Abstract
BackgroundEffective prevention and care for type 2 diabetes requires that people link healthy behaviours to chronic disease-related wellbeing. This study explored how people perceive current and future wellbeing, so as to inform lifestyle education.MethodsEight focus group discussions and 12 in-depth interviews were conducted in Iganga and Mayuge districts in rural Eastern Uganda among people aged 35–60 years in three risk categories (1) People with diabetes, (2) people at higher risk of diabetes (with hypertension or overweight) and (3) community members without diabetes.ResultsPeople define wellbeing in three notions: 1) Physical health, 2) Socio-economic status and 3) Aspirational fulfilment. Most people hold the narrower view of wellbeing that focuses on absence of pain. Most overweight participants did not feel their condition as affecting their wellbeing. However, for several people with hypertension, the pains they describe indicate probable serious heart disease. Some people with diabetes expressed deep worry and loss of hope, saying that ‘thoughts are more bothersome than the illness’. Wellbeing among people with diabetes was described in two perspectives: Those who view diabetes as a ‘static’ condition think that they cannot attain wellbeing while those who view it as a ‘dynamic’ condition think that with consistent treatment and healthy lifestyles, they can be well. While many participants perceive future wellbeing as important, people without diabetes are less concerned about it than those with diabetes. Inadequate knowledge about diabetes, drug stock-outs in health facilities, unaffordable healthier food, and contradictory information were cited as barriers to future wellbeing in people with diabetes.ConclusionsTo make type 2 diabetes prevention relevant to healthy people, health education messages should link current lifestyles to future wellbeing. Diabetes patients need counselling support, akin to that in HIV care, to address deep worry and loss of hope.
Highlights
Effective prevention and care for type 2 diabetes requires that people link healthy behaviours to chronic disease-related wellbeing
We found that most people have a narrow view of wellbeing that focuses on absence of pain and access to basic needs
Preventive efforts for diabetes should make the message of future health and wellbeing relevant for people who feel well and should promote a holistic view of current and future wellbeing as an incentive for behaviour change
Summary
Effective prevention and care for type 2 diabetes requires that people link healthy behaviours to chronic disease-related wellbeing. Culturally-relevant interventions targeting chronic diseases require an understanding of how people perceive risk, and what motivates them to change behaviour [10, 11]. Such information is lacking for many contexts in sub-Saharan Africa [9]. The promise of wellbeing is one of the most authentic incentives for chronic disease related behaviour change [13] It is not clear how communities in LMICs interpret current and future wellbeing in the context of their behaviour
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