Social Support for Self-Care: Patient Strategies for Managing Diabetes and Hypertension in Rural Uganda.

Andrew K Tusubira,Ann R Akiteng,Tracy L Rabin,Anne Katahoire,Evelyn Hsieh,Isaac Ssinabulya,Robert Kalyesubula,Nicola L Hawley,Jeremy I Schwartz,Christine K Nalwadda,Mari Armstrong-Hough,Christine Ngaruiya

doi:10.5334/aogh.3308

Abstract

Background:Low-income countries suffer a growing burden of non-communicable diseases (NCDs). Self-care practices are crucial for successfully managing NCDs to prevent complications. However, little is known about how patients practice self-care in resource-limited settings.Objective:We sought to understand self-care efforts and their facilitators among patients with diabetes and hypertension in rural Uganda.Methods:Between April and June 2019, we conducted a cross-sectional qualitative study among adult patients from outpatient NCD clinics at three health facilities in Uganda. We conducted in-depth interviews exploring self-care practices for hypertension and/or diabetes and used content analysis to identify emergent themes.Results:Nineteen patients participated. Patients said they preferred conventional medicines as their first resort, but often used traditional medicines to mitigate the impact of inconsistent access to prescribed medicines or as a supplement to those medicines. Patients adopted a wide range of vernacular practices to supplement treatment or replace unavailable diagnostic tests, such as tasting urine to gauge blood-sugar level. Finally, patients sought and received both instrumental and emotional support for self-care activities from networks of family and peers. Patients saw their children as their most reliable source of support facilitating self-care, especially as a source of money for medicines, transport and home necessities.Conclusion:Patients valued conventional medicines but engaged in varied self-care practices. They depended upon networks of social support from family and peers to facilitate self-care. Interventions to improve self-care may be more effective if they improve access to prescribed medicines and engage or enhance patients’ social support networks.

Highlights

Low-income countries suffer a growing burden of non-communicable diseases (NCDs)
Patients said they preferred conventional medicines as their first resort, but often used traditional medicines to mitigate the impact of inconsistent access to prescribed medicines or as a supplement to those medicines
Interventions to improve self-care may be more effective if they improve access to prescribed medicines and engage or enhance patients’ social support networks

Summary

Introduction

Low-income countries suffer a growing burden of non-communicable diseases (NCDs). Non-communicable diseases (NCDs) account for the majority of the global burden of disease, and that burden is higher in low- and middle-income countries (LMIC) [1, 2]. The economic burden of these NCDs is high for individuals and families in rural settings [6,7,8]. LMICs must identify cost-effective approaches to manage their growing burden of diabetes and hypertension, with special attention to rural populations. One such approach is to strengthen self-care practices among those living with NCDs

Methods

Results

Discussion

Conclusion