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


METHODS
Exploratory 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.


RESULTS
Health 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.


CONCLUSIONS
Limited 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.
Hjelm
Katarina
K
School of Health and Caring Sciences, Linnaeus University, Växjö, S-351 95 Växjö, Sweden. katarina.hjelm@lnu.se.
Mufunda
Esther
E
Diabet Med. 1997 Sep;14(9):785-91
9300230
J Intern Med. 2000 Mar;247(3):301-10
10762445
Nature. 2001 Dec 13;414(6865):782-7
11742409
J Adv Nurs. 2005 Apr;50(1):47-59
15788065
S Afr Med J. 2005 Oct;95(10):798-802
16341336
Obesity (Silver Spring). 2006 Jan;14(1):1-3
16493116
Int Nurs Rev. 2008 Dec;55(4):434-41
19146555
Diabete Metab. 1990 May-Jun;16(3):207-12
2210015
Midwifery. 2008 Jun;24(2):168-82
17360084
J Adv Nurs. 2003 Mar;41(5):424-34
12603567
Holist Nurs Pract. 2005 Jan-Feb;19(1):10-6
15736725
J Health Psychol. 2003 Sep;8(5):557-72
19177717
Ethn Dis. 2006 Spring;16(2):503-9
17682255
J Adv Nurs. 1999 Nov;30(5):1147-59
10564414
Curationis. 2007 Jun;30(2):58-65
17703823
Afr J Med Med Sci. 1985 Sep-Dec;14(3-4):145-54
3004173
Cent Afr J Med. 1997 Aug;43(8):213-9
9431757
Ethn Dis. 2006 Summer;16(3):718-22
16937610
Int J Nurs Stud. 2003 Aug;40(6):627-43
12834928
Patient Educ Couns. 1996 Oct;29(1):87-97
9006225