RESUMO
BACKGROUND: Given that the diabetes burden is rising rapidly in low- and middle-income countries, it is critical to understand perspectives of people living with diabetes in these settings. This qualitative study examines perceptions of causality and treatment among adults with type 2 diabetes in rural Indigenous communities of Guatemala. METHODS: We conducted semi-structured interviews with 29 people living with type 2 diabetes from a population survey in two majority Indigenous Guatemalan towns. Data were coded inductively and themes were elucidated by consensus. RESULTS: Participants emphasized strong emotional experiences and stress as perceived causes of diabetes, as well as diet and heritability. All participants took biopharmaceutical treatments, but many also endorsed diet, exercise, herbal remedies, and naturopathic products as important remedies. CONCLUSION: Perspectives from people living with diabetes in two rural Indigenous towns in Guatemala differ from the biomedical model of disease and have implications for clinical practice and program development.
Assuntos
Diabetes Mellitus Tipo 2 , Adulto , Humanos , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Guatemala/epidemiologia , Pesquisa Qualitativa , Dieta , Exercício Físico , População RuralRESUMO
OBJECTIVE: The burden of diabetes mellitus is increasing in low-income and middle-income countries (LMICs). Few studies have explored pathways to care among individuals with diabetes in LMICs. This study evaluates care trajectories among adults with diabetes in rural Guatemala. DESIGN: A qualitative investigation was conducted as part of a population-based study assessing incidence and risk factors for chronic kidney disease in two rural sites in Guatemala. A random sample of 807 individuals had haemoglobin A1c (HbA1c) screening for diabetes in both sites. Based on results from the first 6 months of the population study, semistructured interviews were performed with 29 adults found to have an HbA1c≥6.5% and who reported a previous diagnosis of diabetes. Interviews explored pathways to and experiences of diabetes care. Detailed interview notes were coded using NVivo and used to construct diagrams depicting each participant's pathway to care and use of distinct healthcare sectors. RESULTS: Participants experienced fragmented care across multiple health sectors (97%), including government, private and non-governmental sectors. The majority of participants sought care with multiple providers for diabetes (90%), at times simultaneously and at times sequentially, and did not have longitudinal continuity of care with a single provider. Many participants experienced financial burden from out-of-pocket costs associated with diabetes care (66%) despite availability of free government sector care. Participants perceived government diabetes care as low-quality due to resource limitations and poor communication with providers, leading some to seek care in other health sectors. CONCLUSIONS: This study highlights the fragmented, discontinuous nature of diabetes care in Guatemala across public, private and non-governmental health sectors. Strategies to improve diabetes care access in Guatemala and other LMICs should be multisectorial and occur through strengthened government primary care and innovative private and non-governmental organisation care models.
Assuntos
Diabetes Mellitus , Humanos , Adulto , Guatemala/epidemiologia , Hemoglobinas Glicadas , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Fatores de Risco , Pesquisa QualitativaRESUMO
This qualitative study explores perceptions of chronic kidney disease (CKD) among adults with abnormal estimated glomerular filtration rate (eGFR) in Guatemala, where the burden of CKD is rising. Qualitative semi-structured interviews were conducted with 39 individuals screened for CKD and found to have abnormal eGFR (defined as <90â mL/min/1.73â m2, per Kidney Disease Improving Global Outcomes [KDIGO] guidelines). Interviews occurred in participants' homes in Spanish or Kaqchikel Mayan. Interview notes were coded for dominant themes through an inductive approach. Interviewees had limited awareness of diabetes and hypertension as CKD risk factors, but appreciated the progressive nature of the disease. While most reported willingness to pursue renal replacement therapies, if necessary, they anticipated economic and geographic barriers. Public health interventions should focus on the association between diabetes, hypertension, and CKD. Improvement of primary care and screening infrastructure is imperative in CKD prevention in low- and middle-income countries (LMICs).
Assuntos
Diabetes Mellitus , Insuficiência Renal Crônica , Adulto , Taxa de Filtração Glomerular , Guatemala/epidemiologia , Humanos , Percepção , Insuficiência Renal Crônica/epidemiologiaRESUMO
In low- and middle-income countries, gender norms and access to energy-dense, nutrient-poor foods are well-studied determinants of food and physical activity choices for adolescent girls. However, most work has been done in urban and school settings. In many settings, a large proportion of the adolescent population is rural or not enrolled in school. We conducted in-depth interviews with 20 adolescent girls (ages 15-19) in Tecpán, Guatemala, a rural, largely indigenous Maya community. Interviews were coded and themes analyzed for insights into eating habits, food choices, and physical activity. Twelve participants were enrolled in school and eight were employed and not in school. Girls enrolled in school had more disrupted eating schedules and consumed more energy-dense, nutrient-poor foods. Girls not enrolled in school had fewer opportunities for physical activity and were more sedentary. To our knowledge, this study is the first in a low- and middle-income country to consider diet and physical activity of adolescent girls enrolled and not enrolled in school. Key implications include (1) the need to reduce exposure to nutrient-poor foods and promote healthy eating schedules in schools, and (2) the need to create community-based opportunities for the activity for girls no longer enrolled in school.