Living with type 2 diabetes in a Thai population : excperiences and socioeconomic characteristics

Sammanfattning: Type 2 diabetes is a matter of global concern, and has been shown to have an impact on an individual’s way of living, family, and social life. In addition, there is limited knowledge concerning the life experiences of Thai people with diabetes. The aim of this thesis was to explore the experiences of people with type 2 diabetes who live in partly low socioeconomic suburban areas of Thailand. Both qualitative analyses with 19 women of low socioeconomic status with diabetes and quantitative analyses, including 220 people with diabetes, were conducted in the suburban communities near Bangkok between 2012 and 2015. The thesis consists of the results of four studies described in four papers. In paper I the aim was to explore how Thai women of low socioeconomic status handled their lives with diabetes. The findings showed that the women went through many stages of changes in the process of adaptation in handling their vulnerable situation influenced by diabetes and socioeconomic status. A threatened loss of status was sometimes seen as a barrier to handling their disease, whereas empowerment by one’s family helped them to feel powerful and gave them a sense of hope in living with this disease. Paper II illuminated the life experience of Thai women of low socioeconomic status living with diabetes. The findings revealed that women confronted susceptible feelings such as worrying about an unpredictable future and fears of being a burden to their family. However, they were able to maintain a balance through empowerment via the inner and outer sources of their beliefs. In paper III the aims were to investigate and compare the illness perception and self-management among women and men with diabetes, examine the association between illness perception and self-management, and to investigate the psychometric properties of the translated instruments. Both Thai versions of the measurement tools (the revised illness perception, diabetic version questionnaire and the new revision of the diabetes self-management questionnaire) demonstrated acceptable content validity and reliability, includinginternal consistency, inter-rater, and test-retest reliability. The findings showedthat the illness perception and self-management strategies among the womenand men had similar patterns, except for three aspects of illness perception.Whereas the women more often perceived the consequences of diabetes andfluctuating symptoms, the men felt more confident about efficiency of thetreatment prescribed by the healthcare professionals. Furthermore, the illnessperception, especially the confidence in controlling diabetes by themselves andthe confidence about treatment effectiveness, in both women and men showeda weak possitive association with many aspects of self-management strategies.Paper IV examined the illness perception and self-management of Thai peoplewith diabetes according to their socioeconomic status, as defined by income andeducational level. The participants of the low-income and low-education groupsperceived more negative consequences of diabetes, and the participants in the highincomeand high-education group felt more confident in controlling the diabetesby themselves and were more confident about the treatment effectiveness. Theparticipants in the low-education group perceived more fluctuating symptomsof the disease, and the high-education group showed greater understanding oftheir disease conditions. Furthermore, the participants in the low-education group demonstrated less effective self-care in terms of overall self-management strategiesand physical activity.The Thai people with type 2 diabetes demonstrated an ability to be able toadjust to their life situation and to keep a balance in their minds to continuetheir usual life with the disease. Their experiences of living with diabetes werepartially affected by sex differences and socioeconomic characteristics. It may behelpful to take educational level into consideration when designing specific andproper interventions for people with diabetes in low socioeconomic areas. TheThai sociocultural context, especially in terms of family closeness and Buddhistbeliefs, might also have an effect on the life of people with diabetes.