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

Abstract

BackgroundDiabetes 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.MethodsTo 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.ResultsIn 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.ConclusionThe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1504-0) contains supplementary material, which is available to authorized users.

Experiences of type 2 diabetes in sub-Saharan Africa: a scoping review

“…Findings relating to how Participants recognised and interpreted their type 2 diabetes were reported in most papers included in the review [ 8 – 10 , 18 – 34 ]. A recurring observation was that the symptoms of diabetes were often not recognised by those experiencing them, and healthcare professionals tended to be the first to respond to signs of the disease [ 8 , 21 , 26 , 27 , 30 , 33 ]. For example, an informant in Hjelm and Munfunda’s study of health beliefs amongst Zimbabweans with diabetes described:…”

“…The chronic nature of diabetes was also a source of contention for study participants [ 10 , 19 , 20 , 24 , 26 , 30 ]. The majority of studies found that people with diabetes understood that diabetes was a chronic condition for which there was no cure, as this Tanzanian woman exemplifies [ 10 , 18 , 21 , 24 , 26 , 27 , 31 , 32 ]:…”

“…Studies also found that some informants, such as this person from Tanzania, initially attributed their diabetes to witchcraft [ 8 , 10 , 19 – 21 , 27 , 30 ]:…”

“…I was afraid because I had changed a lot; it was a big change for just three days. I thought I was bewitched…” [ 30 ]…”

“…Thirteen studies focused on how people with diabetes employed both biomedical and non-biomedical services in the management of their type 2 diabetes [ 8 – 10 , 19 – 22 , 24 , 26 , 27 , 29 , 31 , 35 ]. Employing non-biomedical services was frequently narrated as part of a search for a cure, as described by this Ghanaian [ 10 , 19 – 21 , 30 ]:…”