Research Article: Premorbid risk perception, lifestyle, adherence and coping strategies of people with diabetes mellitus: A phenomenological study in the Brong Ahafo Region of Ghana

Date Published: June 14, 2018

Publisher: Public Library of Science

Author(s): Philip Teg-Nefaah Tabong, Vitalis Bawontuo, Doris Ningwiebe Dumah, Joseph Maaminu Kyilleh, Tolgou Yempabe, Noël C. Barengo.

http://doi.org/10.1371/journal.pone.0198915

Abstract

One of the non-communicable diseases which is on the rise is type 2 diabetes (T2D). T2D is largely preventable with healthy lifestyle. We therefore conducted this study to explore premorbid perception of risk, behavioural practices and the coping strategies of patients with T2D.

Using descriptive phenomenology approach to qualitative enquiry, we conducted eight focus group discussions (N = 73) with diabetic patients; four among males (N = 36) and four among females (N = 37). In addition, we conducted in-depth interviews with 15 patients, seven caretakers and three physicians. We adopted Colaizzi’s descriptive phenomenology approach to analyse the data with the aid of NVivo 11.

We found that respondents believed diabetes was a condition for the aged and rich and this served as a premorbid risk attenuator. Majority of them engaged in diabetes-related high risk behaviours such as lack of exercise, sedentary lifestyle and unhealthy eating despite their foreknowledge about the role of lifestyle in diabetes pathogenesis. We also found that patients used moringa, noni, prekese, and garlic concurrently with orthodox medications. Adherence to dietary changes and exercises was a challenge with females reporting better adherence than males. The study also revealed that patients believed biomedical health facilities paid little attention to psychosocial aspects of care despite its essential role in coping with the condition.

Diabetic patients had low premorbid perception of risk and engaged in diabetes-related risky behaviours. Diabetic patients had challenges adhering to lifestyle changes and use both biomedical and local remedies in the management of the condition. Psychosocial support is necessary to enhance coping with the condition.

Partial Text

Diabetes mellitus is one of the chronic non-communicable diseases (NCDs) which is on the rise with high burden across the world. In 2013, 382 million were reported to have diabetes and this number is expected to rise to 592 million by 2035 [1]. In 2014, it was estimated that 422 million adults live with diabetes [2]. Although there are regional variations in diabetes, records available show that majority of the people with the condition live in low- and middle-income countries [3]. In 2010, the World Economic Forum ranked NCDs including diabetes among the most important threats to global economic development [4]. The prevalence of diabetes is reported to be higher in urban than rural areas [5,6]. Despite being a preventable condition, it has been estimated that, for persons aged 35–64 in Africa, diabetes claimed 7.1% of all deaths among males, and 7.9% among females [7]. In the year 2012, diabetes was responsible for 1.5 million deaths globally [2]. In Ghana, diabetes prevalence is 6.3% of adult population [8] and more than 450, 000 Ghanaians are living with the condition [9].

We conducted a qualitative study with a descriptive phenomenology approach. We found that diabetes is perceived as a condition for the aged and rich in community. The findings also generally showed that diabetic patients had a low premorbid perception of risk, and hence engaged in diabetes-related high risk behaviour. Prior to diagnosis, the participants also used both orthodox and non-orthodox health facilities. Patients also used local remedies or engage in self-medication in addition to treatment they receive from biomedical facilities. Our study further showed that patients had challenges adhering to dietary requirements, exercises and home-based blood sugar monitoring. The study underscore the need to find innovative ways to encourage patients to adhere to treatment. Education and community sensitization on diabetes should highlight the fact that all individuals irrespectively of their social class and age are vulnerable to diabetes.

Although this study provides evidence on illness perception, lifestyle, health seeking and adherence to treatment that is required to guide policies on health promotion and interventions, it is important to situate the conclusions in the context of some limitations. The first limitation of this study is that it was conducted in one region in Ghana on a sample that is not representative, hence the findings cannot be generalized. This notwithstanding, in conducting the study, we followed the methodological requirements for a qualitative research such as the RATS checklist [64], Consolidated criteria for reporting qualitative research (COREQ), [65] and acceptable practice in fieldwork, analysis and interpretation [66].

Diabetic patients in this study had low premorbid perception of risk and engaged in diabetes-related risk behaviour prior to the diagnosis. Associating diabetes with some socio-economic class served as a risk attenuator and leads to denial of the condition. Both biomedical and local remedies are used concurrently in the management of diabetes among study participants. Furthermore, diabetic patients have challenges living with the condition and adhering to lifestyle changes required to control blood sugar. However, social support was necessary to enhance coping with the condition.

 

Source:

http://doi.org/10.1371/journal.pone.0198915

 

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