmet needs for type 1 diabetes (T1D), a chronic autoimmune condition where individuals are unable to produce insulin, thereby dependent on lifelong insulin therapy and blood glucose management. Although some T1D management requirements overlap with those of T2D, the immediate risk of fatal complications following insulin therapy disruption, the earlier age of onset during childhood, adolescence or young adulthood, and its lower prevalence compared to T2D within communities and local health systems mean that T1D requires nuanced consideration and targeted interventions. Intending to inform program and policy design for people with T1D (PWT1D), we synthesized themes of lived experience from PLWT1D and their caregivers, and the tacit working knowledge of health providers and policymakers in the context of local humanitarian operations. Through a strategic search of health databases (up to July 2023), we identified 11 articles that include interview excerpts from PWT1D, caregivers, healthcare providers and policymakers about T1D management in humanitarian settings. We used reflexive thematic analysis to guide data extraction, coding, and synthesis, resulting in the identification of four overarching themes: food and insulin security, family relations, knowledge translation, and response to diagnosis. The narratives highlight harsh trade-offs made by PWT1D and their families in the face of insulin and food insecurity, as well as the damaging impact of low T1D education in families, communities and health systems. Targeted family and community-based solutions are urgently required, alongside systemic reforms and international collaboration to enable better T1D coping and management in humanitarian settings.
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Affiliation(s)
- Oria James
- MSc Public Health Graduate Class of 2023, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Linda Abbou-Abbas
- International Committee of the Red Cross, Beirut Delegation, Lebanon
- INSPECT-LB (Institut de Santé Publique, Epidemiologie Clinique et Toxicologie-Liban), Beirut, Lebanon
| | - Lavanya Vijayasingham
- NCD in Humanitarian Settings Research Group and Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Speight J, Holmes-Truscott E, Garza M, Scibilia R, Wagner S, Kato A, Pedrero V, Deschênes S, Guzman SJ, Joiner KL, Liu S, Willaing I, Babbott KM, Cleal B, Dickinson JK, Halliday JA, Morrissey EC, Nefs G, O'Donnell S, Serlachius A, Winterdijk P, Alzubaidi H, Arifin B, Cambron-Kopco L, Santa Ana C, Davidsen E, de Groot M, de Wit M, Deroze P, Haack S, Holt RIG, Jensen W, Khunti K, Kragelund Nielsen K, Lathia T, Lee CJ, McNulty B, Naranjo D, Pearl RL, Prinjha S, Puhl RM, Sabidi A, Selvan C, Sethi J, Seyam M, Sturt J, Subramaniam M, Terkildsen Maindal H, Valentine V, Vallis M, Skinner TC. Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations. Lancet Diabetes Endocrinol 2024; 12:61-82. [PMID: 38128969 DOI: 10.1016/s2213-8587(23)00347-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023]
Abstract
People with diabetes often encounter stigma (ie, negative social judgments, stereotypes, prejudice), which can adversely affect emotional, mental, and physical health; self-care, access to optimal health care; and social and professional opportunities. To accelerate an end to diabetes stigma and discrimination, an international multidisciplinary expert panel (n=51 members, from 18 countries) conducted rapid reviews and participated in a three-round Delphi survey process. We achieved consensus on 25 statements of evidence and 24 statements of recommendations. The consensus is that diabetes stigma is driven primarily by blame, perceptions of burden or sickness, invisibility, and fear or disgust. On average, four in five adults with diabetes experience diabetes stigma and one in five experience discrimination (ie, unfair and prejudicial treatment) due to diabetes, such as in health care, education, and employment. Diabetes stigma and discrimination are harmful, unacceptable, unethical, and counterproductive. Collective leadership is needed to proactively challenge, and bring an end to, diabetes stigma and discrimination. Consequently, we achieved unanimous consensus on a pledge to end diabetes stigma and discrimination.
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Affiliation(s)
- Jane Speight
- School of Psychology and Institute for Health Transformation, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia.
| | - Elizabeth Holmes-Truscott
- School of Psychology and Institute for Health Transformation, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | | | - Renza Scibilia
- Diabetogenic, Melbourne, VIC, Australia; JDRF International, New York, NY, USA
| | - Sabina Wagner
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Asuka Kato
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Victor Pedrero
- Faculty of Nursing, Universidad Andrés Bello, Santiago, Chile
| | - Sonya Deschênes
- School of Psychology, University College Dublin, Dublin, Ireland
| | | | - Kevin L Joiner
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Shengxin Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Ingrid Willaing
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark; Institute of Public Health, Department of Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | - Katie M Babbott
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bryan Cleal
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Jane K Dickinson
- Department of Health Studies & Applied Educational Psychology, Teachers College Columbia University, New York, NY, USA
| | - Jennifer A Halliday
- School of Psychology and Institute for Health Transformation, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Eimear C Morrissey
- Health Behavior Change Research Group, School of Psychology, University of Galway, Galway, Ireland
| | - Giesje Nefs
- Department of Medical Psychology, Radboudumc, Nijmegen, Netherlands; Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands; Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, Netherlands
| | - Shane O'Donnell
- Birmingham Law School, University of Birmingham, Birmingham, UK
| | - Anna Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Per Winterdijk
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, Netherlands
| | - Hamzah Alzubaidi
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Bustanul Arifin
- Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Indonesia
| | | | | | - Emma Davidsen
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Mary de Groot
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Maartje de Wit
- Medical Psychology, Amsterdam Public Health, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | - Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK; National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Karoline Kragelund Nielsen
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Tejal Lathia
- Department of Endocrinology, Apollo Hospitals, Navi Mumbai, India
| | | | | | - Diana Naranjo
- Department of Pediatrics, Division of Endocrinology, Stanford School of Medicine, Palo Alto, CA, USA
| | - Rebecca L Pearl
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Suman Prinjha
- Leicester Diabetes Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, College of Liberal Arts & Sciences, University of Connecticut, Storrs, CT, USA
| | | | - Chitra Selvan
- Department of Endocrinology, Ramaiah Medical College, Bengaluru, India
| | - Jazz Sethi
- The Diabesties Foundation, Ahmedabad, India
| | - Mohammed Seyam
- Faculty of Medicine, Al-Quds University, Abu Dis, Palestine
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Mythily Subramaniam
- Institute of Mental Health Singapore, Singapore; Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Helle Terkildsen Maindal
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Timothy C Skinner
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia; La Trobe Rural Health School, La Trobe University, Flora Hill, VIC, Australia; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Ait-Taleb Lahsen H, Ragala MEA, El Abed H, Hajjaj S, El Makhtari R, Benani S, El Hilaly J, Zarrouq B, Halim K. Educational needs of type 1 diabetes mellitus T1DM children and adolescents in Morocco: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:114. [PMID: 37397112 PMCID: PMC10312424 DOI: 10.4103/jehp.jehp_54_23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/06/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Type 1 Diabetes Mellitus T1DM is a chronic disease, mainly observed in children or young adults, with a significantly increased incidence in young children. To enable diabetic children and adolescents to lead a healthy life and manage their disease effectively, right from diagnosis, they must benefit from therapeutic patient education TPE whose first stage is an educational diagnosis. This study aimed to identify the educational needs of T1DM children and adolescents through an educational diagnosis. METHODS AND MATERIAL A qualitative study was conducted with T1DM children and adolescents, aged 8 to 18, at the pediatric department. This qualitative study was conducted through semi-structured face-to-face individual interviews based on a guide with 20 participants in 2022. The internationally recognized ethical research principles were respected and ethical approval was obtained. Data analysis were carried out according to the principles of the reflexive approach of thematic analysis. RESULTS The interviews' thematic analysis revealed five educational themes: Knowledge about T1DM and its complications risks, measures and attitudes for disease monitoring and therapy management, crisis and short-term complications management, diet and physical activity management, and adaptation of daily life to the disease and treatment constraints. CONCLUSIONS The educational diagnosis is an essential TPE step to identify the educational needs of children and adolescents with T1DM, and to set up if needed, an educational program allowing them to develop the required skills. Hence, the health policy in Morocco should integrate the TPE approach systematically in T1DM patients' care.
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Affiliation(s)
- Hanaâ Ait-Taleb Lahsen
- LSNAMOPEQ, FSDM Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Higher Institute of Nursing and Technical Health Professions, Fez, Morocco
| | - Mohammed El Amine Ragala
- LSNAMOPEQ, FSDM Sidi Mohamed Ben Abdellah University, Fez, Morocco
- High School Teachers-Training College (Ecole Normale Superieure), Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Hanane El Abed
- LSNAMOPEQ, FSDM Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Higher Institute of Nursing and Technical Health Professions, Fez, Morocco
| | - Safaa Hajjaj
- Department of Pediatric, Prefectural Hospital Center Ibn Al-Khatib, Fez, Morocco
| | - Rajae El Makhtari
- Department of Pediatric, Prefectural Hospital Center Ibn Al-Khatib, Fez, Morocco
| | - Sarah Benani
- Department of Pediatric, Prefectural Hospital Center Ibn Al-Khatib, Fez, Morocco
| | - Jaouad El Hilaly
- Laboratory of Pedagogical and Didactic Engineering of Sciences and Mathematics, Regional Center of Education and Training (CRMEF), Fez, Morocco
| | - Btissame Zarrouq
- High School Teachers-Training College (Ecole Normale Superieure), Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Laboratory of Epidemiology and Research in Health Sciences, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Karima Halim
- LSNAMOPEQ, FSDM Sidi Mohamed Ben Abdellah University, Fez, Morocco
- High School Teachers-Training College (Ecole Normale Superieure), Sidi Mohamed Ben Abdellah University, Fez, Morocco
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Palmer T, Waliaula C, Shannon G, Salustri F, Grewal G, Chelagat W, Jennings HM, Skordis J. Understanding the Lived Experience of Children With Type 1 Diabetes in Kenya: Daily Routines and Adaptation Over Time. QUALITATIVE HEALTH RESEARCH 2022; 32:145-158. [PMID: 34841984 PMCID: PMC8721679 DOI: 10.1177/10497323211049775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Focusing only on biomedical targets neglects the important role that psychosocial factors play in effective diabetes self-management. This study aims to understand the lived experiences of children with Type 1 Diabetes (T1DM) in Kenya. Children (n = 15) participated in focus group discussions and photo diary data collection. Focus group discussions and semi-structured interviews were also conducted with caregivers (n = 14). We describe an adaptation to diabetes over time, identifying four overarching themes: knowledge and awareness, economic exclusion, the importance of social support, and striving for normality. Photo diaries are then categorized to explore daily realities of diabetes management. Children with T1DM in Kenya face varied barriers to care but can lead a "normal" and fulfilling life, provided adequate support is in place. To improve the lives of children with diabetes in this context and others like it, stakeholders must take note of children's experiences and recognize their multidimensional needs.
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Affiliation(s)
- Tom Palmer
- Institute for Global Health, 4919University College London, London, UK
| | - Cynthia Waliaula
- Institute for Global Health, 4919University College London, London, UK
| | - Geordan Shannon
- Institute for Global Health, 4919University College London, London, UK
| | | | | | | | | | - Jolene Skordis
- Institute for Global Health, 4919University College London, London, UK
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Souris KJ, Caballero Gonzales MDC, Barrington C, Klatman EL, Anderson BJ, Duarte E, Middlehurst AC, Nostas MC, Ogle GD. 'La Vida Normal': Young people adapting to Type 1 diabetes in Bolivia. Chronic Illn 2021; 17:189-204. [PMID: 31064208 DOI: 10.1177/1742395319843172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To identify challenges and coping strategies of young people with Type 1 diabetes (T1D) and their families in Bolivia through qualitative analysis of interviews with beneficiaries of Centro Vivir con Diabetes (CVCD), a diabetes health center supported by the International Diabetes Federation Life for a Child (LFAC) program. METHODS Eighteen young people aged 14-33 and at least one caregiver participated in semi-structured interviews in five cities in Bolivia from May to June 2016. Interviews were recorded, transcribed, and analyzed using inductive thematic analysis. RESULTS Participants described needing guidance at diagnosis and facing stigma in communities. Young people expressed that life with T1D was 'la vida normal' (a normal life), although interpretations of normalcy varied. For some, 'la vida normal' meant resistance to T1D; for others it indicated acceptance. DISCUSSION Access to interdependent spheres of support allowed young people to form a new normal around T1D. Receiving supplies through the CVCD/LFAC partnership maintained family connection to clinical care, CVCD education helped families share in T1D management, and peer support mitigated stigma for young people. Programs like CVCD that combine supply-based aid with clinical education for whole families, create effective support for young people with T1D in low- and middle-income countries.
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Affiliation(s)
- Katherine J Souris
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Emma L Klatman
- International Diabetes Federation Life for a Child Program, Diabetes NSW & ACT, Glebe, Sydney, Australia
| | | | | | - Angela C Middlehurst
- International Diabetes Federation Life for a Child Program, Diabetes NSW & ACT, Glebe, Sydney, Australia
| | | | - Graham D Ogle
- International Diabetes Federation Life for a Child Program, Diabetes NSW & ACT, Glebe, Sydney, Australia
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