title: Diabetes Treatment as "Homework": Consequences for Household Knowledge and Health Practices in Rural Uganda.
abstract: BACKGROUND
  Health professionals assign diabetes patients "homework" in that they give them instructions on how to manage diabetes, recognizing that most diabetes care takes place in the home setting. We studied how homework is practiced and whether knowledge and behavioral practices related to diabetes self-management diffuse from patients to their housemates.
  
  
  METHODS
  This mixed-methods study combined quantitative data from a household survey including 90 rural Ugandan households (50% had a member with type 2 diabetes [T2D]) with qualitative data from health facilities and interviews with 10 patients with T2D. Focus for data collection was knowledge and practices related to diabetes homework. A generalized mixed model was used to analyze quantitative data, while content analysis was used for qualitative data analysis.
  
  
  RESULTS
  Patients with T2D generally understood the diabetes homework assignments given by health professionals and carried out their homework with support from housemates. Although adherence to recommended diet was variable, housemates were likely to eat a healthier diet than if no patient with T2D lived in the household. Knowledge related to diabetes homework diffused from the patients to housemates and beyond to neighbors and family living elsewhere. Knowledge about primary prevention of T2D was almost absent among health staff, patients, and relatives.
  
  
  CONCLUSIONS
  Homework practices related to T2D improve diabetes-related knowledge and may facilitate healthy eating in nondiabetic housemates. These findings suggest that having a chronic disease in the household provides an opportunity to improve health in the entire household and address the lack of knowledge about prevention of T2D.
authors.affiliation: Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark jannien@sunfu.dk.
authors.forename: Jannie
authors.initials: J
authors.lastname: Nielsen
authors.affiliation: St. Francis Hospital Nsambya, Kampala, Uganda.
authors.forename: Silver K
authors.initials: SK
authors.lastname: Bahendeka
authors.affiliation: Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Ib C
authors.initials: IC
authors.lastname: Bygbjerg
authors.affiliation: Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Dan W
authors.initials: DW
authors.lastname: Meyrowitsch
authors.affiliation: Department of Anthropology, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Whyte
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D000072001:Diet, Healthy; D019468:Disease Management; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods; D012307:Risk Factors; D012424:Rural Population; D012648:Self Care; D011795:Surveys and Questionnaires; D014454:Uganda
keywords: chronic disease management; diabetes; international health; patient education; qualitative methods; quantitative methods