Everyday disease diplomacy: an ethnographic study of diabetes self-care in Vietnam

Financial struggles and coping with the aftermath of breast cancer care: An ethnographic study in Vietnam

Breast cancer, the most common cancer diagnosed among women, disproportionately affects low- and middle-income countries (LMICs). Based on an ethnographic study conducted in Central Vietnam in 2019, including observation and interviews with 33 women patients, we investigate how women and their families managed the financial burden of breast cancer care. Our findings suggest that in a context where health-related risk protection is poorly organised and out-of-pocket expenses are burdensome, despite the presence of universal health coverage, patients must rely heavily on informal arrangements to finance their treatment. They proactively researched available information and undertook extensive and ramified work to prove their deservingness for some types of assistance, including strategically disclosing their cancer status or using tactics to accelerate the process of applying for state welfare. Affected families must make hard calculations to prioritise the pressing health need of a member diagnosed with cancer and in many circumstances, forfeited the education of their young children. We offer theoretical understanding of 'patient work' beyond the routine management of the biological aspects of an illness. In addition, we demonstrate how engaging in those various coping practices can reinforce one's vulnerability to a vicious cycle of illness and poverty and amplify socio-economic inequalities among the affected community and the larger society. We argue this situation, if not tackled urgently and appropriately, can impede the progress towards achieving Sustainable Development Goal 3 (Good Health and Wellbeing) and Goal 10 (Reduced Inequalities) in LMICs amidst the non-communicable disease epidemic.

Informal caregiving among people supporting a person with type 2 diabetes in rural communities of Northern Vietnam: A cross-sectional study of caregiver burdens

OBJECTIVE

The prevalence of type 2 diabetes mellitus (T2DM) in Vietnam has doubled from 3% to 6% over the last decades, with potential consequences for persons with diabetes and their caregivers. This study aimed to assess caregiver burdens and factors associated with caregiver burden.

METHOD

A cross-sectional study was conducted in 2019, using data from 1,241 informal caregivers (ICGs). Caregiver burden was scored from 0-32 using 8 questions from the Zarit Burden Interview (ZBI). Quantile regression analysis was used to identify factors associated with caregiver burden.

RESULTS

The median score of the ZBI was 7.0 (Q1-Q3: 2.0-10.0), indicating that the burden among caregiver of persons with T2DM is not high. Quantile regression showed that the higher the monthly income, the lower the burden among caregivers (50% quantile and 75% quantile of burden: -0.004). Lower educational level (25%Q: 4.0, 50%Q; 3.0, 75%Q: 2.16), being a farmer (25%Q: 2.0) and providing care to other people besides the person with T2DM (25%Q: 2.0, 50%Q; 2.54, 75%Q: 1.66) were associated with higher burden on caregivers.

CONCLUSION

The study found that caregivers facing additional life stressors, such as low income or other caregiving responsibilities, reported higher levels of burden. These findings could inform the development of interventions targeted at supporting informal caregivers in rural areas in low- and middle-income countries.

Gammeltoft T, Christian Bygbjerg I, W. Meyrowitsch D, Søndergaard J. Pre-/-post-analyses of a feasibility study of a peer-based club intervention among people living with type 2 diabetes in Vietnam's rural communities

OBJECTIVES

Insufficient self-management is a significant barrier for people with type 2 diabetes (T2D) to achieve glycemic control and consequently reduce the risk of acute and long-term diabetes complications, negatively affecting their quality of life and increasing their risk of diabetes-related death. This pre-post study aimed to evaluate whether a peer-based club intervention might reduce glycated hemoglobin from baseline to post-intervention and enhance self-management among people living with T2D in two rural communities in Vietnam.

METHODS

A pre-post study was implemented with 222 adults with T2D residing in two rural communities in Vietnam. We used a structured questionnaire, clinical examination, and glycated hemoglobin to evaluate the possible effects of a diabetes club intervention by comparing Glycated Hemoglobin (HbA1c), Body Mass Index (BMI), Blood Pressure (BP), and diabetes-related self-management behaviors at baseline and post-intervention. The data were analyzed using SPSS 20, applying two related sample tests (Wilcoxon and McNemar test) and a paired-sample t-test at a significance level of less than 0.05.

RESULTS

The findings indicated that after implementation of the intervention, there were no significant statistical differences when comparing pre-and post-intervention levels of the primary outcome HbA1c, but some components of diabetes self-management showed statistically significant improvement.

CONCLUSIONS

After the peer support intervention in a Vietnamese rural community, there was no significant reduction in the primary outcome proportion of patients having an HbA1c less than 7%, but foot care knowledge and practice had improved.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05602441.

Mobilizing morality: how caregivers in Vietnam handle the challenges of daily diabetes care

BACKGROUND

As a chronic disease, type 2 diabetes (T2D) often involves long-term care obligations for patients' family members. Understanding the socially and culturally specific challenges that family caregivers face and how they cope with them is crucial in developing targeted and effective interventions to support both caregivers and patients with T2D. This research examined family caregiving for people with T2D living in rural northern Vietnam. Although there is a growing literature on family support in Vietnam, little is known about the personal experiences of family caregivers for people with T2D. This paper seeks to fill this gap revealing some of the challenges and coping strategies of family caregivers to people with T2D.

METHODS

This qualitative study is based on ethnographic research using primarily semi-structured interviews with 21 caregivers to a person with T2D in Vietnam. The research was conducted in 2022 by a Vietnamese-Danish research team. Each interview was voice-recorded, transcribed verbatim and thematically coded.

RESULTS

Four major challenges emerged from the analysis: physical health concerns, psychological exhaustion, economic burdens, and lack of support. Caregivers expressed motivation to overcome these challenges as they felt a deep sense of responsibility towards their family member with diabetes. The primary caregiver's sense of responsibility toward their family would often cause them not to share the burdens from caregiving with other family members to avoid burdening them as well. However, negative experiences from caregiving were decreased and positive feelings increased in the instances where caregiving was shared between multiple family members.

CONCLUSION

While family members expressed motivation to take care of the patient because of moral obligations, some caregivers, specifically primary caregivers, did not want to burden other family members with care tasks and were reluctant to ask for assistance. For families who did share the caregiving tasks among several family members, some of the negative sentiments associated with caregiving were diminished. Having multiple members of a family forming a caregiving community thus motivated people in handling care challenges.

The hidden burden of medical testing: public views and experiences of COVID-19 testing as a social and ethical process

BACKGROUND

In May 2020, the Scottish Government launched Test and Protect, a test, trace and isolate programme for COVID-19 that includes a PCR testing component. The programme's success depended on the willingness of members of the public to seek out testing when they experienced symptoms and to comply with guidelines on isolation should they test positive. Drawing on qualitative interview-based research, this paper analyses public understandings, expectations, and experiences of COVID-19 testing during the early stages of the programme. Through anthropological and sociological analysis of the findings we aim to contribute to social understandings of COVID-19 testing practices; and to inform the design of population level testing programmes for future pandemics.

METHODS

Between 7 July and 24 September 2020, 70 semi-structured interviews were conducted with members of the general public (aged 19-85) living in the Lothian region of Scotland. Interviews were held online or by telephone, were transcribed verbatim and analysed using thematic analysis informed by anthropological and sociological theories of medical testing.

FINDINGS

Social relationships and ethical considerations shape testing practices at every stage of the testing process. Members of the public viewed testing as a civic duty to society and moral duty to friends, family, and colleagues. However, the testing process also placed a significant social, economic, and practical burden on the individual and sometimes generated competing obligations. Many participants experienced a disconnect between the government's portrayal of testing as easy and the everyday burden of testing.

CONCLUSIONS

COVID-19 testing is experienced as a social process shaped by multiple relationships and ethical considerations. The full burden of testing should be considered in the design of future testing programmes.