Explanatory models of adult patients with type 2 diabetes mellitus from urban centers of central Ethiopia

Abstract

BackgroundType 2 diabetes, which is increasing as a public health problem in the low resource settings of Africa has been associated with the high prevalence of micro-vascular complications and increasing levels of macro-vascular complications. There is evidence from the developed world that understanding patient perceptions of chronic illness is important to design effective strategies for helping patients manage these conditions. This study utilized Kleinman’s model to explore the illness perceptions of type 2 diabetes patients attending treatment in Addis Ababa and Butajira (Ethiopia) and better understand how they manage their illness.DesignQualitative interviews were conducted to elicit the explanatory models of purposively sampled type 2 diabetes patients attending treatment in three hospitals in central Ethiopia until saturation of key emerging themes was achieved. Analysis of interview transcripts was guided by Kleinman’s model.ResultsA total of 39 participants, 24 from Addis Ababa and the rest from Butajira took part in the study. This study revealed that patients’ explanatory models were informed by both the traditional and biomedical models with emotional distress evident in some of the participants. The traditional model seemed to reflect the strong religious and cultural influences for the majority of study participants. The findings also revealed that symptoms played significant roles in how patients viewed their illness including assessment of its severity. Most were uncertain about the cause of their illness, with those expressing certainty citing factors over which they believed they had little or no control. This may have contributed to the perceptions about the use of religious healing and traditional medicines in a complementary or alternative manner to the biomedical regimen which could affect their adherence to recommended regimens and their health outcomes.ConclusionThis study suggests the need for a strong diabetes care program that is sensitive to patients’ experiences of their illness including emotional distress. Individuals providing the diabetes care should consider local and individual contexts and strive to make their approach patient-centered and engage active participation of patients. There appears to be a need for better training of health providers in different areas including health communications and the fundamentals of mental healthcare.

Patients’ Illness Perceptions of Type 2 Diabetes: A Scoping Review

“…The rationale for a chosen minority population was the higher risk of type 2 diabetes when compared to the general population. Two studies mentioned the importance of individualised diabetes education programmes as the reason for including participants from a specific geographical area [26,32]. The rationale for comparing perceptions across countries/cultures was that perceptions of diabetes are embedded in a historical and cultural context.…”

“…Eleven studies investigated patients' perceptions of identity of type 2 diabetes [14,16,17,23,25,26,[32][33][34][35][36]. The patients in three of the studies reported experiencing symptoms such as fatigue, weight loss, increased thirst and vision problems [14,23,32]. In one study, patients believed that the need for insulin is a symptom of type 2 diabetes [17].…”

“…In one study, patients said that type 2 diabetes has few effects on their daily life [41]. Some patients believed that insulin can cause complications, such as blindness [17,23], while others believed that type 2 diabetes can undermine one's social image and make children less "marriageable [15] or affect people's relationships because it makes patients shorttempered [32]. Nguyen [25] showed that patients have poor knowledge of the long-term consequences and medically inadequate knowledge of type 2 diabetes complications.…”

“…Six studies reported on patients' perceptions of severity of type 2 diabetes [14,16,24,30,32,34]. Only one study measured the mean perceived seriousness of type 2 diabetes, indicating that although it varies between countries (p<.001) patients do not perceive type 2 diabetes as very serious [30].…”

“…Others believed that type 2 diabetes is serious but they can control it and avoid the serious effects [34]. Finally, some patients were pessimistic about their own prognosis [34] and believed type 2 diabetes can kill them in a short period of time [32]. However, participants in Habte et al's [32] study also associated severity with presence of symptoms.…”