'Normal, but...': living with type 2 diabetes in Bangkok, Thailand

Naemiratch, Bhensri; Manderson, Lenore Hilda

doi:10.1177/1742395308090069

Cited by 10 publications

(10 citation statements)

References 18 publications

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“…Our findings support and extend those from previous studies (most based on narrative interviews of people with diabetes, and a single ethnographic study) which highlighted the need to align the self-management agenda with the social demands of people's everyday lives; their need to maintain a coherent identity and a "normal" social life; and the finding that poverty and the physical and social environment may impact on self-management [21,25,31,43]. In particular, our findings resonate strongly with those of a previous study by our team which highlighted a number of 'storylines' within which the practical tasks of self-management acquire social meaning and moral worth, including rebuilding spoiled identity, living a disciplined and balanced life, mobilising a care network, navigating and negotiating in the health care system, and making ethical choices (such as allocating a limited family budget) [25].…”

Section: Resultssupporting

confidence: 87%

“…More recently, Korean researchers observed eating practices in 15 people with diabetes and concluded that cultural meanings were important in food choices [30]. An ethnographic study in Thailand of 33 people with diabetes found no evidence of "spoiled identity", perhaps because diabetes did not have visible manifestations in most people; but participants spent much time and effort in self-management work (diet control, exercise, clinic attendance, self-monitoring) in order to achieve what they described as "normality" [31]. …”

Section: Introductionmentioning

confidence: 99%

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"This does my head in". Ethnographic study of self-management by people with diabetes

Hinder

Greenhalgh

2012

BMC Health Serv Res

149

194

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Background Self-management is rarely studied 'in the wild'. We sought to produce a richer understanding of how people live with diabetes and why self-management is challenging for some. Method Ethnographic study supplemented with background documents on social context. We studied a socio-economically and ethnically diverse UK population. We sampled 30 people with diabetes (15 type 1, 15 type 2) by snowballing from patient groups, community contacts and NHS clinics. Participants (aged 5-88, from a range of ethnic and socio-economic groups) were shadowed at home and in the community for 2-4 periods of several hours (total 88 visits, 230 hours); interviewed (sometimes with a family member or carer) about their self-management efforts and support needs; and taken out for a meal. Detailed field notes were made and annotated. Data analysis was informed by structuration theory, which assumes that individuals' actions and choices depend on their dispositions and capabilities, which in turn are shaped and constrained (though not entirely determined) by wider social structures. Results Self-management comprised both practical and cognitive tasks (e.g. self-monitoring, menu planning, medication adjustment) and socio-emotional ones (e.g. coping with illness, managing relatives' input, negotiating access to services or resources). Self-management was hard work, and was enabled or constrained by economic, material and socio-cultural conditions within the family, workplace and community. Some people managed their diabetes skilfully and flexibly, drawing on personal capabilities, family and social networks and the healthcare system. For others, capacity to self-manage (including overcoming economic and socio-cultural constraints) was limited by co-morbidity, cognitive ability, psychological factors (e.g. under-confidence, denial) and social capital. The consequences of self-management efforts strongly influenced people's capacity and motivation to continue them. Conclusion Self-management of diabetes is physically, intellectually, emotionally and socially demanding. Non-engagement with self-management may make sense in the context of low personal resources (e.g. health literacy, resilience) and overwhelming personal, family and social circumstances. Success of self-management as a policy solution will be affected by interacting influences at three levels: [a] at micro level by individuals' dispositions and capabilities; [b] at meso level by roles, relationships and material conditions within the family and in the workplace, school and healthcare organisation; and [c] at macro level by prevailing economic conditions, cultural norms and expectations, and the underpinning logic of the healthcare system. We propose that the research agenda on living with diabetes be extended and the political economy of self-management systematically studied.

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Section: Resultssupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

"This does my head in". Ethnographic study of self-management by people with diabetes

Hinder

Greenhalgh

2012

BMC Health Serv Res

149

194

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“…In these studies, participants expressed belief that diabetes was a short term condition with the oral anti-diabetic agents providing symptomatic relief but were unneeded once they ‘felt well’, 21 , 29 , 30 , 31 only to restart on them when their illness was visible and possibly affecting their daily routines. 32 Such reports are similar to reports from studies conducted among Ethiopian patients with diabetes which also reported ‘feeling of being well without treatment’ and ‘disappearance of symptoms’ as reasons for low adherence to anti-diabetic medications. 12 , 33 This finding is also supported by other studies from the Ethiopian context where more emphasis is given to symptomatic, acute conditions and where hope for a cure is expressed.…”

Section: Discussionsupporting

confidence: 80%

Barriers and facilitators to adherence to anti-diabetic medications: Ethiopian patients’ perspectives

Habte

Kebede

Fenta

et al. 2017

Afr. j. prim. health care fam. med.

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BackgroundLittle is known about the experiences of Ethiopian patients with type 2 diabetes related to adherence to their anti-diabetic medications. This may limit attempts to develop and implement patient-centred approaches that consider Ethiopian contexts.ObjectivesTo conduct an exploratory study with a focus on identifying barriers and facilitators to anti-diabetic medications adherence in Ethiopian patients with type 2 diabetes.MethodsQualitative methods were used to conduct semi-structured interviews with 39 purposively selected participants attending clinic in three public hospitals in central Ethiopia. Open coding was used to analyse the data to identify key themes.ResultsA number of factors were identified as barriers and facilitators to participants’ adherence to their anti-diabetic medications. The most common factors were perceptions related to their illness including symptoms, consequences and curability; perceptions of medications including safety concerns, convenience and their necessity; religious healing practices and beliefs; perceptions about and experiences with their healthcare providers and the healthcare system including the availability of medications and diabetes education; and finally perceived self-efficacy and social support.ConclusionsThe findings of this study provide guidance to strengthen diabetes education programmes so that they reflect local patient contexts focusing among other things on the illness itself and the anti-diabetic medications.

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“…Furthermore, research has found a negative influence of the disease on family and social life ( de Silva et al, 2012 ; Manderson & Kokanovic, 2009 ). However, a Thai study has found that women define themselves as being “normal” when they can work and perform daily activities of their usual lives even if they have diabetes ( Naemiratch & Manderson, 2008 ). Another study of Thai Buddhist and Muslim women with T2D mentions religion as a significant factor that promotes psychosocial well-being when living with the disease ( Lundberg & Thrakul, 2013 ), and one of the Buddhist teachings indicates illness as a common element in the cycle of human life ( Phromtha, 1999 ).…”

Section: Introductionmentioning

confidence: 99%

“…The oft-mentioned lack of empirical studies that consider the lives of Asian people with diabetes ( Li, Drury, & Taylor, 2013 ; Lundberg & Thrakul, 2013 ; Naemiratch & Manderson, 2008 ; Sowattanangoon et al, 2009 ; Yamakawa & Makimoto, 2008 ) and the high prevalence and morbidity of T2D as one of the top five chronic diseases in Thailand ( Bureau of Epidemiology, Ministry of Public Health, 2013 ) encourage the understanding of how people perceive their lives with this disease. Moreover, the higher diabetes prevalence among Thai women makes it important to focus a study on their perceptions ( Bureau of Epidemiology, Ministry of Public Health, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

Living with Diabetes: Experiences of Inner and Outer Sources of Beliefs in Women with Low Socioeconomic Status

Boonsatean¹,

Carlsson²,

Östman³

et al. 2015

GJHS

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The purpose of this study was to examine the life experiences of nineteen Thai women of low socioeconomic status who were living with type 2 diabetes. A qualitative research design was conducted, and the women were identified by the snowball technique. Data was collected through semi-structured interviews, and processes of induction and abstraction were used for data analysis. The theme “keeping equilibrium of one’s mind” involved two sub-themes: experiencing an unpredictable future and being empowered by emerged beliefs. The first sub-theme encompassed worries concerning health and fears of being a burden to one’s family. The second sub-theme comprised the experiences of continuing life without being conquered by the disease and believing in the natural law described in Buddhist teachings. These findings revealed that participants could maintain a balance among their concerns through empowerment by inner and outer sources of beliefs, particularly in Buddhist teachings. Despite the vulnerable situations caused by diabetes and low socioeconomic status, the women remained calm, with a consciousness to continue their lives with the disease. The Buddhist views on life, specifically natural law, assisted them to consider life with diabetes as simply a natural course. Buddhism served as a spiritual refuge and helped the women to cope with their psychological burden from diabetes. These findings may reflect the need for health care professionals to provide more holistic care that would assist patients to live with their disease. Buddhist beliefs can be used as a tool to assist Thai patients to empower themselves successfully.

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'Normal, but...': living with type 2 diabetes in Bangkok, Thailand

Cited by 10 publications

References 18 publications

"This does my head in". Ethnographic study of self-management by people with diabetes

"This does my head in". Ethnographic study of self-management by people with diabetes

Barriers and facilitators to adherence to anti-diabetic medications: Ethiopian patients’ perspectives

Living with Diabetes: Experiences of Inner and Outer Sources of Beliefs in Women with Low Socioeconomic Status

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