Perceptions and management practices followed by type II Diabetes Mellitus patients attending Kenyatta National Hospital in Nairobi, Kenya

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Type 2 diabetes mellitus (T2DM) is increasingly an important public health problem the world over. The prevalence rate in Kenya is approximately 10%, with the most at risk group of people between 35 -64 years. Given its chronic nature, management of the illness by the patient remains central to control of its effects. This study was designed to explore the perceptions and management practices followed by T2DM patients attending Kenyatta National Hospital (KNH) in Nairobi, Kenya. The study design was cross-sectional and adopted qualitative methods of data collection. Specifically, in-depth interviews, key informant interviews and unstructured observations were used to collect data. In-depth interviews were conducted among thirty two (32) T2DM patients (16 male and 16 female) aged between 35 - 64 years, who were attending the OPDC at KNH and who had been clinically diagnosed with the disease for a period of not less than two years. The patients were recruited at KNH as they attended the OPDC. Consent to participate in the study was sought and they gave their contact information which made it possible to later on be followed to their homes for interviews. Questions about their lived experiences with T2DM in terms of their perceptions of the illness, how they manage it, the role of home caregivers/relatives in diabetes management, and the problems experienced in daily management of their illness were posed. In addition, Key informant interviews. with twenty (20) home caregivers/relatives and five (5) health care providers were also conducted. They provided additional information on how the T2DM patients manage their illness at home, the role played by their caregivers and the problems experienced in daily management of their condition. All interviews were audio-taped and the transcripts were analyzed based on emerging themes using a grounded theory approach. The main findings of this study indicate that T2DM patients had varied perceptions about the etiology, risk factors, symptoms and complications of the disease. The descriptions they gave about the disease contained elements of both the biomedical and folk knowledge system. They utilized both biomedical and non-biomedical management options in their daily living with their diabetic condition. The shift from using one management regimen to another was based on the effectiveness, affordability and the EMs they held about their illness. The fmdings also reveal that patients' caregivers, mainly the family members, play significant roles in management of diabetes by providing both tangible and socio- emotional support. In the course of daily management of diabetes, patients do experience numerous problems with financial incapability emerging as the chief of all. This study contributes to literature on the body of work on T2DM in Kenya. It also has implications for care of patients with T2DM. The study therefore recommends the need for health care providers to improve on patients' perception of the illness and management practices. This can be done through carrying out diabetes health education programs in a sensitive and culturally competent way. Kleinman's EMs remains the best avenue in guiding such programs. Similarly, this study contributes rich information on the management of T2DM that can be used by policy makers and programme implementers to make informed decisions that will help abate the mortality and morbidity by giving attention to patients' perceptions and management practices, considering that diabetes is a chronic illness.

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