Paper short abstract:

Diabetes requires life-long management that is influenced by patients' perspectives and illness narratives. Using Kleinman's patients' explanatory model, this study aimed to explore socio-cultural perceptions and barriers related to proposed diabetes care for improved case management and compliance.

Paper long abstract:

Background: Pakistan ranks third highest in diabetes prevalence globally, with 33 million population living with diabetes. An ethnography was conducted to assess the effectiveness of a diabetes standardized care package, delivered through primary healthcare facilities in district Sargodha, Punjab, Pakistan. This study aimed to develop an understanding of lay beliefs, information access, norms, social service context, and socio-cultural barriers to contextualize the used diabetes care package, and enhance case management and compliance with the proposed treatment.

Methods: Interview guide and observational checklist were used to conduct in-depth interviews with adherent and non-adherent patients in an intervention site. Kleinman's patients' explanatory model was used to analyze the responses and explore the journey of type-2 diabetics, their experiences, and adherence to treatment.

Results: Several direct social factors (i.e., perception(s) towards public healthcare system, role of paramedic, opportunity cost, and social identity of diabetic) and cross-cutting indirect factors (environmental factors, education, health illiteracy, and age) were found to influence patient's compliance. Adherence to lifestyle modification was found to be influenced by certain direct cultural factors (perception towards the treatment of diabetes (especially desire for cure), gender, and concept of diet and physical activity) and indirect factors (position status in family, perceived seriousness of diabetes, and financial pressures).

Conclusion: Treatment compliance was studied through Kleinman's patients' explanatory model. In-depth patients' perspectives may help generate culturally proficient strategies for troubleshooting barriers and improved compliance throughout diabetes care by scaling up culturally competent patients' education and involvement of key stakeholders in case management.