Zimbabwean diabetics' beliefs about health and illness: an interview study

Katarina Hjelm,Esther Mufunda

doi:10.1186/1472-698x-10-7

Abstract

BackgroundDiabetes mellitus (DM) is increasing globally, with the greatest increase in Africa and Asia. In Zimbabwe a threefold increase was shown in the 1990s. Health-related behaviour is important in maintaining health and is determined by individual beliefs about health and illness but has seen little study. The purpose of the study was to explore beliefs about health and illness that might affect self-care practice and health care seeking behaviour in persons diagnosed with DM, living in Zimbabwe.MethodsExploratory study. Consecutive sample from a diabetes clinic at a central hospital. Semi-structured interviews were held with 21 persons aged 19-65 years. Data were analysed using qualitative content analysis.ResultsHealth was described as freedom from disease and well-being, and individual factors such as compliance with advice received and drugs were considered important to promote health. A mixture of causes of DM, predominantly individual factors such as heredity, overweight and wrong diet in combination with supernatural factors such as fate, punishment from God and witchcraft were mentioned. Most respondents did not recognize the symptoms of DM when falling ill but related the problems to other diseases, e.g. HIV, malaria etc. Limited knowledge about DM and the body was indicated. Poor economy was mentioned as harmful to health and a consequence of DM because the need to buy expensive drugs, food and attend check-ups. Self-care was used to a limited extent but if used, a combination of individual measures, household remedies or herbs and religious acts such as prayers and holy water were frequently used, and in some cases health care professionals were consulted.ConclusionsLimited knowledge about DM, based on beliefs about health and illness including biomedical and traditional explanations related to the influence of supernatural forces, e.g. fate, God etc., were found, which affected patients' self-care and care-seeking behaviour. Strained economy was stated to be a factor of the utmost importance affecting the management of DM and thus health. To develop cost-effective and optimal diabetes care in a country with limited resources, not only educational efforts based on individual beliefs are needed but also considering systemic and structural conditions in order to promote health and to prevent costly consequences of DM.

Highlights

Diabetes mellitus (DM) is increasing globally, with the greatest increase in Africa and Asia
Conclusions limited knowledge was demonstrated there were indications of a potential to develop an attitude for improving knowledge and self-care if this is supported by relevant information about DM and improved socioeconomic conditions, as many respondents emphasized a willingness to comply with advice received, knew that the disease is life-long and had adequate fears of developing complications related to DM
In a country and life situation with a highly strained economic situation, as for example in Zimbabwe today [20] and in many other developing countries, health care needs to switch from predominantly focusing on disease control and compliance with medication to a holistic attitude starting from an individual perspective and considering social determinants of health [26,30] to promote health and prevent DM and complications related to DM [26] in order to decrease the burden of the disease in light of the overarching pandemic of DM [2,8]

Summary

Introduction

Diabetes mellitus (DM) is increasing globally, with the greatest increase in Africa and Asia. The purpose of the study was to explore beliefs about health and illness that might affect self-care practice and health care seeking behaviour in persons diagnosed with DM, living in Zimbabwe. Diabetes mellitus (DM) affects millions of people worldwide and its related complications continue to be of great concern [1]. Of those diagnosed with DM, 90-95% have type 2 DM. The number of affected people is estimated to double by 2025, with the greatest increase occurring in developing countries [2]. The regions with the greatest potential increase of DM in the future are Africa and Asia, where diabetes is estimated to become two to three times more common than today [1]. The main consequences of DM are reduced life expectancy, increased mortality and morbidity associated with development of complications with enormous costs, and DM will constitute a heavy burden for individuals as well as society [7,8]

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