Preprint / Version 1

Normalizing Diabetes in Delhi: A Qualitative Study of Health and Health Care

Authors

  • Emily MPH Assistant Professor of Global Health, School of Foreign Service, Georgetown University, 37th & O Streets, NW, Washington, DC 20057, USA
  • H BSFS Research Fellow, School of Foreign Service, Georgetown University, 37th & O Streets, NW, Washington, DC 20057, USA
  • Roopa MD Senior Research Associate, COE-CARRS and Center for Control of Chronic Conditions, Public Health Foundation of India, Plot No 47, Sector 44, Institutional Area Gurgaon – 122002, India
  • KM PhD Professor, Emory Global Diabetes Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA
  • Nikhil PhD Professor, Department of Endocrinology and Metabolism, All Indian Institute of Medical Research (AIIMS), Ansari Nagar, New Delhi, India
  • Dorairaj DSc Director, Associate, COE-CARRS and Center for Control of Chronic Conditions, Public Health Foundation of India, Plot No 47, Sector 44, Institutional Area Gurgaon – 122002, India; Honorary Professor, London School of Hygiene and Tropical Medicine, London, UK

Keywords:

type 2 diabetes, India, self-care, morality, stigma, medical anthropology

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

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