Normalizing diabetes in Delhi: a qualitative study of health and health care.
The Type 2 diabetes epidemic in India poses challenges to the health system. Yet little is known about how urban Indians view treatment and self-care. Such views are important within the pluralistic healthcare landscape of India, bringing together allopathic and non-allopathic (or traditional) paradigms and practices. We used in-depth qualitative interviews to examine how people living with diabetes in India selectively engage with allopathic and non-allopathic Indian care paradigms. We propose a 'discourse marketplace' model that demonstrates competing ways in which people frame diabetes care-seeking in India's medical pluralism, which includes allopathic and traditional systems of care. Four major domains emerged from grounded theory analysis: (1) normalization of diabetes in social interactions; (2) stigma; (3) stress; and (4) decision-making with regard to diabetes treatment. We found that participants selectively engaged with aspects of allopathic and non-allopathic Indian illness paradigms to build personalized illness meanings and care plans that served psychological, physical, and social needs. Participants constructed illness narratives that emphasized the social-communal experience of diabetes and, as a result, reported less stigma and stress due to diabetes. These data suggest that the pro-social construction of diabetes in India is both helpful and harmful for patients - it provides psychological comfort, but also lessens the impetus for prevention and self-care. Clarifying the social constructions of diabetes and chronic disease in India and other medically pluralistic contexts is a crucial first step to designing locally situated treatment schemes.
a School of Foreign Service , Georgetown University , 37th & O Streets, NW, Washington , DC , 20057 , USA.
Emily
E
Mendenhall
a School of Foreign Service , Georgetown University , 37th & O Streets, NW, Washington , DC , 20057 , USA.
H Stowe
HS
McMurry
b COE-CARRS and Center for Control of Chronic Conditions , Public Health Foundation of India , Plot No 47, Sector 44, Institutional Area Gurgaon - 122002 , India.
Roopa
R
Shivashankar
c Emory Global Diabetes Research Center, Rollins School of Public Health , Emory University , 1518 Clifton Road, NE, Atlanta , GA , 30322 , USA.
K M Venkat
KM
Narayan
d Department of Endocrinology and Metabolism , All Indian Institute of Medical Research (AIIMS) , Ansari Nagar, New Delhi , India.
Nikhil
N
Tandon
b COE-CARRS and Center for Control of Chronic Conditions , Public Health Foundation of India , Plot No 47, Sector 44, Institutional Area Gurgaon - 122002 , India.
Dorairaj
D
Prabhakaran
D060432:Anthropology, Medical; D002908:Chronic Disease; D003469:Culture; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control / Q000523:psychology* / Q000628:therapy*; D004192:Discrimination, Psychological; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D007194:India; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009014:Morals; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000523:psychology*; D010465:Perception; D036301:Qualitative Research; D012648:Self Care / Q000523:psychology; D057545:Social Stigma; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000209:etiology
India; Type 2 diabetes; medical anthropology; morality; self-care; stigma