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Constraints faced by urban poor in managing diabetes care: patients' perspectives from South India

Upendra Bhojani, Arima Mishra, Subramani Amruthavalli, Narayanan Devadasan, Patrick Kolsteren UGent, Stefaan De Henauw UGent and Bart Criel (2013) GLOBAL HEALTH ACTION. 6.
abstract
Background: Four out of five adults with diabetes live in low- and middle-income countries (LMIC). India has the second highest number of diabetes patients in the world. Despite a huge burden, diabetes care remains suboptimal. While patients (and families) play an important role in managing chronic conditions, there is a dearth of studies in LMIC and virtually none in India capturing perspectives and experiences of patients in regard to diabetes care. Objective: The objective of this study was to better understand constraints faced by patients from urban slums in managing care for type 2 diabetes in India. Design: We conducted in-depth interviews, using a phenomenological approach, with 16 type 2- diabetes patients from a poor urban neighbourhood in South India. These patients were selected with the help of four community health workers (CHWs) and were interviewed by two trained researchers exploring patients’ experiences of living with and seeking care for diabetes. The sampling followed the principle of saturation. Data were initially coded using the NVivo software. Emerging themes were periodically discussed among the researchers and were refined over time through an iterative process using a mind-mapping tool. Results: Despite an abundance of healthcare facilities in the vicinity, diabetes patients faced several constraints in accessing healthcare such as financial hardship, negative attitudes and inadequate communication by healthcare providers and a fragmented healthcare service system offering inadequate care. Strongly defined gender-based family roles disadvantaged women by restricting their mobility and autonomy to access healthcare. The prevailing nuclear family structure and inter-generational conflicts limited support and care for elderly adults. Conclusions: There is a need to strengthen primary care services with a special focus on improving the availability and integration of health services for diabetes at the community level, enhancing patient centredness and continuity in delivery of care. Our findings also point to the need to provide social services in conjunction with health services aiming at improving status of women and elderly in families and society.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
patients' perspective, slum, chronic illness, diabetes, access to care, healthcare service, HEALTH, MEDICATIONS, PREVALENCE, DISEASES
journal title
GLOBAL HEALTH ACTION
Glob. Health Action
volume
6
article number
22258
pages
9 pages
Web of Science type
Article
Web of Science id
000325134900001
JCR category
PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
JCR impact factor
1.646 (2013)
JCR rank
55/143 (2013)
JCR quartile
2 (2013)
ISSN
1654-9880
DOI
10.3402/gha.v6i0.22258
language
English
UGent publication?
yes
classification
A1
copyright statement
I have retained and own the full copyright for this publication
id
4158392
handle
http://hdl.handle.net/1854/LU-4158392
date created
2013-10-08 21:04:38
date last changed
2017-03-07 12:14:59
@article{4158392,
  abstract     = {Background: Four out of five adults with diabetes live in low- and middle-income countries (LMIC). India has the second highest number of diabetes patients in the world. Despite a huge burden, diabetes care remains suboptimal. While patients (and families) play an important role in managing chronic conditions, there is a dearth of studies in LMIC and virtually none in India capturing perspectives and experiences of patients in regard to diabetes care.
Objective: The objective of this study was to better understand constraints faced by patients from urban slums in managing care for type 2 diabetes in India.
Design: We conducted in-depth interviews, using a phenomenological approach, with 16 type 2- diabetes patients from a poor urban neighbourhood in South India. These patients were selected with the help of four community health workers (CHWs) and were interviewed by two trained researchers exploring patients{\textquoteright} experiences of living with and seeking care for diabetes. The sampling followed the principle of saturation. Data were initially coded using the NVivo software. Emerging themes were periodically discussed among the researchers and were refined over time through an iterative process using a mind-mapping tool.
Results: Despite an abundance of healthcare facilities in the vicinity, diabetes patients faced several constraints in accessing healthcare such as financial hardship, negative attitudes and inadequate communication by healthcare providers and a fragmented healthcare service system offering inadequate care. Strongly defined gender-based family roles disadvantaged women by restricting their mobility and autonomy to access healthcare. The prevailing nuclear family structure and inter-generational conflicts limited support and care for elderly adults.
Conclusions: There is a need to strengthen primary care services with a special focus on improving the availability and integration of health services for diabetes at the community level, enhancing patient centredness and continuity in delivery of care. Our findings also point to the need to provide social services in conjunction with health services aiming at improving status of women and elderly in families and society.},
  articleno    = {22258},
  author       = {Bhojani, Upendra and Mishra, Arima and Amruthavalli, Subramani and Devadasan, Narayanan and Kolsteren, Patrick and De Henauw, Stefaan and Criel, Bart},
  issn         = {1654-9880},
  journal      = {GLOBAL HEALTH ACTION},
  keyword      = {patients' perspective,slum,chronic illness,diabetes,access to care,healthcare service,HEALTH,MEDICATIONS,PREVALENCE,DISEASES},
  language     = {eng},
  pages        = {9},
  title        = {Constraints faced by urban poor in managing diabetes care: patients' perspectives from South India},
  url          = {http://dx.doi.org/10.3402/gha.v6i0.22258},
  volume       = {6},
  year         = {2013},
}

Chicago
Bhojani, Upendra, Arima Mishra, Subramani Amruthavalli, Narayanan Devadasan, Patrick Kolsteren, Stefaan De Henauw, and Bart Criel. 2013. “Constraints Faced by Urban Poor in Managing Diabetes Care: Patients’ Perspectives from South India.” Global Health Action 6.
APA
Bhojani, U., Mishra, A., Amruthavalli, S., Devadasan, N., Kolsteren, P., De Henauw, S., & Criel, B. (2013). Constraints faced by urban poor in managing diabetes care: patients’ perspectives from South India. GLOBAL HEALTH ACTION, 6.
Vancouver
1.
Bhojani U, Mishra A, Amruthavalli S, Devadasan N, Kolsteren P, De Henauw S, et al. Constraints faced by urban poor in managing diabetes care: patients’ perspectives from South India. GLOBAL HEALTH ACTION. 2013;6.
MLA
Bhojani, Upendra, Arima Mishra, Subramani Amruthavalli, et al. “Constraints Faced by Urban Poor in Managing Diabetes Care: Patients’ Perspectives from South India.” GLOBAL HEALTH ACTION 6 (2013): n. pag. Print.