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"In a situation of rescuing life": meanings given to diabetes symptoms and care-seeking practices among adults in Southeastern Tanzania: a qualitative inquiry.

Metta E, Bailey A, Kessy F, Geubbels E, Hutter I, Haisma H - BMC Public Health (2015)

Bottom Line: 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.The data were analyzed using principles of grounded theory and applying cultural schema theory as a deductive framework.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.

View Article: PubMed Central - PubMed

Affiliation: Ifakara Health Institute, Box 78373, Dar es Salaam, Tanzania. emetta@ihi.or.tz.

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.

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A case study of the care seeking process for diabetes.
© Copyright Policy - open-access
Related In: Results  -  Collection

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Fig1: A case study of the care seeking process for diabetes.

Mentions: The process of interpreting and assigning meaning to the diabetes symptoms, and then obtaining a diagnosis of the condition, was seen as challenging by the majority of participants in the study. A number of the diabetes patients said they faced problems in getting a diagnosis even after they sought care in modern health care facilities. During the patient group discussions, the majority of participants reported that when they went to the health facilities they were initially diagnosed and treated for other diseases, like urinary tract infections (UTIs) and sexual transmitted diseases (STDs), because of their frequent urination and itching around the genital area. Other patients said that when they visited the health facilities and explained to the clinician how they felt, a malaria test was ordered; and that when malaria was not detected they were sent home with painkillers only. Several of the patients reported that they were given a number of different tests before the provider finally prescribed a test for diabetes. This apparent tendency among health care workers to misdiagnose delayed the identification of the problem, and complicated the care-seeking responses of the patients and their ability to manage their condition. FigureĀ 1 below depicts a case study of the process that one of the diabetes patients who was interviewed in-depth reported going through before she was finally correctly diagnosed.Figure 1


"In a situation of rescuing life": meanings given to diabetes symptoms and care-seeking practices among adults in Southeastern Tanzania: a qualitative inquiry.

Metta E, Bailey A, Kessy F, Geubbels E, Hutter I, Haisma H - BMC Public Health (2015)

A case study of the care seeking process for diabetes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4358854&req=5

Fig1: A case study of the care seeking process for diabetes.
Mentions: The process of interpreting and assigning meaning to the diabetes symptoms, and then obtaining a diagnosis of the condition, was seen as challenging by the majority of participants in the study. A number of the diabetes patients said they faced problems in getting a diagnosis even after they sought care in modern health care facilities. During the patient group discussions, the majority of participants reported that when they went to the health facilities they were initially diagnosed and treated for other diseases, like urinary tract infections (UTIs) and sexual transmitted diseases (STDs), because of their frequent urination and itching around the genital area. Other patients said that when they visited the health facilities and explained to the clinician how they felt, a malaria test was ordered; and that when malaria was not detected they were sent home with painkillers only. Several of the patients reported that they were given a number of different tests before the provider finally prescribed a test for diabetes. This apparent tendency among health care workers to misdiagnose delayed the identification of the problem, and complicated the care-seeking responses of the patients and their ability to manage their condition. FigureĀ 1 below depicts a case study of the process that one of the diabetes patients who was interviewed in-depth reported going through before she was finally correctly diagnosed.Figure 1

Bottom Line: 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.The data were analyzed using principles of grounded theory and applying cultural schema theory as a deductive framework.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.

View Article: PubMed Central - PubMed

Affiliation: Ifakara Health Institute, Box 78373, Dar es Salaam, Tanzania. emetta@ihi.or.tz.

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.

Show MeSH
Related in: MedlinePlus