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Jere J, Ruark A, Bidwell JT, Butterfield RM, Neilands TB, Weiser SD, Mulauzi N, Mkandawire J, Conroy AA. "High blood pressure comes from thinking too much": Understandings of illness among couples living with cardiometabolic disorders and HIV in Malawi. PLoS One 2023; 18:e0296473. [PMID: 38153924 PMCID: PMC10754453 DOI: 10.1371/journal.pone.0296473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/13/2023] [Indexed: 12/30/2023] Open
Abstract
Cardiometabolic disorders (CMD) such as hypertension and diabetes are increasingly prevalent in sub-Saharan Africa, placing people living with HIV at risk for cardiovascular disease and threatening the success of HIV care. Spouses are often the primary caregivers for people living with CMD, and understanding patients' and partners' conceptions of CMD could inform care. We conducted semi-structured interviews with 25 couples having a partner living with HIV and either hypertension or diabetes. Couples were recruited from HIV clinics in Malawi and were interviewed on beliefs around symptoms, causation, prevention, and treatment for CMD. Data were analyzed at the individual and dyadic levels using framework analysis and Kleinman's theory of explanatory models as a lens. On average, participants were 51 years old and married for 21 years. Approximately 57%, 14%, and 80% had hypertension, diabetes, and HIV. Couples endorsed a combination of biomedical explanatory models (beliefs around physical and mental health) and traditional explanatory models (beliefs around religion and natural remedies), although tended to emphasize the biomedical model. Half of couples believed stress was the main cause of hypertension. For diabetes, diet was believed to be a common cause. In terms of prevention, dietary changes and physical activity were most frequently mentioned. For disease management, medication adherence and diet modifications were emphasized, with some couples also supporting herbal remedies, stress reduction, and faith in God as strategies. Participants were generally more concerned about CMD than HIV due to poor access to CMD medications and beliefs that CMD could lead to sudden death. Within couples, partners often held many of the same beliefs but diverged around which etiological or preventive factors were most important (e.g., stress versus diet) and the best diet for CMD. Health education programs should involve primary partners to build knowledge of CMD and address overlap with HIV, and reinforce accurate information on lifestyle factors for the prevention and treatment of CMD.
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Affiliation(s)
- Jane Jere
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Allison Ruark
- Wheaton College, Biological and Health Sciences, Wheaton, IL, United States of America
| | - Julie T. Bidwell
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California, United States of America
| | - Rita M. Butterfield
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, United States of America
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, United States of America
| | - Sheri D. Weiser
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | | | | | - Amy A. Conroy
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, United States of America
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Nkambule E, Wella K, Msosa A, Mbakaya BC, Chilemba E, Msiska G. Patient's experiences of diabetes care at a tertiary health facility in Lilongwe, Malawi. BMC Health Serv Res 2023; 23:1093. [PMID: 37828591 PMCID: PMC10571416 DOI: 10.1186/s12913-023-10039-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Little is known about experiences of rural people with diabetes care at a tertiary health facility in low-income settings. Understanding their experiences is essential for developing effective diabetes care interventions. METHODS The study employed a qualitative narrative inquiry. Participants were identified at a diabetes clinic at a tertiary-level healthcare facility. Ten participants from the rural areas attending the diabetes clinic were purposively selected. Data were collected through in-depth interviews in the privacy of the homes of the study participants and analysis was done using the Riessman approach to thematic narrative analysis. RESULTS In this study, the following four themes emerged: (1) the long pathway to a diagnosis of diabetes; (2) Poverty-related hardships and diabetic clinic attendance; (3) The impact of health worker attitudes and behavior on diabetes care; and (4) Low resources and their impact on self-management. CONCLUSIONS Rural-based patients living with diabetes encounter enormous challenges as they access diabetes care. One of the challenges is delayed diagnosis of diabetes. There is a need to introduce point-of-care (POC) testing to improve diabetes diagnosis. In addition, there is a need to strengthen awareness campaigns among the population so that people are well informed about the signs and symptoms of diabetes to promote early diagnosis. Diabetes care must be decentralized from tertiary hospitals to primary health centers. This will improve access to diabetes care and reduce the burden associated with traveling a long distance to access diabetes care in Malawi.
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Affiliation(s)
- Ellen Nkambule
- St John's Institute for Health, P.O. Box 18, Mzuzu, Malawi.
| | - Kondwani Wella
- Kamuzu University of Health Sciences, P/Bag 1, Lilongwe, Malawi
| | - Annie Msosa
- Kamuzu University of Health Sciences, P/Bag 1, Lilongwe, Malawi
| | | | - Evelyn Chilemba
- Kamuzu University of Health Sciences, P/Bag 1, Lilongwe, Malawi
| | - Gladys Msiska
- Kamuzu University of Health Sciences, P/Bag 1, Lilongwe, Malawi
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Ernersson Å, Mufunda E, Hjelm K. Audit of essential knowledge of diabetes in patients with diabetes in Zimbabwe. Pan Afr Med J 2023; 45:103. [PMID: 37719056 PMCID: PMC10504438 DOI: 10.11604/pamj.2023.45.103.31770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/24/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction in Zimbabwe, the organized diabetes education in the governmental health care system is limited, but the Diabetes Association has some educational activities in which persons with diabetes can participate. In this study, the purpose was to measure essential knowledge of diabetes and its management in persons with diabetes living in Zimbabwe. Methods a cross-sectional descriptive study design was used to audit essential knowledge of diabetes and its management in persons with type 2 diabetes through a survey of 64 persons attending meetings at the Zimbabwe Diabetes Association. Both descriptive and analytic statistical methods were used. Results in general respondents have acceptable knowledge of diabetes, whereas their knowledge of glycaemic control is low (45%), likewise their knowledge of how to manage medical treatment when ill. Knowledge concerning lifestyle-related issues was generally low. Respondents had limited knowledge about changes in blood glucose during physical activity (18%) and their knowledge about appropriate food for people with diabetes was low (67%). Most respondents were aware of the importance of regular examinations to avoid long-term complications related to diabetes (>87%) but their knowledge of how to prevent foot complications and perform daily preventive foot care was limited (73 %). Conclusion there is limited knowledge of diabetes in Zimbabwean persons with type 2 diabetes even if they have participated in educational activities at the patient associations. This further supports the need for development of education for patients in health care which requires increased competence in the field among health care staff.
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Affiliation(s)
- Åsa Ernersson
- Department of Health, Medicine and Care, Linköping University, Linköping, Sweden
| | - Esther Mufunda
- Department of Health Sciences, Zimbabwe Open University, Harare, Zimbabwe
| | - Katarina Hjelm
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Phytochemical Analysis, Acute Toxicity, as well as Antihyperglycemic and Antidiabetic Activities of Corchorus olitorius L. Leaf Extracts. ScientificWorldJournal 2022; 2022:1376817. [PMID: 35898284 PMCID: PMC9314181 DOI: 10.1155/2022/1376817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/15/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
Backgroundand Aim. Diabetes mellitus is a metabolic disorder that has no known cure with continuous endeavors to find a therapy for the condition. According to some studies, traditional leafy vegetables could prevent and manage diabetes by modifying the carbohydrate and lipid metabolism. In this study, a phytochemical analysis, acute toxicity, as well as antihyperglycemic and antidiabetic activity testing of the methanolic, diethyl ether, and aqueous leaf extracts of Corchorus olitorius L. was performed. Materials and Methods. Methanolic, diethyl ether, and aqueous leaf extracts of Corchorus olitorius L. were prepared by serial extraction. Phytochemical analysis was performed following standard methods. 52 mice were separated into 13 groups (A–M) of 4 and received extracts' doses ranging from 1000 mg/kg to 5000 mg/kg for the acute toxicity testing. For the antihyperglycemic and antidiabetic activities testing, 48 rats were divided into 8 groups of 6 and received 500 mg/kg of each extract. 10 mg/kg of glibenclamide and distilled water were used as controls. Data were analyzed using Prism GraphPad version 8.0.2 (263). Results. Phytochemical analysis revealed the presence of alkaloids, reducing sugars, saponins, and terpenoids. There were no acute toxicity signs observed in this study. Corchorus olitorius L. extracts demonstrated moderate antihyperglycemic and antidiabetic activities. The methanolic extract exhibited the highest degree of antihyperglycemic activity. However, there was no statistically significant difference between the extracts and the negative control (p > 0.05), but with glibenclamide (p < 0.01). Conclusion. Corchorus olitorius L. is a safe and potential postprandial antidiabetic vegetable that could minimize the rise in blood glucose after a meal. We therefore recommend further investigations into the antidiabetic properties of the vegetable using purified extracts.
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Bayked EM, Kahissay MH, Workneh BD. Patients' perceptions, associations, and justifications for the causes of diabetes in North-East Ethiopia: A qualitative study. Diabetes Metab Syndr 2022; 16:102502. [PMID: 35597056 DOI: 10.1016/j.dsx.2022.102502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Ewunetie Mekashaw Bayked
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia.
| | - Mesfin Haile Kahissay
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Birhanu Demeke Workneh
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
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Davoodi M, Dindamal B, Dargahi H, Faraji-Khiavi F. A phenomenological study on barriers of adherence to medical advice among type 2 diabetic patients. BMC Endocr Disord 2022; 22:18. [PMID: 34991587 PMCID: PMC8740353 DOI: 10.1186/s12902-021-00928-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND More than three decades of research and study for overcoming the problem of "non-acceptance/non-compliance" of patients has neither resolved nor reduced the severity of this problem. This phenomenological study aimed to identify barriers of adherence to medical advice among type 2 diabetic patients. METHODS This study was a qualitative research using phenomenology approach, and the data were analyzed using content analysis approach. Participants were 69 type 2 diabetic patients covered by the diabetes unit of West and East Community Health Centers of Ahvaz, Iran. The views and attitudes of patients about the barriers of adherence to medical advice were elicited by conducting 20-45 min sessions of semi-structured interviews. Data analysis was performed following Colaizzi's seven-step method. RESULTS Barriers of adherence to medical advice were classified into systemic and individual barriers. Individual barriers included 11 codes and 5 categories, and systemic barriers contained within 5 codes and 3 categories. Physiologic and physical factors, financial problems, occupational factors, attitudinal problems and lack of knowledge, and social and family problems were identified as individual barriers. Systemic barriers included inadequate publicizing and limited notification, inadequate equipment and facilities, and poor inter-sectional coordination. CONCLUSIONS Generally, problems stated by diabetic patients at the individual level can partly be solved by training patients and the people around them. However, as for the systemic problems, it seems that solving the barriers of adherence to medical advice requires coordination with other organizations as well as intersection coordination. Overall, these problems require not only comprehensive health service efforts, but also the support of policymakers to resolve barriers at infrastructure level.
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Affiliation(s)
- Monire Davoodi
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Behnaz Dindamal
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hossein Dargahi
- Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Faraji-Khiavi
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Ogunlana MO, Govender P, Oyewole OO, Odole AC, Falola JL, Adesina OF, Akindipe JA. Qualitative exploration into reasons for delay in seeking medical help with diabetic foot problems. Int J Qual Stud Health Well-being 2021; 16:1945206. [PMID: 34219610 PMCID: PMC8259813 DOI: 10.1080/17482631.2021.1945206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose Delay in reporting foot symptoms in patients with diabetes to health-care professionals is said to be responsible for limb amputation. While reasons for these delays have been investigated elsewhere, they are not well documented in Nigeria. This study explored the causes of delayed presentation in a Nigerian sample of patients with diabetic foot ulcers. Method The study followed an explorative qualitative design in which the lived experience of eight participants with diabetes were explored. The participants completed in-depth interviews which were digitally audio-recorded and transcribed verbatim. Data were analysed thematically using deductive reasoning. Results The study identified four themes which included knowledge and awareness of foot challenges, risk perception, health seeking triggers and behaviours and competing priority as the factors responsible for delay in presentation of diabetic foot complications. Conclusions Limited knowledge and awareness and negative health seeking behaviours including self-management and consultation of traditionalists were the major reasons for delays.
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Affiliation(s)
- Michael Opeoluwa Ogunlana
- Federal Medical Centre, Abeokuta, Nigeria.,College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Pragashnie Govender
- Discipline of Occupational Therapy, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Olufemi Oyeleye Oyewole
- Department of Physiotherapy , Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | | | | | - Olubiyi F Adesina
- Unit of Endocrinology, Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Jabez Ariyo Akindipe
- Unit of Plastic Surgery, Department of Surgery, Federal Medical Centre, Abeokuta, Nigeria
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Sanuade OA, Dodoo FNA, Koram K, de-Graft Aikins A. Explanatory models of stroke in Ghana: perspectives of stroke survivors and their caregivers. ETHNICITY & HEALTH 2021; 26:697-719. [PMID: 30922062 DOI: 10.1080/13557858.2018.1557116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 12/01/2018] [Indexed: 06/09/2023]
Abstract
Objective: This study examines explanatory models (EMs) of stroke and its complications among people living with stroke, and their caregivers, in two urban poor communities in Accra (Ga Mashie) and Korle Bu Teaching Hospital (KBTH), Accra.Methods: Twenty-two stroke survivors and 29 caregivers were recruited from 2 urban poor communities in Accra and KBTH. Qualitative data were obtained using semi-structured interviews that lasted between 45 minutes and 2 hours. The interviews were audiotaped, transcribed and analysed thematically, informed by the concept of EMs of illness.Results: Participants referred to stroke as a sudden event and they expressed different emotional responses after the stroke onset. Stroke survivors and their caregivers attributed stroke with poor lifestyle practices, high blood pressure, unhealthy diet and dietary practices, supernatural causes, stress, family history, other chronic diseases, and delay in treatment of symptoms. While the stroke survivors associated stroke complications with physical disability and stigmatisation, the caregivers associated these with physical disability, behavioural and psychological changes, cognitive disability and death. These associations were mostly influenced by the biomedical model of stroke.Conclusion: The biomedical model of stroke is important for developing interventions that will be accepted by the stroke survivors and the caregivers. Nevertheless, sociocultural explanations of stroke need to be taken into consideration during delivery of medical information to the participants. This study proposes an integrated biopsychosociocultural approach for stroke intervention among the study participants.
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Affiliation(s)
| | | | - Kwadwo Koram
- The Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
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Understanding the diagnostic delays and pathways for diabetes in eastern Uganda: A qualitative study. PLoS One 2021; 16:e0250421. [PMID: 33882116 PMCID: PMC8059813 DOI: 10.1371/journal.pone.0250421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/06/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Type 2 diabetes is rapidly becoming a significant challenge in Uganda and other low and middle-income countries. A large proportion of the population remains undiagnosed. To understand diagnostic delay, we explored the diagnostic pathways for diabetes among patients receiving care at a semi-urban district hospital in eastern Uganda. METHODS Eligible participants were patients aged 35-70 years receiving care at the diabetes clinic of Iganga district hospital between April and May 2019 and their healthcare providers. Patients were interviewed using an interview guide to collect information on patients' symptoms and their diagnostic experience. A separate interview guide was used to understand the organisation of the diabetes services and the diabetes diagnostic process at the hospital. Using maximum variation purposive sampling, we selected 17 diabetes patients aged 35-68 years, diagnosed within the previous three years, and the three health workers managing the diabetes clinic at Iganga hospital. The data was analysed using ATLAS.ti version 8 to code, organise and track the data segments. We conducted template analysis using a priori themes derived from the intervals of Walter's model of Pathways to Treatment to identify the factors influencing diagnostic delay. RESULTS We identified four typologies: a short diagnostic pathway, protracted appraisal pathway, protracted appraisal and diagnostic interval pathway, and delayed treatment pathway. The pathways of patients with protracted appraisal or diagnostic intervals demonstrated strong socio-cultural influences. There was a firm reliance on traditional healers both before and after diagnosis which deferred enrolment into care. Other health system barriers implicated in delayed diagnosis included stock-out of diagnostic supplies, misdiagnosis, and missed diagnosis. Denial of diagnosis was also found to lead to delayed initiation of care. CONCLUSION Reducing diagnostic delay requires addressing both negative socio-cultural influences and the adoption of system-wide interventions to address barriers to timely diagnosis.
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Widayanti AW, Green JA, Heydon S, Norris P. Health-Seeking Behavior of People in Indonesia: A Narrative Review. J Epidemiol Glob Health 2021; 10:6-15. [PMID: 32175705 PMCID: PMC7310809 DOI: 10.2991/jegh.k.200102.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/21/2019] [Indexed: 11/01/2022] Open
Abstract
This review aims to locate existing studies on health-seeking behavior of people in Indonesia, identify gaps, and highlight important findings. Articles were retrieved from Medline, Scopus, Web of Science, Academic Search Complete (via Ebsco), and ProQuest with a number of key words and various combinations. Articles from Indonesian journals were also searched for with Google Scholar. A total of 56 articles from peer-reviewed journal databases and 19 articles from Indonesian journals were reviewed. Quantitative designs were applied more frequently than qualitative, and mixed methods designs were used in some studies. The majority gathered retrospective information about people's behaviors. Communicable diseases and maternity care were the most frequently studied conditions, in contrast to noncommunicable diseases. In terms of geographical distribution, most research was conducted on Java island, with very few in outside Java. Important findings are a model of Indonesian care-seeking pathways, an understanding of determinants of people's care choices, and the role of sociocultural beliefs. The findings from this narrative review provide insight to what and how Indonesians make decisions to manage their illness and why. This makes an important contribution to understanding the problem of underutilization of medical services despite the government's extensive efforts to improve accessibility.
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Affiliation(s)
- Anna Wahyuni Widayanti
- School of Pharmacy, University of Otago, Dunedin, New Zealand.,Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - James A Green
- School of Pharmacy, University of Otago, Dunedin, New Zealand.,School of Allied Health and Physical Activity for Health, Health Research Institute (HRI), University of Limerick, Limerick, Ireland
| | - Susan Heydon
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Pauline Norris
- School of Pharmacy, University of Otago, Dunedin, New Zealand
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Suglo JN, Evans C. Factors influencing self-management in relation to type 2 diabetes in Africa: A qualitative systematic review. PLoS One 2020; 15:e0240938. [PMID: 33091039 PMCID: PMC7580976 DOI: 10.1371/journal.pone.0240938] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/05/2020] [Indexed: 12/30/2022] Open
Abstract
AIM Effective control of type 2 diabetes is predicated upon the ability of a person with diabetes to adhere to self-management activities. In order to develop and implement services that are locally relevant and culturally acceptable, it is critical to understand people's experiences of living with the disease. We synthesized qualitative research evidence describing the views and experiences of persons with type 2 diabetes in Africa regarding diabetes self-management. METHODS Five data bases (MEDLINE, EMBASE, PsychINFO, SCOPUS and CINAHL) were searched for qualitative studies published between the year 2000 and December 2019. After study selection, the included papers were critically appraised using an established tool. The data were extracted, and findings were coded and analysed to identify descriptive and analytical themes using a thematic synthesis approach. This review was registered in the international prospective register of systematic reviews (PROSPERO) with registration number CRD42018102255. RESULTS Sixteen studies were included in this review, representing a total of 426 participants across seven countries. Synthesis of findings produced six analytical themes. The diagnosis of diabetes triggered a range of emotions and revealed culturally specific understandings of the condition that negatively affected self-management practices. People with diabetes seeking health care at hospitals encountered several challenges including long waiting times and costly diabetes treatment. Family support and a state of acceptance of the condition were identified as facilitators to diabetes self-management. CONCLUSION Effective self-management of type 2 diabetes is a challenge for most persons with diabetes in Africa. There is an urgent need for culturally appropriate education strategies and restructuring of the health system to facilitate self-management of diabetes.
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Affiliation(s)
| | - Catrin Evans
- School of Health Sciences, The University of Nottingham, Nottingham, United Kingdom
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12
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Mohammed AS, Adem F, Tadiwos Y, Woldekidan NA, Degu A. Level of Adherence to the Dietary Recommendation and Glycemic Control Among Patients with Type 2 Diabetes Mellitus in Eastern Ethiopia: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2020; 13:2605-2612. [PMID: 32801812 PMCID: PMC7384875 DOI: 10.2147/dmso.s256738] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/08/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Dietary modification is the cornerstone and initial recommendation in the management of diabetes mellitus. Adhering to the recommended dietary practice has a significant role in diabetic control, but not uniformly practised. OBJECTIVE To assess dietary adherence and glycemic control among type 2 diabetic patients on follow-up at Dilchora Referral Hospital (DRH), Dire Dawa, Eastern Ethiopia. METHODS A hospital-based cross-sectional study was conducted from 22 August to 23 October 2019, at DRH. Data were collected through an interviewer-administered questionnaire. The Perceived Dietary Adherence Questionnaire (PDAQ) was used to estimate the level of dietary adherence. Glycemic control was measured using fasting blood glucose. Multivariate logistic regression analyses were employed to identify factors associated with dietary adherence. RESULTS Of the 307 included patients, 62.5% were poorly adherent to the recommended diet. Lack of dietary education (83.38%) and inability to afford a healthy diet (71.33%) were the perceived barriers to practice dietary recommendation. More than half (54.7%) failed to achieve the recommended fasting blood glucose target. In multivariate logistic regression, patients who were adherent to dietary recommendations were 3.56 times more likely to have good glycemic control. Those patients living in urban areas, having monthly income greater than 1000 Ethiopia Birr, family history of the disease, duration of treatment greater than 10 years and who received counseling were more likely to have good dietary adherence. CONCLUSION The level of adherence to the dietary recommendation and glycemic control was low. Healthcare providers should be proactive in tackling the barrier for non-adherence and should promote adherence to dietary recommendations in T2DM patients.
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Affiliation(s)
- Ammas Siraj Mohammed
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fuad Adem
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yohannes Tadiwos
- Department of Pharmacology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nigist Alemayehu Woldekidan
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amsalu Degu
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy and Health Science, United States International University Africa, Nairobi, Kenya
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Upadhyay D, Mohamed Ibrahim M, Mishra P, Alurkar V. Impact assessment of pharmacist-supervised intervention on health-related quality of life of newly diagnosed diabetics: A pre-post design. J Pharm Bioallied Sci 2020; 12:234-245. [PMID: 33100782 PMCID: PMC7574756 DOI: 10.4103/jpbs.jpbs_6_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/16/2020] [Accepted: 04/03/2020] [Indexed: 11/09/2022] Open
Abstract
Introduction: Diabetics face a series of challenges that affect all aspects of their daily life. Diabetes related complications adversely affect patient’s health-related quality of life (HRQoL). Knowledge and self-care skills of diabetics are corner stones to improve their HRQoL. Objective: To assess the impact of pharmacist-supervised intervention on HRQoL of newly diagnosed diabetics using an Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire. Materials and Methods: A pre-post comparison study was conducted among the control group (CG), test 1 group (T1G) and test 2 group (T2G) patients with three treatment arms to explore the impact of pharmacist-supervised intervention on HRQoL of newly diagnosed diabetics for 18 months. Patients’ HRQoL scores were determined using ADDQoL questionnaire at baseline, 3, 6, 9 and 12-months. T1G patients received pharmacist’s intervention whereas T2G patients received diabetic kit demonstration in addition to pharmacist’s intervention. CG patients were deprived of pharmacist intervention and diabetic kit demonstration, and only received care from attending physician/nurses. Non-parametric tests were used to find the differences in an average weighted impact scores (AWIS) among the groups before and after the intervention at P ≤ 0.05. Results: Friedman test identified significant (P < 0.001) improvement in AWIS among the test groups’ patients. Differences in scores were significant between T1G and T2G at 6-months (P = 0.033), 9-months (P < 0.001) and 12-months (P < 0.001); between CG and T1G at 12-months (P < 0.001) and between CG and T2G at 9-months (P < 0.001) and 12-months (P < 0.0010) on Mann.Whitney U test. Conclusion: Pharmacist’s intervention improved AWIS of test groups’ diabetics. Diabetic kit demonstration strengthened the disease understanding and selfcare skills of T2G patients. Disease and self-care awareness among diabetics should be increased in Nepali healthcare system by involving pharmacists for better patient’s related outcomes.
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Alloh F, Hemingway A, Turner-Wilson A. Exploring the Experiences of West African Immigrants Living with Type 2 Diabetes in the UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3516. [PMID: 31547169 PMCID: PMC6801552 DOI: 10.3390/ijerph16193516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 11/16/2022]
Abstract
The increasing prevalence and poorer management of Type 2 diabetes among West African immigrants in the UK is a public health concern. This research explored the experiences of West African immigrants in the management of Type 2 diabetes in the UK using a constructivist grounded theory approach. In-depth individual interviews were conducted with thirty-four West African immigrants living with Type 2 diabetes in the London area. Fifteen male and nineteen female adult West African immigrants with age range from 33-82 years participated in the study. Participants were recruited from five diabetes support groups and community settings. Initial, focused and theoretical coding, constant comparison and memos were used to analyse collected data. Three concepts emerged: Changing dietary habits composed of participants' experiences in meeting dietary recommendations, improving physical activity concerned with the experience of reduced physical activity since moving to the UK and striving to adapt which focus on the impact of migration changes in living with Type 2 diabetes in the UK. These address challenges that West African immigrants experience in the management of Type 2 diabetes in the UK. The findings of this research provide a better understanding of the influencing factors and can be used to improve the support provided for West Africans living with Type 2 diabetes in the UK, presenting a deeper understanding of socio-cultural factors that contribute to supporting individuals from this population.
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Affiliation(s)
- Folashade Alloh
- Department of Public Health and Human Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH1 3LH, UK.
| | - Ann Hemingway
- Department of Public Health and Human Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH1 3LH, UK.
| | - Angela Turner-Wilson
- Department of Public Health and Human Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH1 3LH, UK.
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Mohammed MA, Sharew NT. Adherence to dietary recommendation and associated factors among diabetic patients in Ethiopian teaching hospitals. Pan Afr Med J 2019; 33:260. [PMID: 31692826 PMCID: PMC6814932 DOI: 10.11604/pamj.2019.33.260.14463] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/06/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Dietary management is considered to be one of the cornerstones of diabetes care. Improvement of dietary practice alone can reduce glycosylated hemoglobin (HbA1c) by an absolute 1 to 2% with the greatest impact at the initial stages of diabetes. Methods Data from Hospital based cross sectional study were used to assess the level of dietary adherence and its determinants among diabetic patients. The morisky 8 item medication adherence scale was used to develop 10 item tool for evaluation of dietary adherence. Multiple logistic regression was conducted to identify factors which affect dietary adherence and variables with P vale < 0.05 were considered statistically significant. Results More than half of 303 participants (55.7%) were found to be non-adherent to the recommended dietary approach. Gathering with family and friends and eating out were the major reasons for not being compliant with the recommended regimen. Attending diabetic nutrition education (AOR=2.8 95% C 1.97, 5.61) and having the disease for more than 10 years (AOR 2.9 95% CI 1.32, 5.84) were statistically significant with adherence to dietary recommendation. Conclusion Non-adherence to recommended dietary practice was observed in more than fifty percent of patients; it is therefore a major public health problem. Attending diabetic nutrition education and length of diabetes greater than 10 years were the factors associated with adherence to dietary recommendation. This findings indicate that it is important to design strategies to help patients understand their dietary regimens and improve their adherence.
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Affiliation(s)
- Mohammed Akibu Mohammed
- Debre Berhan University, Institute of Medicine and Health science, Department of Midwifery Debre Berhan, Ethiopia
| | - Nigussie Tadesse Sharew
- Debre Berhan University, Institute of Medicine and Health science, Department of Midwifery Debre Berhan, Ethiopia
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de-Graft Aikins A, Dodoo F, Awuah RB, Owusu-Dabo E, Addo J, Nicolaou M, Beune E, Mockenhaupt FP, Danquah I, Bahendeka S, Meeks K, Klipstein-Grobusch K, Afrifa-Anane E, Smeeth L, Stronks K, Agyemang C. Knowledge and perceptions of type 2 diabetes among Ghanaian migrants in three European countries and Ghanaians in rural and urban Ghana: The RODAM qualitative study. PLoS One 2019; 14:e0214501. [PMID: 30939148 PMCID: PMC6445464 DOI: 10.1371/journal.pone.0214501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 03/14/2019] [Indexed: 11/21/2022] Open
Abstract
African migrants in Europe and continental Africans are disproportionately affected by type 2 diabetes (T2D). Both groups develop T2D at a younger age, and have higher morbidity and mortality from T2D and complications, compared to European populations. To reduce risk, and avoidable disability and premature deaths, culturally congruent and context specific interventions are required. This study aimed to: (a) assess perceptions and knowledge of T2D among Ghanaian migrants in Europe and their compatriots in Ghana and (b) identify specific perceptions and knowledge gaps that might predispose migrants to higher risk of diabetes. Data was gathered through 26 focus groups with 180 individuals, aged 21 to 70, from Amsterdam, Berlin and London and rural and urban Ashanti Region, Ghana. Thematic analysis of the data was informed by Social Representations Theory, which focuses on the sources, content and functions of social knowledge. Three key insights emerged from analysis. First, there was general awareness, across migrant and non-migrant groups, of T2D as a serious chronic condition with life threatening complications, and some knowledge of biomedical strategies to prevent diabetes (e.g healthy eating) and diabetes complications (e.g medication adherence). However, knowledge of T2D prevention and reduction of diabetes complications was not comprehensive. Secondly, knowledge of biomedical diabetes theories and interventions co-existed with theories about psychosocial and supernatural causes of diabetes and the efficacy of herbal and faith-based treatment of diabetes. Finally, migrants' knowledge was informed by both Ghanaian and European systems of T2D knowledge suggesting enculturation dynamics. We discuss the development of culturally congruent and context-specific T2D interventions for the research communities.
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Affiliation(s)
- Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Legon, Ghana
| | - Francis Dodoo
- Regional Institute for Population Studies, University of Ghana, Legon, Ghana
| | | | - Ellis Owusu-Dabo
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Juliet Addo
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mary Nicolaou
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Erik Beune
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Frank P. Mockenhaupt
- Institute of Tropical Medicine and International Health, Charite, University Medicine Berlin, Berlin, Germany
| | - Ina Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany
| | | | - Karlijn Meeks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Kirstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University, Medical Center Utrecht, Utrecht, the Netherlands
| | - Ernest Afrifa-Anane
- Regional Institute for Population Studies, University of Ghana, Legon, Ghana
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Stephani V, Opoku D, Beran D. Self-management of diabetes in Sub-Saharan Africa: a systematic review. BMC Public Health 2018; 18:1148. [PMID: 30268115 PMCID: PMC6162903 DOI: 10.1186/s12889-018-6050-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 09/20/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The prevalence of diabetes in sub-Saharan Africa has increased rapidly over the last years. Self-management is a key element for the proper management, but strategies are currently lacking in this context. This systematic review aims to describe the level of self-management among persons living with type 2 diabetes mellitus in sub-Saharan Africa. METHOD Relevant databases including PubMed, Web of Science and Google Scholar were searched up to September 2016. Studies reporting self-management behavior of people with type 2 diabetes mellitus and living in sub-Saharan Africa were included. RESULTS A total of 550 abstracts and 109 full-text articles were assessed. Forty-three studies, mainly observational, met the inclusion criteria. The studies showed that patients rarely self-monitored their glucose levels, had low frequency/duration of physical activity, moderately adhered to recommended dietary and medication behavior, had poor level of knowledge regarding diabetes related complications and sought traditional or herbal medicines beside of their biomedical treatment. The analysis also revealed a lack of studies on psychosocial aspects. CONCLUSION Except for the psychosocial area, there is a good amount of recent studies on self-management behavior of type 2 diabetes mellitus sub-Saharan Africa. These studies indicate that self-management in sub-Saharan Africa is poor and therefore a serious threat to the health of individuals and the health systems capacity.
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Affiliation(s)
- Victor Stephani
- Department of Health Care Management, Technical University of Berlin, Berlin, Germany
| | - Daniel Opoku
- Department of Health Care Management, Technical University of Berlin, Berlin, Germany
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Genève, Switzerland
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Osakunor DNM, Sengeh DM, Mutapi F. Coinfections and comorbidities in African health systems: At the interface of infectious and noninfectious diseases. PLoS Negl Trop Dis 2018; 12:e0006711. [PMID: 30235205 PMCID: PMC6147336 DOI: 10.1371/journal.pntd.0006711] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
There is a disease epidemiological transition occurring in Africa, with increasing incidence of noninfectious diseases, superimposed on a health system historically geared more toward the management of communicable diseases. The persistence and sometimes emergence of new pathogens allows for the occurrence of coinfections and comorbidities due to both infectious and noninfectious diseases. There is therefore a need to rethink and restructure African health systems to successfully address this transition. The historical focus of more health resources on infectious diseases requires revision. We hypothesise that the growing burden of noninfectious diseases may be linked directly and indirectly to or further exacerbated by the existence of neglected tropical diseases (NTDs) and other infectious diseases within the population. Herein, we discuss the health burden of coinfections and comorbidities and the challenges to implementing effective and sustainable healthcare in Africa. We also discuss how existing NTD and infectious disease intervention programs in Africa can be leveraged for noninfectious disease intervention. Furthermore, we explore the potential for new technologies-including artificial intelligence and multiplex approaches-for diagnosis and management of chronic diseases for improved health provision in Africa.
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Affiliation(s)
- Derick Nii Mensah Osakunor
- Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | | | - Francisca Mutapi
- Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- National Institute for Health Research, Global Health Research Unit Tackling Infections to Benefit Africa, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
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Zimmermann M, Bunn C, Namadingo H, Gray CM, Lwanda J. Experiences of type 2 diabetes in sub-Saharan Africa: a scoping review. Glob Health Res Policy 2018; 3:25. [PMID: 30214942 PMCID: PMC6134599 DOI: 10.1186/s41256-018-0082-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background The prevalence of diabetes in Sub-Saharan Africa (SSA) is growing rapidly. Qualitative research on experiences of type 2 diabetes in SSA is emerging, but no qualitative synthesis has been attempted. This scoping review aims to redress this lack of synthesis and to extract policy-relevant suggestions from the literature. Methods Scoping review methodology was employed. Eleven online databases were searched (CINAHLplus, Cochrane Library, EBESCOhost, GALE Group, MEDLINE, Pro-Quest, Pscyhinfo, Pubmed, SCOPUS, Web of Science, WorldCat), using terms designed to identify qualitative studies of experiences of diabetes in SSA. Findings from records identified in the search were analysed inductively in NVivo 10 in three stages, to produce an analytical synthesis of studies of diabetes experiences in SSA. Results Searches were conducted in 2017 and identified 2743 records, which were reduced to 21 after screening. The earliest identified record was published in 2003 and there was a clustering of records published between 2014 and 2016. The 21 records were based in eight SSA countries: Cameroon, Ethiopia, Ghana, Senegal, South Africa, Tanzania, Uganda, and Zimbabwe. A majority of the studies were conducted in Ghana (5) and South Africa (5), limiting the generalisability of our findings.The analytical synthesis produced five themes: identifying type 2 diabetes (how participants conceptualise and position their illnesses); hybridity of diabetes care (how multiple forms of care are often blended and/or pursued concurrently); impediments, improvisation and diabetes management (describing challenges faced, how these are responded to and management via diet and physical activity); sources of support (who supports participants and how); and diabetes and HIV/AIDs (the ways in which the two conditions are sometimes confused and how stigma is often experienced). Conclusions The experiences of people with type 2 diabetes in SSA are under-researched across the region, pointing to a gap in knowledge. Interpreting our analytical synthesis, we suggest three priority areas for policy makers and implementers. Firstly, uncertainties relating to access to diabetes treatment need to be reduced. Secondly, more needs to be done to acknowledge and alleviate the economic struggles that those with diabetes face. Finally, high-quality information and education would improve recognition and management of the condition.
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Affiliation(s)
- Mikaela Zimmermann
- 1Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Christopher Bunn
- 1Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Hazel Namadingo
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Cindy M Gray
- 1Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - John Lwanda
- 1Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
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Mufunda E, Ernersson Å, Hjelm K. Limited knowledge of diabetes in patients attending an outpatient diabetes clinic at a referral hospital in Zimbabwe: a cross-sectional study. Pan Afr Med J 2018; 29:144. [PMID: 30050608 PMCID: PMC6057559 DOI: 10.11604/pamj.2018.29.144.12301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 12/05/2017] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Diabetes mellitus (DM) has increased globally, with a significant increase noted in African communities. Self-care health-related behavior is determined by beliefs about health and illness which are based on the person?s knowledge of diabetes. The present study aimed to assess patients' diabetes awareness and level of diabetes knowledge in Zimbabwean adults with diabetes attending an outpatient diabetes clinic at a main referral hospital. METHODS In this cross-sectional descriptive study, the Diabetes Knowledge Test (DKT) was used to measure 96 (71 women and 25 men) patients' knowledge of diabetes and their treatment. Both descriptive and analytic statistical methods were used. RESULTS Most respondents had poor knowledge in all the three knowledge categories, total knowledge of diabetes, general knowledge of diabetes and knowledge of insulin use. Major knowledge gaps were noted related to insulin use, glycemic control and diet. Attending DM classes was significantly associated with general knowledge about diabetes (p 0.026) while the level of education was an independent determinant of Total Knowledge and Insulin use knowledge scores. CONCLUSION The identified knowledge gaps need to be addressed to control and minimize diabetes mellitus-related complications.
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Affiliation(s)
- Esther Mufunda
- Department of Health Sciences, Zimbabwe Open University, Harare, Zimbabwe
| | - Åsa Ernersson
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Katarina Hjelm
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
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Das M, Angeli F, Krumeich AJSM, van Schayck OCP. Patterns of illness disclosure among Indian slum dwellers: a qualitative study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:3. [PMID: 29338708 PMCID: PMC5771001 DOI: 10.1186/s12914-018-0142-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 01/03/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Slum dwellers display specific traits when it comes to disclosing their illnesses to professionals. The resulting actions lead to poor health-seeking behaviour and underutilisation of existing formal health facilities. The ways that slum people use to communicate their feelings about illness, the type of confidants that they choose, and the supportive and unsupportive social and cultural interactions to which they are exposed have not yet been studied in the Indian context, which constitutes an important knowledge gap for Indian policymakers and practitioners alike. To that end, this study examines the patterns of illness disclosure in Indian slums and the underpinning factors which shape the slum dwellers' disclosing attitude. METHODS In-depth, semi-structured interviews were conducted among 105 men and 113 women who experienced illness in the year prior to the study period. Respondents were selected from four urban slums in two Indian cities, Bangalore and Kolkata. RESULTS Findings indicate that women have more confidants at different social levels, while men have a limited network of disclosures which is culturally and socially mediated. Gender role limitations, exclusion from peer groups and unsupportive local situations are the major cause of disclosure delay or non-disclosure among men, while the main concerns for women are a lack of proper knowledge about illness, unsupportive responses received from other people on certain occasions, the fear of social stigma, material loss and the burden of the local situation. Prompt sharing of illness among men is linked with prevention intention and coping with biological problems, whereas factors determining disclosure for women relate to ensuring emotional and instrumental safety, preventing collateral damage of illness, and preventing and managing biological complications. CONCLUSIONS The findings reveal that patterns of disclosure are not determined by the acknowledgment of illness but largely depend on the interplay between individual agency, disclosure consequences and the socio cultural environment. The results of this study can contribute significantly to mitigating the pivotal knowledge gap between health policymakers, practitioners and patients, leading to the formulation of policies that maximise the utilisation of health facilities in slums.
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Affiliation(s)
- Moumita Das
- School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
- Institute for Social and Economic Change (ISEC), Bangalore, India
| | - Federica Angeli
- Department of Organization Studies, School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Anja J. S. M. Krumeich
- Department of Health Ethics and Society, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Onno C. P. van Schayck
- Department of General Practice, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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Sayampanathan AA, Cuttilan AN, Pearce CJ. Barriers and enablers to proper diabetic foot care amongst community dwellers in an Asian population: a qualitative study. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:254. [PMID: 28706922 DOI: 10.21037/atm.2017.04.31] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Diabetic foot complications are common within Asian populations. They arise due to poor diabetic control and foot care. In this study, we aimed to identify the causes for proper and improper diabetic foot care. METHODS A qualitative study consisting of key informant interviews with 17 healthcare professionals, including doctors and various allied health workers, was conducted. Participants included had at least five years of caring for diabetic foot patients either in public institutions or private clinics. Data collected was analyzed via thematic analysis. RESULTS Diabetic patients were generally observed to have a mixture of proper and improper information and beliefs which eventually resulted in the extent of proper foot care. Factors which influenced the extent of proper and improper state of information and beliefs were classified into predisposing and precipitating factors. Predisposing factors were further categorised into modifiable factors (e.g., education level, socioeconomic status, social support) and non-modifiable factors (e.g., age, presence and severity of co-morbidities restricting ability to selfcare, past experiences). Precipitating factors were categorized into patient factors (e.g., degree of reception of information, presence of psychological barriers), provider factors (presence and degree of multi-disciplinary approach to care, presence of administrative inconveniences) and disease factors (presence of diabetic sensory neuropathy, complexity of disease process). CONCLUSIONS The extent of proper foot care amongst diabetic patients is influenced by numerous predisposing and precipitating factors. Further studies can look at further development of the described structure as well as quantitatively defining the various components and factors which make up the described system.
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Shu PS, Chan YM, Huang SL. Higher body mass index and lower intake of dairy products predict poor glycaemic control among Type 2 Diabetes patients in Malaysia. PLoS One 2017; 12:e0172231. [PMID: 28234927 PMCID: PMC5325472 DOI: 10.1371/journal.pone.0172231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 02/01/2017] [Indexed: 01/08/2023] Open
Abstract
This cross-sectional study was designed to determine factors contributing to glyceamic control in order to provide better understanding of diabetes management among Type 2 Diabetes patients. A pre-tested structured questionnaire was used to obtain information on socio-demographic and medical history. As a proxy measure for glycaemic control, glycosylated haemoglobin (HbA1c) was obtained as secondary data from the medical reports. Perceived self-care barrier on diabetes management, diet knowledge and skills, and diet quality were assessed using pretested instruments. With a response rate of 80.3%, 155 subjects were recruited for the study. Mean HbA1c level of the subjects was 9.02 ± 2.25% with more than 70% not able to achieve acceptable level in accordance to WHO recommendation. Diet quality of the subjects was unsatisfactory especially for vegetables, fruits, fish and legumes as well as from the milk and dairy products group. Higher body mass index (BMI), poorer medication compliance, lower diet knowledge and skill scores and lower intake of milk and dairy products contributed significantly on poor glycaemic control. In conclusion, while perceived self-care barriers and diet quality failed to predict HbA1c, good knowledge and skill ability, together with appropriate BMI and adequate intake of dairy products should be emphasized to optimize glycaemic control among type 2 diabetes patients.
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Affiliation(s)
- Ping Soon Shu
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Yoke Mun Chan
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Selangor, Malaysia
- * E-mail:
| | - Soo Lee Huang
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
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Nielsen J, Bahendeka SK, Bygbjerg IC, Meyrowitsch DW, Whyte SR. Diabetes Treatment as "Homework": Consequences for Household Knowledge and Health Practices in Rural Uganda. HEALTH EDUCATION & BEHAVIOR 2017; 43:100S-11S. [PMID: 27037141 DOI: 10.1177/1090198115610569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Health professionals assign diabetes patients "homework" in that they give them instructions on how to manage diabetes, recognizing that most diabetes care takes place in the home setting. We studied how homework is practiced and whether knowledge and behavioral practices related to diabetes self-management diffuse from patients to their housemates. METHOD This mixed-methods study combined quantitative data from a household survey including 90 rural Ugandan households (50% had a member with type 2 diabetes [T2D]) with qualitative data from health facilities and interviews with 10 patients with T2D. Focus for data collection was knowledge and practices related to diabetes homework. A generalized mixed model was used to analyze quantitative data, while content analysis was used for qualitative data analysis. RESULTS Patients with T2D generally understood the diabetes homework assignments given by health professionals and carried out their homework with support from housemates. Although adherence to recommended diet was variable, housemates were likely to eat a healthier diet than if no patient with T2D lived in the household. Knowledge related to diabetes homework diffused from the patients to housemates and beyond to neighbors and family living elsewhere. Knowledge about primary prevention of T2D was almost absent among health staff, patients, and relatives. CONCLUSIONS Homework practices related to T2D improve diabetes-related knowledge and may facilitate healthy eating in nondiabetic housemates. These findings suggest that having a chronic disease in the household provides an opportunity to improve health in the entire household and address the lack of knowledge about prevention of T2D.
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Affiliation(s)
- Jannie Nielsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Ib C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dan W Meyrowitsch
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susan R Whyte
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
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Abdulrehman MS, Woith W, Jenkins S, Kossman S, Hunter GL. Exploring Cultural Influences of Self-Management of Diabetes in Coastal Kenya: An Ethnography. Glob Qual Nurs Res 2016; 3:2333393616641825. [PMID: 28462335 PMCID: PMC5342641 DOI: 10.1177/2333393616641825] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/20/2016] [Accepted: 02/25/2016] [Indexed: 12/27/2022] Open
Abstract
In spite of increasing prevalence of diabetes among Kenyans and evidence suggesting Kenyans with diabetes maintain poor glycemic control, no one has examined the role of cultural attitudes, beliefs, and practices in their self-management of diabetes. The purpose of this ethnographic study was to describe diabetes self-management among the Swahili of coastal Kenya, and explore factors that affect diabetes self-management within the context of Swahili culture. Thirty men and women with type 2 diabetes from Lamu town, Kenya, participated in this study. Diabetes self-management was insufficiently practiced, and participants had limited understanding of diabetes. Economic factors such as poverty and the high cost of biomedical care appear to have more influence in self-management behavior than socio-cultural and educational factors do. Economic and socio-cultural influences on diabetes self-management should not be underestimated, especially in a limited resource environment like coastal Kenya, where biomedical care is not accessible or affordable to all.
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Affiliation(s)
- Munib Said Abdulrehman
- Advocate Medical Group, Bloomington, Illinois, USA.,Illinois State University, Normal, Illinois, USA.,Lamu Center of Preventative Health, Lamu, Kenya
| | - Wendy Woith
- Illinois State University, Normal, Illinois, USA
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Upadhyay DK, Ibrahim MIM, Mishra P, Alurkar VM, Ansari M. Does pharmacist-supervised intervention through pharmaceutical care program influence direct healthcare cost burden of newly diagnosed diabetics in a tertiary care teaching hospital in Nepal: a non-clinical randomised controlled trial approach. Daru 2016; 24:6. [PMID: 26926657 PMCID: PMC4772684 DOI: 10.1186/s40199-016-0145-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 02/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cost is a vital component for people with chronic diseases as treatment is expected to be long or even lifelong in some diseases. Pharmacist contributions in decreasing the healthcare cost burden of chronic patients are not well described due to lack of sufficient evidences worldwide. In developing countries like Nepal, the estimation of direct healthcare cost burden among newly diagnosed diabetics is still a challenge for healthcare professionals, and pharmacist role in patient care is still theoretical and practically non-existent. This study reports the impact of pharmacist-supervised intervention through pharmaceutical care program on direct healthcare costs burden of newly diagnosed diabetics in Nepal through a non-clinical randomised controlled trial approach. METHODS An interventional, pre-post non-clinical randomised controlled study was conducted among randomly distributed 162 [control (n = 54), test 1 (n = 54) and test 2 (n = 54) groups] newly diagnosed diabetics by a consecutive sampling method for 18 months. Direct healthcare costs (direct medical and non-medical costs) from patients perspective was estimated by 'bottom up' approach to identify their out-of-pocket expenses (1USD = NPR 73.38) before and after intervention at the baseline, 3, 6, 9 and 12 months follow-ups. Test groups' patients were nourished with pharmaceutical care intervention while control group patients only received care from physician/nurses. Non-parametric tests i.e. Friedman test, Mann-Whitney U test and Wilcoxon signed rank test were used to find the differences in direct healthcare costs among the groups before and after the intervention (p ≤ 0.05). RESULTS Friedman test identified significant differences in direct healthcare cost of test 1 (p < 0.001) and test 2 (p < 0.001) groups patients. However, Mann-Whitney U test justified significant differences in direct healthcare cost between control group and test 1 group, and test 2 group patients at 6-months (p = 0.009, p = 0.010 respectively), 9-months (p = 0.005, p = 0.001 respectively) and 12-months (p < 0.001, p < 0.001 respectively). CONCLUSION Pharmacist supervised intervention through pharmaceutical care program significantly decreased direct healthcare costs of diabetics in test groups compared to control group and hence describes pharmacist's contribution in minimizing direct healthcare cost burden of patients.
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Affiliation(s)
- Dinesh Kumar Upadhyay
- Faculty of Pharmacy, Asian Institute of Medicine, Science and Technology University, Jalan Bedong-Semeling, 08100, Bedong, Kedah, Malaysia
| | | | - Pranaya Mishra
- Department of Pharmacology, American University of the Caribbean School of Medicine, 1 University Drive at Jordan Road, Cupecoy, St. Maarten, Netherlands Antilles
| | - Vijay M Alurkar
- Department of Medicine, Manipal College of Medical Sciences and Manipal Teaching Hospital, Phulbari-11, Pokhara, Nepal
| | - Mukhtar Ansari
- Department of Pharmacy and Pharmacology, National Medical College, Birgunj, Nepal.
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Dube L, Van den Broucke S, Dhoore W, Kalweit K, Housiaux M. An Audit of Diabetes Self-Management Education Programs in South Africa. J Public Health Res 2015; 4:581. [PMID: 26753160 PMCID: PMC4693339 DOI: 10.4081/jphr.2015.581] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/09/2015] [Indexed: 11/24/2022] Open
Abstract
Background: Diabetes is a significant contributor to the burden of disease worldwide. Since its treatment requires extensive self-care, self-management education is widely recommended, particularly in resource limited settings. This study aimed to review the current state of policies and implementation of diabetes self-management education (DSME) in South Africa, with a specific focus on cultural appropriateness. Design and Methods: The audit involved a review of policy documents and semi-structured questionnaires with providers and experts in public and private health services. Forty-four respondents were interviewed. Documents were analysed with reference to the International Standards for Diabetes Education from the International Diabetes Federation. Data were entered and analysed in excel to give a description of the DSME programs and ad hoc interventions. Results: Three guidelines for Type 2 diabetes and two for chronic diseases were retrieved, but none were specifically dedicated to DSME. Five structured programs and 22 ad-hoc interventions were identified. DSME is mostly provided by doctors, nurses and dieticians and not consistently linked to other initiatives such as support groups. Health education materials are mainly in English with limited availability. Conclusions: DSME in South Africa is limited in scope, content and consistency, especially in the public services. A National curricula and materials for diabetes education need to be developed and adapted to the socio-economic context, culture and literacy levels of the target populations. It is recommended that DSME would be addressed in national policies and guidelines to guide the development and implementation of standardised programs. Significance for public health Diabetes significantly contributes to the global burden of disease. This burden is especially felt in developing countries, where resources are limited and the health system simultaneously has to deal with communicable and non-communicable diseases. While there is a growing body of literature on the development and implementation of diabetes self-management education, nearly all programs originate from developed countries. Very little is known about the current state of diabetes self-management education in developing countries. By focusing on diabetes self-management education in Southern Africa, the current paper provides policy makers and decision makers in South Africa with information that will help decide on where and how to intervene with regard to diabetes self-management education. The paper also has relevance for decision makers from other developing countries by providing recommendations on diabetes policies and diabetes self-management education.
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Affiliation(s)
- Loveness Dube
- Psychological Sciences Research Institute, Universite Catholique de Louvain , Louvain-la-Neuve, Belgium
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, Universite Catholique de Louvain , Louvain-la-Neuve, Belgium
| | - William Dhoore
- lnstitute of Health and Society, Universite Catholique de Louvain , Brussels, Belgium
| | - Kerry Kalweit
- School of Health Systems and Public Health, University of Pretoria , South Africa
| | - Marie Housiaux
- Psychological Sciences Research Institute, Universite Catholique de Louvain , Louvain-la-Neuve, Belgium
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Issaka A, Lamaro G, Renzaho A. Sociocultural factors and perceptions associated with type 2 diabetes among sub-Saharan African migrants in Melbourne, Victoria. Nutr Diet 2015. [DOI: 10.1111/1747-0080.12167] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ayuba Issaka
- School of Health and Social Development; Faculty of Health; Deakin University; Melbourne Victoria
- Hume City Council; Policy & Planning, Aged Services & Public Health Department; Melbourne Victoria
| | - Greer Lamaro
- School of Health and Social Development; Faculty of Health; Deakin University; Melbourne Victoria
- Centre for Health through Action on Social Exclusion (CHASE); Deakin University; Melbourne Victoria
| | - André Renzaho
- School of Social Sciences and Psychology; University of Western Sydney; Sydney New South Wales
- Migration, Social Disadvantage and Health Programs; Monash University
- Centre for International Health; Burnet Institute; Melbourne Victoria
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Metta E, Bailey A, Kessy F, Geubbels E, Hutter I, Haisma H. "In a situation of rescuing life": meanings given to diabetes symptoms and care-seeking practices among adults in Southeastern Tanzania: a qualitative inquiry. BMC Public Health 2015; 15:224. [PMID: 25886626 PMCID: PMC4358854 DOI: 10.1186/s12889-015-1504-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 02/04/2015] [Indexed: 11/28/2022] Open
Abstract
Background Diabetes mellitus is an emerging public health problem in Tanzania. For the community and the health system to respond adequately to this problem, it is important that we understand the meanings given to its symptoms, and the care-seeking practices of individuals. Methods To explore collective views on the meanings given to diabetes symptoms, we conducted nine focus group discussions with adult diabetes patients and members of the general community. To gain a better understanding of how the meanings in the community inform the care-seeking practices of individuals, 19 in-depth interviews were conducted with diabetes patients. The data were analyzed using principles of grounded theory and applying cultural schema theory as a deductive framework. Results In the communities and among the patients, knowledge and awareness of diabetes are limited. Both people with diabetes and community members referred to their prevailing cultural meaning systems and schemas for infectious diseases to interpret and assign meaning to the emerging symptoms. Diabetes patients reported that they had initially used anti-malarial medicines because they believed their symptoms—like headache, fever, and tiredness—were suggestive of malaria. Schemas for body image informed the meaning given to diabetes symptoms similar to those of HIV, like severe weight loss. Confusion among members of the community about the diabetes symptoms instigated tension, causing patients to be mistrusted and stigmatized. The process of meaning-giving and the diagnosis of the diabetes symptoms was challenging for both patients and health care professionals. Diabetes patients reported being initially misdiagnosed and treated for other conditions by medical professionals. The inability to assign meaning to the symptoms and determine their etiologies informed the decision made by some patients to consult traditional healers, and to associate their symptoms with witchcraft causes. Conclusion The meanings given to diabetes symptoms and the care-seeking practices described in the study are shaped by the prevailing cultural schemas for infectious diseases and their treatments. Efforts to educate people about the symptoms of diabetes and to encourage them to seek out appropriate care should build on the prevailing cultural meaning system and schemas for diseases, health and illness. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1504-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emmy Metta
- Ifakara Health Institute, Box 78373, Dar es Salaam, Tanzania. .,Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands.
| | - Ajay Bailey
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands.
| | - Flora Kessy
- Mzumbe University, Box 20226, Dar es Salaam, Tanzania.
| | | | - Inge Hutter
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands.
| | - Hinke Haisma
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands.
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Abstract
BACKGROUND The number of people in Thailand who have Type 2 diabetes has increased dramatically making it one of the country's major health problems. The rising prevalence of diabetes in Thailand is associated with dietary changes, reduced physical activity and health education. Although there is much research about health education programmes, the most effective methods for promoting sustainability and adherence to self-management among diabetics remains unclear. OBJECTIVES To examine the perceptions of participants in Thailand regarding Type 2 diabetes and to utilize the findings to formulate a model for patient education. METHODS A grounded theory approach was selected and semi-structured face to face interviews and focus group were used to gather data from 33 adults with Type 2 diabetes. RESULTS Five explanatory categories emerged from the data: causing lifelong stress and worry, finding their own ways, after a while, still cannot and wanting a normal life. CONCLUSION A new approach to patient education about Type 2 diabetes in Thailand is needed to give patients a better understanding, provide recommendations that they can apply to their daily lives, and include information about alternative medication. The Buddhist way of thinking and effective strategies enhancing self-efficacy should be applied to patient education to promote sustainability and adherence to self-management.
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Affiliation(s)
- Nitima Suparee
- Faculty of Health, Birmingham City University, Birmingham, UK
| | - Paula McGee
- Faculty of Health, Birmingham City University, Birmingham, UK
| | - Salim Khan
- Faculty of Health, Birmingham City University, Birmingham, UK
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Upadhyay DK, Mohamed Ibrahim MI, Mishra P, Alurkar VM. A non-clinical randomised controlled trial to assess the impact of pharmaceutical care intervention on satisfaction level of newly diagnosed diabetes mellitus patients in a tertiary care teaching hospital in Nepal. BMC Health Serv Res 2015; 15:57. [PMID: 25888828 PMCID: PMC4448530 DOI: 10.1186/s12913-015-0715-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 01/26/2015] [Indexed: 11/12/2022] Open
Abstract
Background Patient satisfaction is the ultimate goal of healthcare system which can be achieved from good patient-healthcare professional relationship and quality of healthcare services provided. Study was conducted to determine the baseline satisfaction level of newly diagnosed diabetics and to explore the impact of pharmaceutical care intervention on patients’ satisfaction during their follow-ups in a tertiary care teaching hospital in Nepal. Methods An interventional, pre-post non-clinical randomised controlled study was designed among randomly distributed 162 [control group (n = 54), test 1 group (n = 54) and test 2 group (n = 54)] newly diagnosed diabetes mellitus patients by consecutive sampling method for 18 months. Diabetes Patient Satisfaction Questionnaire was used to evaluate patient’s satisfaction scores at baseline, three, six, nine and, twelve months’ follow-ups. Test groups patients were provided pharmaceutical care whereas control group patients only received their usual care from physician/nurses. The responses were entered in SPSS version 16. Data distribution was not normal on Kolmogorov-Smirnov test. Non-parametric tests i.e. Friedman test, Mann-Whitney U test and Wilcoxon signed rank test were used to find the differences among the groups before and after the intervention (p ≤0.05). Results There were significant (p < 0.001) improvements in patients’ satisfaction scores in the test groups on Friedman test. Mann-Whitney U test identified the significant differences in satisfaction scores between test 1 and test 2 groups, control and test 1 groups and, control and test 2 groups at 3-months (p = 0.008), (p < 0.001) and (p < 0.001), 6-months (p = 0.010), (p < 0.001) and (p < 0.001), 9-months (p < 0.001), (p < 0.001) and (p < 0.001) and, 12-months (p < 0.001), (p < 0.001) and (p < 0.001) follow-ups respectively. Conclusion Pharmaceutical care intervention significantly improved the satisfaction level of diabetics in the test groups compare to the control group. Diabetic kit demonstration strengthened the satisfaction level among the test 2 group patients. Therefore, pharmacist can act as a counsellor through pharmaceutical care program and assist the patients in managing their disease. This will not only modify the patients’ related outcomes and their level of satisfaction but also improve the healthcare system.
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Affiliation(s)
- Dinesh Kumar Upadhyay
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia. .,Department of Pharmacology, Manipal College of Medical Sciences and Manipal Teaching Hospital, Pokhara, Nepal.
| | | | - Pranaya Mishra
- American University of the Caribbean School of Medicine, 1 University Drive at Jordan Road, Cupecoy, St. Maarten.
| | - Vijay M Alurkar
- Department of Medicine, Manipal College of Medical Sciences and Manipal Teaching Hospital, Pokhara, Nepal.
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Worku A, Mekonnen Abebe S, Wassie MM. Dietary practice and associated factors among type 2 diabetic patients: a cross sectional hospital based study, Addis Ababa, Ethiopia. SPRINGERPLUS 2015; 4:15. [PMID: 25635244 PMCID: PMC4306673 DOI: 10.1186/s40064-015-0785-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 01/02/2015] [Indexed: 11/10/2022]
Abstract
Background Dietary management which is considered to be one of the cornerstones of diabetes care is based on the principle of healthy eating in the context of social, cultural and psychological influences on food choice. In Ethiopia, there is lack of data on the dietary practice of diabetic patients which underestimates its role in the management of diabetes. Hence, this study assesses the level of dietary practices and their associated factors among Type 2 diabetic patients in Addis Ababa, Ethiopia. Methods Institution-based cross-sectional quantitative study design was employed. A total of 403 study subjects were included in the study. A pretested questionnaire was used to collect data. The collected data were entered into Epi Info version 3.5.3 and exported to SPSS version 20.0 software packages for further statistical analysis. The data were analyzed using bivariate and multivariate logistic regression. The degree of association between dependent and independent variables was assessed using the odds ratio with a 95% confidence interval and variables with p-value ≤0.05 were considered significant. Results About 46.4% of the patients were overweight and obese. More than half of the respondents (58.8%) had FBG level ≥ 126 mg/dl. The level of dietary practice among 207 (51.4%) type 2 diabetic patients was poor. Not getting nutrition education in hospitals [AOR = 4.47, 95% CI: (1.92,10.40)], despondency [AOR = 2.15, 95% CI: (1.14,4.02)], facing difficulty to choose foods [AOR = 9.66, 95% CI: (5.12,18.24)], non- availability of fruits and vegetables [AOR = 2.78, 95% CI: (1.03,7.54)], thinking about the high cost of foods [AOR = 2.36,95% CI: (1.18, 4.70)] were the factors significantly associated with the poor dietary practice. Conclusion Findings of this study indicated that the majority of the patients had poor dietary practice. Therefore, the integration of diabetic based nutrition education with motivation and home gardening is highly recommended.
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Affiliation(s)
- Amelmal Worku
- Department of Human Nutrition, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Mekonnen Abebe
- Department of Human Nutrition, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Molla Mesele Wassie
- Department of Human Nutrition, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Prevalence of diabetes in Zimbabwe: a systematic review with meta-analysis. Int J Public Health 2014; 60:1-11. [PMID: 25432797 DOI: 10.1007/s00038-014-0626-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 10/31/2014] [Accepted: 11/17/2014] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Diabetes appears to be a growing problem in the African region. This study aims to estimate the prevalence of diabetes in Zimbabwe by collating and analyzing previously published data. METHODS Systematic review and meta-analysis of data reporting prevalence of diabetes in Zimbabwe was conducted based on the random effects model. We searched for studies published between January 1960 and December 2013 using MEDLINE, EMBASE and Scopus and University of Zimbabwe electronic publication libraries. In the meta-analysis, sub-groups were created for studies conducted before 1980 and after 1980, to understand the potential effect of independence on prevalence. RESULTS Seven studies were included in the meta-analysis with a total of 29,514 study participants. The overall pooled prevalence of diabetes before 1980 was 0.44% (95% CI 0.0-1.9%), after 1980 the pooled prevalence was 5.7% (95% CI 3.3-8.6%). CONCLUSIONS This study showed that the prevalence of diabetes in Zimbabwe has increased significantly over the past three decades. This poses serious challenges to the provision of care and prevention of disabling co-morbidities in an already disadvantaged healthcare setting.
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Lopes Ibanez-Gonzalez D. Perspectives on healthcare, chronic non-communicable disease, and healthworlds in an urban and rural setting. Glob Health Action 2014; 7:25317. [PMID: 25261700 PMCID: PMC4176675 DOI: 10.3402/gha.v7.25317] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/20/2014] [Accepted: 08/22/2014] [Indexed: 11/14/2022] Open
Abstract
Background Amidst diverging discourses describing chronic non-communicable disease (NCD) and healthcare access, the hermeneutical tradition within sociology, particularly as exemplified in the work of Jurgen Habermas, provides a starting point for exploring and interpreting the experiences of chronic illness and healthcare access. In this study, we aimed to understand how women living with NCDs experience their illness and access healthcare in an urban and rural context. Methods This study was a mixed-methods comparative case study of the healthcare access experiences of women with NCDs in an urban and rural area in South Africa. The core of the study methodology was a comparative qualitative case study, with quantitative methods serving to contextualise the findings. Results The cross-sectional survey describes a low resource population with a high prevalence of NCDs. Slightly over half the respondents in urban Soweto (50.7%) reported having at least one NCD. Only around a third (33.3%) of these participants reported accessing formal healthcare services in the past 6 months. Similar trends were found in the review of research carried out in rural Agincourt. The qualitative case study in Soweto is characterised by a preoccupation with how medicine from the clinic interacts with the body. The Agincourt qualitative case study highlights the importance of church membership, particularly of African Christian Churches, as the strongest factor motivating against the open use of traditional medicine. Discussion A consideration of the findings suggests five broad themes for further research: 1) processes of constructing body narratives; 2) encounters with purposive–rational systems; 3) encounters with traditional medicine; 4) encounters with contemporary informal medicine; and 5) religion and healthcare. These five themes constitute the beginning of a comprehensive schema of the lifeworld/healthworld.
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Affiliation(s)
- Daniel Lopes Ibanez-Gonzalez
- MRC/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;
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de-Graft Aikins A, Awuah RB, Pera TA, Mendez M, Ogedegbe G. Explanatory models of diabetes in urban poor communities in Accra, Ghana. ETHNICITY & HEALTH 2014; 20:391-408. [PMID: 25048822 DOI: 10.1080/13557858.2014.921896] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The objective of the study was to examine explanatory models of diabetes and diabetes complications among urban poor Ghanaians living with diabetes and implications for developing secondary prevention strategies. DESIGN Twenty adults with type 2 diabetes were recruited from three poor communities in Accra. Qualitative data were obtained using interviews that run between 40 and 90 minutes. The interviews were audio-taped, transcribed and analysed thematically, informed by the 'explanatory model of disease' concept. RESULTS Respondents associated diabetes and its complications with diet, family history, lifestyle factors (smoking, excessive alcohol consumption and physical inactivity), psychological stress and supernatural factors (witchcraft and sorcery). These associations were informed by biomedical and cultural models of diabetes and disease. Subjective experience, through a process of 'body-listening,' constituted a third model on which respondents drew to theorise diabetes complications. Poverty was an important mediator of poor self-care practices, including treatment non-adherence. CONCLUSIONS The biomedical model of diabetes was a major source of legitimate information for self-care practices. However, this was understood and applied through a complex framework of cultural theories of chronic disease, the biopsychological impact of everyday illness experience and the disempowering effects of poverty. An integrated biopsychosocial approach is proposed for diabetes intervention in this research community.
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Affiliation(s)
- Ama de-Graft Aikins
- a Regional Institute for Population Studies , University of Ghana , Accra , Ghana
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Abebe SM, Berhane Y, Worku A, Assefa A. Diabetes mellitus in North West Ethiopia: a community based study. BMC Public Health 2014; 14:97. [PMID: 24479725 PMCID: PMC3913966 DOI: 10.1186/1471-2458-14-97] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes mellitus is recognized as one of the emerging public health problems in developing countries. However, its magnitude has not been studied at community levels, making the provision of appropriate services difficult in such countries. Hence, this study aimed to compare the magnitude and associated risks of diabetes mellitus among urban and rural adults in northwest Ethiopia. METHODS A cross-sectional population based survey was performed using the WHO STEPwise method on adults aged 35 years and above. A multistage cluster random sampling strategy was used to select study participants from urban and rural locations. Fasting blood glucose levels were determined using peripheral blood samples by finger puncture. Prevalence was computed with a 95% confidence interval for each residential area. Selected risk factors were assessed using logistic regression. RESULTS The prevalence of diabetes mellitus among adults aged 35 years and above was 5.1% [95% CI: 3.8, 6.4] for urban and 2.1% [95% CI: 1.2, 2.9] for rural dwellers. The majority (69%) of the identified diabetic cases were not diagnosed prior to the survey. The highest proportion (82.6%) of the undiagnosed cases was noted among the rural population and 63% among the urban population. Family history of diabetes (AOR = 5.05; 2.43, 10.51), older age (AOR = 4.86; 1.99, 11.9) and physical inactivity (AOR = 1.92; 1.06, 3.45) were significantly associated with diabetes mellitus among the urban population. Alcohol consumption (AOR = 0 .24, 0 .06, 0.99) was inversely associated with diabetes mellitus in rural areas. CONCLUSION The prevalence of diabetes mellitus is considerably high among the urban compared to the rural population. Diabetes is largely undiagnosed and untreated, especially in rural settings. Appropriate actions need to be taken to provide access to early diagnosis and treatment in order to reduce associated complications.
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Affiliation(s)
- Solomon Mekonnen Abebe
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Lundberg PC, Thrakul S. Religion and self-management of Thai Buddhist and Muslim women with type 2 diabetes. J Clin Nurs 2014; 22:1907-16. [PMID: 23745642 DOI: 10.1111/jocn.12130] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2012] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To report of a qualitative study of how religion affects the self-management of Thai Buddhist and Muslim women with type 2 diabetes. BACKGROUND The importance of diabetes self-management is well recognised. However, research on such self-management in Thailand is scarce, in particular on the influence of religion on the self-management of Thai Buddhist and Muslim women with type 2 diabetes. DESIGN A descriptive qualitative study was conducted. METHODS Purposive convenience sampling was used, and 48 women, 19 Buddhist and 29 Muslim, aged from 28-80 years, participated. Data were collected in 2008-09 and analysed by use of manifest and latent content analysis. RESULTS Four themes of the influence of religion on the self-management among Thai women with type 2 diabetes emerged: religion - a way of coping with diabetes, spiritual practice - a help for disease control, spiritual practice - an effort to struggle with everyday life, and support from family - a cultural practice. CONCLUSIONS The Buddhist and Muslim women had self-management capabilities that were often related to their religions. However, many of them had poor control of their blood sugar levels and needed assistance. RELEVANCE TO CLINICAL PRACTICE Reference to religion and spiritual practice can be an effective means of helping diabetes patients better manage their disease and change their lifestyles. Furthermore, family and economic and social environments should be taken into account both in care and in interventions aimed at helping patients cope and empowering them to control their disease.
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Affiliation(s)
- Pranee C Lundberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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Hjelm K, Beebwa E. The influence of beliefs about health and illness on foot care in ugandan persons with diabetic foot ulcers. Open Nurs J 2013; 7:123-32. [PMID: 24039644 PMCID: PMC3771228 DOI: 10.2174/1874434601307010123] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 07/05/2013] [Accepted: 07/19/2013] [Indexed: 12/30/2022] Open
Abstract
Diabetes mellitus is becoming pandemic, particularly affecting Sub-Saharan Africa, and the prevalence of complications is increasing. Diabetic foot disorders are a major source of morbidity and disability. Delay in the health care process due to patients' beliefs may have deleterious consequences for limb and life in persons with diabetic foot ulcers. No previous studies of beliefs about health and illness in persons with diabetic foot ulcers living in Africa have been found. The aim of the study was to explore beliefs about health and illness among Ugandans with diabetic foot ulcers that might affect self-care and care seeking behaviour. In an explorative study with consecutive sample semi-structured interviews were held with 14 Ugandan men and women, aged 40-79, with diabetic foot ulcer. Knowledge was limited about causes, management and prevention of diabetic foot ulcers. Foot ulcers were often detected as painful sores, perceived to heal or improve, and led to stress and social isolation due to smell and reduced mobility. Most lacked awareness of the importance of complete daily foot care and seldom practised self-care. Health was described as absence of disease and pain. Many feared future health and related it to contact with nurses in the professional sector from whom they sought information, blood tests and wound dressings and desired better organised diabetes clinics offering health education and more opening hours. Many have an underutilised potential for self-care and need education urgently, delivered in well-organised diabetes clinics working to raise awareness of the threat and prevent foot ulcers.
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Affiliation(s)
- Katarina Hjelm
- School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden ; Department of Social and Welfare Studies, University of Linköping, Campus Norrköping, Sweden
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Rutebemberwa E, Katureebe SK, Gitta SN, Mwaka AD, Atuyambe L. Perceptions of diabetes in rural areas of Eastern Uganda. Curationis 2013; 36:E1-7. [PMID: 23718775 DOI: 10.4102/curationis.v36i1.121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 03/01/2013] [Accepted: 04/14/2013] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND People diagnosed with diabetes mellitus are increasing in sub-Saharan Africa and prompt care seeking depends on perceptions of the illness. OBJECTIVE The objective was to explore perceptions of diabetes in rural areas. METHOD We conducted a qualitative, explorative and descriptive study in rural eastern Uganda. Eight focus group discussions with community members were conducted. Community members were presented with a story about a person with diabetes symptoms and their perceptions of the diagnosis and treatment elicited. Four focus group discussions with people with diabetes and seven key informant interviews with health workers were conducted. Respondents were asked how the community interpreted symptoms of diabetes, its causes and whether it was curable. Manifest content analysis was used. RESULTS Some respondents thought people with diabetes symptoms had HIV or were bewitched. Causes of diabetes mentioned included consuming too much fatty food. Some respondents thought diabetes is transmitted through air, sharing utensils with or sitting close to people with diabetes. Some respondents thought that diabetes could heal fast whilst others thought it was incurable. CONCLUSION Misdiagnosis may cause delay in seeking proper care. Preventive programmes could build on people's thinking that too much fatty food causes diabetes to promote diets with less fat. The perception of diabetes as a contagious disease leads to stigmatisation and affects treatment seeking. Seeing diabetes as curable could create patient expectations that may not be fulfilled in the management of diabetes. Rural communities would benefit from campaigns creating awareness of prevention, symptoms, diagnosis and management of diabetes.
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Affiliation(s)
- Elizeus Rutebemberwa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health.
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Hjelm K, Bard K. Beliefs about health and illness in latin-american migrants with diabetes living in sweden. Open Nurs J 2013; 7:57-65. [PMID: 23802030 PMCID: PMC3680992 DOI: 10.2174/1874434601307010057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 01/15/2013] [Accepted: 01/18/2013] [Indexed: 12/16/2022] Open
Abstract
The study explored beliefs about health and illness in Latin American migrants diagnosed with diabetes mellitus (DM) living in Sweden, and investigated the influence on health-related behavior including self-care and care-seeking behavior. Migrants are particularly affected in the diabetes pandemia. Beliefs about health and illness determine health-related behaviour and health but no studies have been found on Latin American migrants with DM. An explorative study design with focus-group interviews of nine persons aged 36-77 years from a diabetes clinic was used. Health was described from a pathogenetic or a salutogenetic perspective: 'freedom from disease or feeling of well-being', and being autonomous and able to work. Economic hardship due to expenses for medications and food for DM affected health. Individual factors such as diet, exercise and compliance with advice, and social factors with good social relations and avoidance of stress, often caused by having experienced severe events related to migrational experiences, were considered important for maintaining health and could cause DM. Disturbed relations to others (social factors), punishment by God or Fate (supernatural factors), intake of diuretics and imbalance between warmth and cold (natural factors) were also perceived as causes. A mix of biomedical and traditional explanations and active self-care behaviour with frequent use of herbs was found. It is important to assess the individual's beliefs, and health professionals, particularly nurses, should incorporate discussions of alternative treatments and other components of explanatory models and co-operate with social workers to consider influence of finances and migrational experiences on health.
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Affiliation(s)
- Katarina Hjelm
- School of Health and Caring Sciences, Linnaeus University, Växjö, S-351 95 Växjö, Sweden
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Stewart WC, Adams MP, Stewart JA, Nelson LA. Review of clinical medicine and religious practice. JOURNAL OF RELIGION AND HEALTH 2013; 52:91-106. [PMID: 23484213 DOI: 10.1007/s10943-012-9578-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose was to evaluate faith-based studies within the medical literature to determine whether there are ways to help physicians understand how religion affects patients’ lives and diseases. We reviewed articles that assessed the influence of religious practices on medicine as a primary or secondary variable in clinical practice. This review evaluated 49 articles and found that religious faith is important to many patients, particularly those with serious disease, and patients depend on it as a positive coping mechanism. The findings of this review can suggest that patients frequently practice religion and interact with God about their disease state. This spiritual interaction may benefit the patient by providing comfort, increasing knowledge about their disease, greater treatment adherence, and quality of life. The results of prayer on specific disease states appear inconsistent with cardiovascular disease but stronger in other disease states.
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Rutebemberwa E, Lubega M, Katureebe SK, Oundo A, Kiweewa F, Mukanga D. Use of traditional medicine for the treatment of diabetes in Eastern Uganda: a qualitative exploration of reasons for choice. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2013; 13:1. [PMID: 23282020 PMCID: PMC3544563 DOI: 10.1186/1472-698x-13-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 12/18/2012] [Indexed: 12/13/2022]
Abstract
UNLABELLED BACKGROUND While there are biomedical drugs for managing diabetes mellitus, some patients with diabetes use traditional medicine. The aim of the study was to explore why patients with diabetes use traditional medicine for the treatment of diabetes. METHODS The study was conducted in Iganga and Bugiri districts in Eastern Uganda using four focus group discussions (FGDs) with patients with diabetes; two with female patients and two with male patients, thirteen key informant interviews (KIIs); nine with health workers working with patients with diabetes and four with herbalists. FGDs and KIIs focused on what respondents perceived as reasons for patients with diabetes taking traditional medicine. Analysis was done using content analysis. RESULTS Reasons for taking traditional medicine included finding difficulties accessing hospitals, diabetic drugs being out of stock, traditional medicine being acceptable and available within community, as well as being supplied in big quantities. Others were traditional medicine being cheaper than biomedical treatment and payment for it being done in installments. Traditional medicine was also more convenient to take and was marketed aggressively by the herbalists. Influence of family and friends as well as traditional healers contributed to use of traditional medicine. CONCLUSIONS Possibilities of putting diabetic drugs at facilities closer to patients need to be considered and health facilities should have a constant supply of diabetic drugs. Community members need to be sensitized on the proper treatment for diabetes mellitus and on the dangers of taking traditional medicine.
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Affiliation(s)
- Elizeus Rutebemberwa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
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Mufunda E, Wikby K, Björn A, Hjelm K. Level and determinants of diabetes knowledge in patients with diabetes in Zimbabwe: a cross-sectional study. Pan Afr Med J 2012; 13:78. [PMID: 23396799 PMCID: PMC3567417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 11/21/2012] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION A previous study of beliefs about health and illness in Zimbabweans with diabetes mellitus indicated limited knowledge about diabetes and the body, affecting self-care and health-care seeking behaviour. The aim of this study was to assess the level of diabetes knowledge in Zimbabwean adults with diabetes mellitus, to determine the main gaps in knowledge and identify the socio-demographic and diabetes-related determinants that predict diabetes awareness and self-care practices. METHODS A cross-sectional descriptive study was performed using a standardized self-report Diabetes Knowledge Test questionnaire (DKT) of 58 respondents, 32 women and 26 men. Results were analysed with descriptive and analytic statistical methods. RESULTS The majority of the respondents scored average knowledge on all three sub-scales: general knowledge, insulin use and total knowledge, with an overall score of 63.1 ± 14, 2%. Major knowledge gaps were in areas related to diet, insulin use and glycaemic control. No significant differences in mean scores were detected in the diabetes knowledge sub-scales when comparisons were made of mean knowledge scores in relation to socio-demographic and diabetes-related characteristics. However, diabetes-related complications were significantly associated with lower total and general diabetes knowledge, and female gender was an independent determinant of low general knowledge. CONCLUSION Knowledge gaps were evident in areas regarding insulin use, diet and glycaemic control. Low diabetes knowledge was associated with female gender and could be a risk factor for development of diabetes-related complications. Knowledge gaps need to be addressed in diabetes education to prevent development of diabetes-related complications.
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Affiliation(s)
- Esther Mufunda
- School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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Mufunda E, Albin B, Hjelm K. Differences in health and illness beliefs in zimbabwean men and women with diabetes. Open Nurs J 2012; 6:117-25. [PMID: 22977655 PMCID: PMC3439846 DOI: 10.2174/1874434601206010117] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 06/05/2012] [Accepted: 07/18/2012] [Indexed: 11/22/2022] Open
Abstract
This study explored beliefs about health and illness that might affect self-care and health-seeking behaviours in Zimbabwean men and women with diabetes. Gender differences were indicated in a previous study but their extent has not been studied. The present study used a qualitative descriptive design with semi-structured interviews to gain a deeper understanding of the phenomena. The sample consisted of 21 participants, 11 females aged 19-61 years (Median 44 years) and 10 males aged 22-65 years (Median 52 years). Qualitative content analysis was used. Health was described as freedom from diseases and enjoying well-being. Both males and females displayed limited knowledge about diabetes and dissimilarities in health-seeking behaviours. Women, in contrast to men, were more active in self-care and used various measures besides drugs as they related to a higher extent the cause of diabetes to supernatural factors like gods and witches. They sought information from self-help groups and help from outside the professional health sector like healers in the folk sector. Prolonged economic disruption also had negative effects towards maintenance of healthy life-styles as both men and women struggled to get money for food and drugs. Thus, the study highlighted that knowledge about diabetes and its management are important for self-care. There is therefore need to develop acceptable and affordable gender- sensitive diabetes care programmes that enhance patient participation, empowerment and promotion of health.
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Affiliation(s)
- Esther Mufunda
- School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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Hjelm K, Atwine F. Health-care seeking behaviour among persons with diabetes in Uganda: an interview study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2011; 11:11. [PMID: 21943099 PMCID: PMC3213135 DOI: 10.1186/1472-698x-11-11] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 09/26/2011] [Indexed: 11/30/2022]
Abstract
Background Healthcare-seeking behaviour in patients with diabetes mellitus (DM) has been investigated to a limited extent, and not in developing countries. Switches between different health sectors may interrupt glycaemic control, affecting health. The aim of the study was to explore healthcare-seeking behaviour, including use of complementary alternative medicine (CAM) and traditional healers, in Ugandans diagnosed with DM. Further, to study whether gender influenced healthcare-seeking behaviour. Methods This is a descriptive study with a snowball sample from a community in Uganda. Semi-structured interviews were held with 16 women and 8 men, aged 25-70. Data were analysed by qualitative content analysis. Results Healthcare was mainly sought among doctors and nurses in the professional sector because of severe symptoms related to DM and/or glycaemic control. Females more often focused on follow-up of DM and chronic pain in joints, while males described fewer problems. Among those who felt that healthcare had failed, most had turned to traditional healers in the folk sector for prescription of herbs or food supplements, more so in women than men. Males more often turned to private for-profit clinics while females more often used free governmental institutions. Conclusions Healthcare was mainly sought from nurses and physicians in the professional sector and females used more free-of-charge governmental institutions. Perceived failure in health care to manage DM or related complications led many, particularly women, to seek alternative treatment from CAM practitioners in the folk sector. Living conditions, including healthcare organisation and gender, seemed to influence healthcare seeking, but further studies are needed.
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Affiliation(s)
- Katarina Hjelm
- School of Health and Caring Sciences, Linnaeus University, Växjö, S-351 95 Växjö, Sweden.
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Lundberg PC, Thrakul S. Type 2 diabetes: how do Thai Buddhist people with diabetes practise self-management? J Adv Nurs 2011; 68:550-8. [PMID: 21711465 DOI: 10.1111/j.1365-2648.2011.05756.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS This paper is a report of a study of how Thai Buddhist people with type 2 diabetes practice self-management. BACKGROUND The importance of diabetes self-management is recognized in the literature. However, research on self-care management in Thailand, in particular concerning Buddhist people with type 2 diabetes, is scarce. METHODS A descriptive qualitative study was conducted. Purposive convenience sampling was used, and thirty men and women with diabetes, aged 28-79 years, participated. Data were collected from June to August 2009 and analysed by use of manifest and latent content analysis. FINDINGS Five themes of self-management among Thai Buddhist people with type 2 diabetes were identified: cultural influence on disease control, Buddhism and Thai culture, struggle for disease control, family support and economy a high priority. CONCLUSION Even though the Buddhist people with diabetes had certain self-management capabilities, many had poor control of their blood sugar levels and needed assistance. Reference to Buddhist moderation can be an effective means of helping the people with diabetes better manage their disease and change their lifestyles. In addition to cultural and religious traditions, family, economy and social environment should be taken into account both in the care and in interventions aimed at helping people with diabetes cope and empowering them to control their disease.
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Affiliation(s)
- Pranee C Lundberg
- Department of Public Health and Caring Sciences, Uppsala University, Sweden.
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