Lay understandings of type 2 diabetes: Thai adolescents and their caregivers

1. Lay understandings of type 2 diabetes: Thai adolescents and their caregivers Sappaporn Wirattanapokin(sappaporn.wirattanapokin@med.monash.edu.au) Social Sciences & Health Research Unit Findings Introduction Conclusion Table 1: Lay perceptions of diabetes • Although lay explanations of diabetes in this study are concordant with the biomedical model, they are partly correct (Table 1). • According to medical evidence, obesity and darker skin at the neck, which are a sign of insulin resistance, are less known as a pathological sign and symptom of developing type 2 diabetes by adolescents and caregivers in this study (Table 1). • Adolescents who perceived diabetes as non-severe were less likely to adapt their lifestyle, while the minority of those who perceived diabetes as severe were likely to change their lifestyle to be healthier (Fig 1). • Although there is no difference in the number of young respondents who perceived diabetes to be incurable or curable, those the latter were more likely to change their unhealthy lifestyle (Fig 2). In urban Thailand, there has been a dramatic increase in prevalence of obesity in parallel with the increasing prevalence of type 2 diabetes among young people (Likitmaskul et al., 2003). Lay constructions are not static, but they change across time due to personal experiences and new information. Hence, lay people may simultaneously hold contradictory explanations in relation to one or more of the five issues described in the Kleinman’s explanatory model – aetiology, symptoms, pathophysiology, course of illness and treatment (Kleinman et al., 1978). Despite the care of healthcare providers, ill adolescents and their caregivers hold the most responsibility for self-management of diabetes. The achievement of diabetes management and lifestyle modification is influenced by lay understandings of the illness. Methodology Implications • Aims • This poster presents adolescents’ and main caregivers’ perspectives of type2 diabetes and people with this disease in relation to a medical model. The influence of adolescents’ perceptions of (non) severity and of (in) curability of diabetes on lifestyle change is also illustrated. • Participants • 16 Thai adolescents, aged 12-19 years, diagnosed with pre-diabetes/type 2 diabetes for at least 6 months • 25 primary caregivers (mainly mothers) Study site • Methods • In-depth interviews • Participant observation • Document review (hospital brochures, newspapers) Analysis • ☻Grounded theory • ☻Comparative analysis • Ethical approvals • Monash Research Ethics Committee • Chulalongkorn Hospital Ethics Committee • Rajavithi Hospital Ethics Committee The study findings lead to an understanding of how young people with pre-diabetes and diabetes in urban Thailand manage their illness. Their behavior is determined by insights about and interpretations of their illness, shaped by their family, society and culture. The data may assist physicians to review which information needs to be clarified to patients and their caregivers as well as the knowledge and support to be provided to them. References Eisenberg, L. (1977). Disease and illness Distinctions between professional and popular ideas of sickness. Culture, Medicine and Psychiatry, 1, 9 - 23. Hunt, L., & Arar, H. (2001). An Analytical Framework for contrasting Patient and Provider Views of the Process of Chronic Disease Management. Medical Anthropology Quarterly, 15 (3), 347-367. Kleinman, A. (1986). Concepts and a model for the comparison of medical systems as cultural systems. In C. Currer & M. Stacey (Eds.), Concepts of health, illness and disease: a comparative perspective (pp. 29 - 47). New York: Berg Publishers Ltd. Kleinman, A., Eisenberg, L., and Good, B. (1978). Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. The Annals of Internal Medicine, 88, 251 - 258. Likitmaskul, S., Kiattisathavee, P., Chaichanwatanakul, K., Punnakanta, L., Angsusingha, K., and Tuchinda, C. (2003). Increasing prevalence of type 2 diabetes mellitus in Thai children and adolescents associated with increasing prevalence of obesity. Journal of Pediatric Endocrinology & Metabolism, 16 (1), 71-77. Fig 1: Adolescent participants’ perceived severity of diabetes vs. observed lifestyle change Acknowledgements • My profound appreciation to • My supervisors: - Dr Milica Markovic, Professor Lenore Manderson and Dr Andrea Whittaker • My field advisor - Professor Suttipong Wacharasindhu • All participants and their families • The School of Psychology, Psychiatry & Psychological • Medicine for providing a School Graduate Student Conference • Attendance Grant for my attendance. Fig 2: Adolescent participants’ perceived curability/ incurability of diabetes vs. observed lifestyle change