title: "In a situation of rescuing life": meanings given to diabetes symptoms and care-seeking practices among adults in Southeastern Tanzania: a qualitative inquiry.
abstract: BACKGROUND
  Diabetes mellitus is an emerging public health problem in Tanzania. For the community and the health system to respond adequately to this problem, it is important that we understand the meanings given to its symptoms, and the care-seeking practices of individuals.
  
  
  METHODS
  To explore collective views on the meanings given to diabetes symptoms, we conducted nine focus group discussions with adult diabetes patients and members of the general community. To gain a better understanding of how the meanings in the community inform the care-seeking practices of individuals, 19 in-depth interviews were conducted with diabetes patients. The data were analyzed using principles of grounded theory and applying cultural schema theory as a deductive framework.
  
  
  RESULTS
  In the communities and among the patients, knowledge and awareness of diabetes are limited. Both people with diabetes and community members referred to their prevailing cultural meaning systems and schemas for infectious diseases to interpret and assign meaning to the emerging symptoms. Diabetes patients reported that they had initially used anti-malarial medicines because they believed their symptoms-like headache, fever, and tiredness-were suggestive of malaria. Schemas for body image informed the meaning given to diabetes symptoms similar to those of HIV, like severe weight loss. Confusion among members of the community about the diabetes symptoms instigated tension, causing patients to be mistrusted and stigmatized. The process of meaning-giving and the diagnosis of the diabetes symptoms was challenging for both patients and health care professionals. Diabetes patients reported being initially misdiagnosed and treated for other conditions by medical professionals. The inability to assign meaning to the symptoms and determine their etiologies informed the decision made by some patients to consult traditional healers, and to associate their symptoms with witchcraft causes.
  
  
  CONCLUSIONS
  The meanings given to diabetes symptoms and the care-seeking practices described in the study are shaped by the prevailing cultural schemas for infectious diseases and their treatments. Efforts to educate people about the symptoms of diabetes and to encourage them to seek out appropriate care should build on the prevailing cultural meaning system and schemas for diseases, health and illness.
authors.affiliation: Ifakara Health Institute, Box 78373, Dar es Salaam, Tanzania. emetta@ihi.or.tz.|Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands. emetta@ihi.or.tz.
authors.forename: Emmy
authors.initials: E
authors.lastname: Metta
authors.affiliation: Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands. a.bailey@rug.nl.
authors.forename: Ajay
authors.initials: A
authors.lastname: Bailey
authors.affiliation: Mzumbe University, Box 20226, Dar es Salaam, Tanzania. fkessy@mzumbe.ac.tz.
authors.forename: Flora
authors.initials: F
authors.lastname: Kessy
authors.affiliation: Ifakara Health Institute, Box 78373, Dar es Salaam, Tanzania. egeubbels@ihi.or.tz.
authors.forename: Eveline
authors.initials: E
authors.lastname: Geubbels
authors.affiliation: Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands. i.hutter@rug.nl.
authors.forename: Inge
authors.initials: I
authors.lastname: Hutter
authors.affiliation: Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands. h.h.haisma@rug.nl.
authors.forename: Hinke
authors.initials: H
authors.lastname: Haisma
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D003469:Culture; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000523:psychology*; D003937:Diagnosis, Differential; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000175:diagnosis; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012017:Referral and Consultation; D012424:Rural Population / Q000706:statistics & numerical data; D013636:Tanzania
chemical_list: D000962:Antimalarials