Immigrant Patients with Diabetes: How They Understand, Learn to Manage and Live with Their Diabetes

Sammanfattning: This study was initially based on the assumption that difficulties that arise between the Swedish health-care providers and immigrant diabetes patients are due to linguistic and cultural barriers. This assumption weakened as the study developed and began to point to the fact that the patient’s own understanding of his experience of living with and managing his diabetes has a more far-reaching effect than that of the cultural and linguistic differences.The study developed through three sub-studies. During sub-study A I described problems as perceived by immigrant patients and their health-care providers. This was carried out in two phases: first phase by interviewing both patients and health-care providers. In phase two, I arranged a workshop to which patients, interpreters and health-care providers were invited to discuss these problems. The results indicated that even though culture constitutes one problem, it is just one aspect among others to be considered.In sub-study B, the objective was to try to elicit the patients’ own experiences and understanding of their illness. Through semi-structured in-depth interviews, ten patients were interviewed. A model was developed describing patients’ understanding of diabetes.Sub-study C consisted of a follow-up of the learning process where two kinds of interventions were observed. The first was teacher-centred, where the patient was passive. The second was patient-centred where the patient was active, reflective and experimented. During this kind of intervention the role of the health provider entailed supporting and helping the patient. It was after such interventions that behavioural changes occurred and learning took place.Culture and ethnic background is only a part of the patient’s understanding of diabetes. In order for health providers to plan effective interventions leading to changes in patient’s behaviour, they need to understand how patients understand their diabetes and help them in the learning process towards accomplishing the task of managing their diabetes. The model developed could be used as a helpful tool for accessing the patient’s understanding of his experience of his illness and planning more effective interventions.