Non-compliance and diabetes self-care activities : a case study of Asian and Caucasians.
The global prediction of diabetes mellitus as forecasted by the World Health Organisation
(WHO) is sombre. Accordingly, by the year 2025 the number of adults likely to be affected
by diabetes has been predicted to rise to approximately 300 million. As a non-communicable
disease diabetes has a tendency to indiscriminately affect individuals of any
age (irrespective of gender) and culture. Diabetes Mellitus does not fully respond to
medical treatment, either in the form of subcutaneous insulin or oral anti-diabetic agents,
or even when a combination of both insulin and tablets are prescribed. Instead,
management needs to be further supplemented by diabetes self-care activities, a guise
currently presented as 'self-care' and 'empowerment', in an attempt to retard or prevent·
complications associated with diabetes.
This cross-cultural qualitative case study therefore sought to explore the notion of non-compliance,
which is a moral, analytical and prescriptive category often attached to the
career profile of diabetic patients. A multi-method approach to data collection was
adopted. This comprised of a semi-structured interview expounding on the multiplex
aspects of care needed to be considered during diabetes self-care activities, a 35-item
questionnaire which examined the diabetes self-care activities of participants over the
preceding seven days and a 7-day health diary exploring the trajectory of diabetes
management. A purposeful sample 25 Asians and 24 indigenous Caucasians agreed to
participate in this study. Most were recruited from the local diabetic clinic by the Diabetic
Specialist Nurse (DSN). A small percentage of the Asians became involved through a
snowball effect. Except for the five English speaking Asians, data from the remaining
twenty Asians were collected by three paid Asian interpreters. Their methodological
implications were noted.
The findings revealed that some variations in certain key aspects of diabetes self-care
activities were apparent in both groups. Often 'non-compliance' was based on rational
decisions made by the participants using practical everyday reasoning. 'Non-compliance'
further appeared to have been compounded by ineffective communication. The economic
status of many precluded them from purchasing blood glucose monitors while linguistic
shortcomings prevented others from reading diabetic related booklets and/or pamphlets.
Participants also tended to question the value of many of the self-care activities referred in
this study as 'magical rites'. Further there was a tendency to disclose the diagnosis of
diabetes to significant others.
Two theories are also offered as a way of understanding non-compliance during the
management of diabetes mellitus. The first relates to the use of magic as a closed system of
logic enabling diabetic individuals to handle uncertainty while the second refers to the
notion of stigma and tainted personality. Finally, this cross-cultural case study concludes
by offering a number of recommendations likely to improve diabetes self-care activities.