Constraints faced by urban poor in managing diabetes care: patients’ perspectives from South India

Figures & data

Table 1 Broad enquiry domains explored in the interviews

Onset and interpretation of illness

Experiences of seeking healthcare

Perceptions about risks, precautions, illness management, and complications

Suggestions for/expectations from healthcare services

Table 2 Profile of the respondents

Respondent number	Sex	Age (years)	Approximate duration (years) since diagnosis of type 2 diabetes	Comorbidity	Occupation
R1	Woman	21	2.5	–	Homemaker
R2	Woman	35	7	Hypertension	Homemaker
R3	Woman	45	3	Hypertension	Homemaker
R4	Woman	52	8–9 months	Hypertension	Homemaker
R5	Woman	60	9	Hypertension	Homemaker
R6	Woman	65+	3–4	Hypertension	Homemaker
R7	Woman	55	8	Hypertension	Homemaker
R8	Man	48	15	Heart problem	Self-employed (small business)
R9	Man	54	15	Heart problem	Not working
R10	Man	46	8	–	Semi-skilled labour (tile cleaning)
R11	Man	38	10	Kidney problem	Skilled labour (plumbing)
R12	Man	43	8	Hypertension	Skilled labour (tailoring)
R13	Man	55	11	–	Skilled labour (driver)
R14	Man	65	10	Hypertension	Not working
R15	Man	48	2	–	Not working
R16	Man	44	6	–	Skilled labour (driver)

Table 3 Dominant themes defining constraints to diabetes care

Struggling to make both ends meet

Diabetes taking a lesser priority

I think twice before buying tablets worth ten rupees [approximately 0.2 USD]. I can use those ten rupees to buy a coconut and prepare chutney [paste] and serve it with food to them [family members]. (R3, woman 45 years)

Compromised care

He [doctor] told me to take one tablet per day but it is costly and so I take half a tablet per day. (R4, woman 52 years)

Self-adjustments of medication

I take it [medication] only when I feel I have a problem [frequent urination]. (R13, man 55 years)

On being ‘woman’ and ‘elderly’

Gender-based family roles

They [staff at a government secondary hospital] asked me to get admitted. I told them that I have a very young child to take care of and came back home. … I could not go again. It will be a problem if I get admitted in the hospital, leaving the baby at home. (R1, woman 25 years)

Nuclear family structure

If someone takes [me to health facility], I go. I can't see properly so it is difficult to cross that road [to reach the government health centre]. Yesterday, I was out and not able to see anything and bumped into someone. (R6, woman 65+ years)

Inter-generational conflicts

My son is able to buy medicines for me, but he probably feels that it is a waste of money as I am old. (R14, man 65 years)

Providers’ attitudes and communication

Inadequate communication

He [doctor] does not explain anything. As soon as I go there, he will write a prescription, take his fees and send us away …. Only if he tells us not to eat this, or to eat only that, we will know about it. But if he himself doesn't tell us, what will we know? We are uneducated, so we will simply sit quietly. (R2, woman 35 years)

Negative attitudes

We would have left the children at home, and at the hospital we will keep thinking about home, family etc. that we would have left behind and come to the hospital …. When we go to the hospital in this state of mind, they should talk properly to us and tell us that this is the problem …. (R8, man 48 years)

About ‘good’ doctors

By the grace of Allah, after we started going to this doctor, the sugar level is under control and the doctor also explains everything properly. Even if we have to spend a little more money, it gives me peace of mind. (R5, woman 60 years)

Approaching the health system

Fragmented primary care

At XXX [a government centre], they say that I have to get [my] blood checked at some other place [private laboratory], and take the report to them to get the medication. I do not want it in that manner …. If you want to help poor people, all the facilities should be there at one place. (R7, woman 55 years)

‘Free’ health camps

One more thing is, to become popular, the politicians put up boards and organise camps for eye testing and diabetes, once in a year …. There, they [doctors] check, and tell us to come to their hospitals for medication …. If we go there [hospitals], they will charge a minimum of one thousand rupees [approximately 18.2 USD] for the treatment. (R3, woman 45 years)

Tertiary care

The treatment there [a tertiary government hospital] is free of cost, but we will be made to do a lot of running around. For this one problem [kidney problem], I was running around for eight days…. If you go to a doctor once, he will not be there when you go there for the second time. There will be some other doctor. This doctor will ask us to get some other test done. If each doctor says something different, what shall I do? (R9, man 54 years)