Normalizing diabetes in Delhi: a qualitative study of health and health care

ABSTRACT

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.

KEYWORDS:

• Type 2 diabetes
• India
• self-care
• morality
• stigma
• medical anthropology

Ethical approval

Emory University (USA) and Public Health Foundation of India (India) Institutional Review Boards provided ethical approval for the study.

Acknowledgements

We are grateful to the study participants who shared their time and personal experiences with us and well as our dedicated research assistants, Sneha Sharma and Allam Ashraf.

The research was conducted in Delhi with the support of Public Health Foundation of India.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. We published a more extensive discussion of the intersection of stress, mental health, and diabetes in Social Science, and Medicine in 2012.

Additional information

Funding

The first author (EM) was supported by the Fogarty International Center of the National Institutes of Health through the International Clinical Research Fellows Program at Vanderbilt University [grant number R24 TW007988] and the American Relief and Recovery Act. The third author (RS) was supported by a National Institutes of Health D43 Fellowship [grant number D43 HD065249] from the Fogarty International Center and the Eunice Kennedy Shriver National Institute of Child Health & Human Development. This project also was funded in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health (Contract No. HHSN2682009900026C).