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

Abstract

Background Understanding people’s subjective experiences of everyday lives with chronic health conditions such as diabetes is important for appropriate healthcare provisioning and successful self-care. This study explored how individuals with type 2 diabetes in northern Vietnam handle the everyday life work that their disease entails. Methods Detailed ethnographic data from 27 extended case studies conducted in northern Vietnam’s Thái Bình province in 2018–2020 were analyzed. Results The research showed that living with type 2 diabetes in this rural area of Vietnam involves comprehensive everyday life work. This work often includes efforts to downplay the significance of the disease in the attempt to stay mentally balanced and ensure social integration in family and community. Individuals with diabetes balance between disease attentiveness, keeping the disease in focus, and disease discretion, keeping the disease out of focus, mentally and socially. To capture this socio-emotional balancing act, we propose the term “everyday disease diplomacy.” We show how people’s efforts to exercise careful everyday disease diplomacy poses challenges to disease management. Conclusions In northern Vietnam, type 2 diabetes demands daily labour, as people strive to enact appropriate self-care while also seeking to maintain stable social connections to family and community. Health care interventions aiming to enhance diabetes care should therefore combine efforts to improve people’s technical diabetes self-care skills with attention to the lived significance of stable family and community belonging.

Self-management practices for preventing complications of type II diabetes mellitus in low and middle-income countries: A scoping review

“…In Africa, the proportion of diabetes-attributable deaths mainly occurs in persons under the age of 60 years ( Saeedi et al., 2020 ). In addition, millions of people in low-income regions experience diabetes complications and an accompanying reduction in general well-being ( Gammeltoft et al., 2022 ), which creates a ripple effect through multiple sectors of the economy ( Awah, 2019 ). As such, the prevention of diabetes and associated complications is crucial to the achievement of Sustainable Development Goals, especially in low and middle-income countries.…”

Diabetes-related Distress and the Association to Hypertension and Cardiovascular Disease Among Individuals Living with Type 2 Diabetes in Rural areas in Vietnam

“…Nonetheless, a part of the Vietnamese practise includes a strong wish of not troubling or being a burden to others and, hence, a strong tendency to tone down personal problems and obstacles. (Gammeltoft, Tine M: The Force of Love: Type II Diabetes in Vietnam as Tentatively Transformative Experince), [35]. This could potentially lead to an underreporting of DRD and hereby a reporting bias which could potentially lead to differential misclassification.…”

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

“…Only two participants tested positive prior to being interviewed, which limited our insight into people’s experience of the consequences of testing positive. In line with conventions for anthropologically informed qualitative research, validity, rather than representativity, was the main quality parameter for this study [ 50 , 84 ].…”

“…This is despite social and ethical issues being at the forefront of the testing experience for members of the public [4,9,42]. We therefore argue that the burden of testing needs to be understood as practical, economic and ethical and that navigating the ethics of COVID-19 testing can be considered a hidden form of public health and epidemic response work [50,51].…”

“…An anthropology of ethics approach to testing therefore highlights the moral and social consequences for participants of choosing to test, as well the ethical dimensions of waiting for test results, and in trying to interpret and act on results in the best possible way. Bringing together this approach to testing as a form of ethical practice with recent anthropological research on health-seeking as a form of work [ 50 ] and the intensification of informal and voluntary health-related work in public health emergencies [ 51 ], we reflect on the extent to which ethical dilemmas and decision making can be considered a hidden burden of voluntary testing programmes.…”