Ethnicity and Type 2 Diabetes
2. Materials and Methods
2.1. Participant Selection
2.2. Interview Procedure
- The experiences of managing T2DM in the UK.
- The influence of living in WA in the management of T2DM in the UK.
- The impact of environmental influence in the management of T2DM in the UK.
2.3. Data Analysis
- How do West Africans come to experience living with Type 2 diabetes mellitus in the UK?
- What do they make of their experiences?
- What are the important factors that influence the process of managing Type 2 diabetes mellitus in the UK?
3.1. Challenges in Managing Type 2 Diabetes Mellitus in the UK
3.1.1. Changing Dietary Habits
“I was advised to stop eating so many of the foodstuffs that I was used to eat, as we were told they had too much starch”.(Ken 48 years, male)
3.1.2. Understanding Unhealthy Diets
“Obviously refined sugars are not good but sugars that are absorbed very slowly into the body like starches, starch based foods are to be preferred to sugar while foods that yield sugar content readily like grapes should be avoided”.(Konge 45 years, male)
“I didn’t have a sweet tooth as such like cakes and chocolates and all that even before the diagnosis of diabetes”.(Bobaro 57 years, male)
“There were specific aspects of shopping that I found interesting, it meant changes to approaches to grocery shopping. Yes so I would pay a lot of attention to packages and nutritional information and it was quite an eye opener finding out how much sugar is in stuffs, that was a valuable experience I had”.(Bolula 48 years, female)
“Yes, just a simple illustration coming from Nigeria, West African we have sugar only in teas and coffees but not in anything else, so I arrive in the UK and there is sugar in everything else expect in teas”.(Nimbabo 49 years, male)
3.1.3. Having Large Dietary Portions
“You know how we like our food, I have large food portion unlike this small things that they eat here, it just cannot be enough for me that is really frustrating”.(Mange 57 years, male)
“I used to try my best but when I have to eat all the vegetables to get full because they digest quickly as far as I am concerned, what more can i do? These does not fill me up like my eba and fufu7 does” (Kinjile 72 years, male) (eba and fufu are popular West African diets derived from cassava tuber. Cassava is a root tuber plant that is rich in important nutrients and starch and so may have health benefits when consumed in moderation).
“I eat when am hungry for food, the issue is that I have big appetite and so their small food sizes cannot be enough for an African man like me. I have to focus on me when am hungry is the thing”.(Mange 57 years, male)
3.1.4. Paying for Healthy Diets
“Yes it is because when I switched to the healthy food, anytime I go for shopping, I spend a lot of money and am thinking is it because it is not Nigerian food. At times that I used to buy a lot of Nigerian food and like that but when it comes to all this healthy food, even small portion is a lot of money”.(Gamboe 42 years, male)
3.1.5. Getting Dietary Support
“And my wife who is not also very well herself, so many years after she still makes special effort to make sure that I have my meals even at time when have other constraints I will struggle to do it myself and she has tried to make extra effort to make sure that I eat and so that have been good. She has been monitoring and just keeping an eye on what I eat”.(Zurisa 69 years, male)
“I have got someone to help me but she kind of like English food, she is a Nigerian friend of mine but she doesn’t even know anything about Nigeria. She hasn’t been there but she helps me a lot in healthy eating before I even detect that I have got type 2 diabetes. So am good in eating healthy food, so when I got to know that I have to be checking out what am taking and all that, she helps me a little bit more”.(Dee 33 years, male)
“I have always gone for yearly medical check-up, I just feel it is good as the hospital is there anyway”.(Yaranto 67 years, female)
“Although I will rather talk to doctors that can fully understand my concerns. I would say it is better to know that I will be treated with the best available facilities here which are not available in Africa”.(Bolu 44 years, female)
3.2. Meeting Physical Activity Needs
“The kind of life we live here is just difficult to meet those exercise that my doctors ask me to always get, you know? I mean I go to work which helps a bit but this place just seem to have made everything within my reach o, i hardly need to walk or do any major work is the issue here”.(Josera 42 years, male)
3.2.1. Comorbidity Impact on Meeting Physical Activity Needs
“Well sadly I cannot afford gym but there was a time when just getting by a day was a problem but I a lot of time I just resting lying down but after sometimes I started walking short distances by increasing you know that walk until you know I could go round the block…you know sometimes it will take me 15 to 20 mins when I started initially when I started to rest as I walked long because my heart which is the effect of my illness and my heart.”.(Bobaro 57 years, male)
“Well, I can’t even walk as I have arthritis, I have knee replacement surgeries so mobility is one of my biggest problems. I would love to walk but I struggle to walk but from time to time when I can… once a week or two or if I can at all… I go to the gym to use the treadmill, because at least I can hold on to something because I have mobility issue as well as diabetes. You know my bad arthritis, so that is all I do. I don’t do anything much”.(Mam 64 years, female)
3.2.2. Environmental Influence on Physical Activity
“Physical activity? This is not really something I get involved in now, it has been all too difficult to get enough exercise since I came here even before I got my diabetes. I think it has to do with the values attached to going to the gym among us as Africans. I cannot just be going to gym or running as exercise, it is not part of me”.(Wemi 56 years, female)
3.2.3. Finding Alternative Treatment
“I had a stroke once as a result of complications from my diabetes, I was told there is no help that they give you in hospital. Curing the stroke was entirely up to my own efforts. I was fortunate to be in Africa then, you know we have herbs. I was given herbs which I will rub on my right side and sneeze like snuff and sneeze my head off which they say activate my blood circulation”.(Egbede 64 years, male)
“I was in a desperate state at this point and was willing to do anything to cure my diabetes. I drank my own urine, drank ewuro (ewuro (Vernonia amygdalina) is also known as bitter leaf), ate onions and garlic but no cure”.(Yeriyaya 77 years, male)
“In Africa, we were told to eat bitter food as they help cure or at least reduce the blood sugar, so I used to eat aloe vera, ewuro and green igba” Green Igba is Unripe garden egg (Solanum aethiopicum).(Bolula 48 years, female)
3.3. Striving to Adapt
“The stress is not easy o, crazy something is that the changes that I have to deal with are not the same”.(Bobaro 57 years, male)
“We know things will not be the same as we used to have, the issue is how to adapt to these changes. As you know, some of the things are easier while others are difficult for us”.(Orisa 52 years, male)
4.1. Cultural Influence on Type 2 Diabetes Mellitus Management
4.2. Limitations and Strengths
Conflicts of Interest
- Moody, A.; Cowley, G.; Ng Fat, L.; Mindell, J.S. Social inequalities in prevalence of diagnosed and undiagnosed diabetes and impaired glucose regulation in participants in the Health Surveys for England series. BMJ Open 2016, 6, e010155. [Google Scholar] [CrossRef] [PubMed]
- Chow, E.A.; Foster, H.; Gonzalez, V.; McIver, L. The Disparate Impact of Diabetes on Racial/Ethnic Minority Populations. Clin. Diabetes 2012, 30, 130–133. [Google Scholar] [CrossRef]
- Montesi, L.; Caletti, M.T.; Marchesini, G. Diabetes in migrants and ethnic minorities in a changing World. World J. Diabetes 2016, 7, 34–44. [Google Scholar] [CrossRef] [PubMed]
- King, P.; Peacock, I.; Donnelly, R. The UK Prospective Diabetes Study (UKPDS): Clinical and therapeutic implications for type 2 diabetes. Br. J. Clin. Pharmacol. 1999, 48, 643–648. [Google Scholar] [CrossRef] [PubMed]
- Public Health England. Diabetes. Available online: https://fingertips.phe.org.uk/profile-group/cardiovascular-disease-diabetes-kidney-disease/profile/diabetes-ft/data#page/13/gid/1938133138/pat/46/par/E39000018/ati/153/are/E38000004 (accessed on 27 March 2019).
- Roglic, G.; Unwin, N.; Bennett, H.P.; Mathers, C.; Tuomilehto, J.; Nag, S.; Connolly, V.; King, H. The Burden of Mortality Attributable to Diabetes: Realistic estimates for the year 2000. Diabetes Care 2005, 28, 6. [Google Scholar] [CrossRef] [PubMed]
- Diabetes UK. Diabetes in the UK 2010: Key Statistics on Diabetes. Available online: https://www.diabetes.org.uk/resources-s3/2017-11/diabetes_in_the_uk_2010.pdf (accessed on 8 March 2019).
- Hex, N.; Bartlett, C.; Wright, D.; Taylor, M.; Varley, D. Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabet. Med. 2012, 29, 855–862. [Google Scholar] [CrossRef] [PubMed]
- Meetoo, D. Diabetes: Complications and the economic burden. Br. J. Healthc. Manag. 2014, 20, 60. [Google Scholar] [CrossRef]
- National Diabetes Audit. Claims of 24,000 “excess” Deaths from Diabetes. Available online: https://www.nhs.uk/news/diabetes/claims-of-24000-excess-deaths-from-diabetes/ (accessed on 8 March 2019).
- Clark, N.G.; Fox, K.M.; Grandy, S. Symptoms of Diabetes and Their Association With the Risk and Presence of Diabetes. Diabetes Care 2007, 30, 2868–2873. [Google Scholar] [CrossRef] [PubMed]
- Yusuf, S.; Reddy, S.; Ounpuu, S.; Anans, S. Global Burden of Cardiovascular Diseases Part I: General Considerations, the Epidemiologic Transition, Risk Factors, and Impact of Urbanization. Circulation 2001, 104, 9. [Google Scholar] [CrossRef]
- Osei, K.; Schuster, D.P. Metabolic characteristics of African descendants: A comparative study of African-Americans and Ghanaian immigrants using minimal model analysis. Diabetologia 1995, 38, 1103–1109. [Google Scholar] [CrossRef]
- Office of National Statistics. 2011 Census Analysis: Ethnicity and Religion of the Non-UK Born Population in England and Wales: 2011. Available online: https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/ethnicity/articles/2011censusanalysisethnicityandreligionofthenonukbornpopulationinenglandandwales/2015-06-18 (accessed on 5 April 2019).
- Diabetes UK. Facts and Statistics. Available online: https://www.diabetes.org.uk/Documents/Position%20statements/DiabetesUK_Facts_Stats_Oct16.pd (accessed on 5 April 2019).
- Reuven, Y.; Dreiher, J.; Shvartzman, P. The prevalence of diabetes, hypertension and obesity among immigrants from East Africa and the former Soviet Union: A retrospective comparative 30-year cohort study. Cardiovasc. Diabetol. 2016, 15, 74. [Google Scholar] [CrossRef] [PubMed]
- Diabetes UK. State of the Nation 2016: Time to Take Control of Diabetes. Available online: https://www.diabetes.org.uk/Documents/Position%20statements/Diabetes%20UK%20State%20of%20the%20Nation%202016.pdf (accessed on 5 April 2019).
- Meeks, K.A.C.; Stronks, K.; Beune, E.J.A.J.; Adeyemo, A.; Henneman, P.; Mannens, M.M.A.M.; Nicolaou, M.; Peters, R.J.G.; Rotimi, C.N.; Snijder, M.B.; et al. Prevalence of type 2 diabetes and its association with measures of body composition among African residents in the Netherlands—The HELIUS study. Diabetes Res. Clin. Pract. 2015, 110, 137–146. [Google Scholar] [CrossRef] [PubMed]
- Tillin, T.; Hughes, A.D.; Mayet, J.; Whincup, P.; Sattar, N.; Forouhi, N.G.; McKeigue, P.M.; Chaturvedi, N. The Relationship Between Metabolic Risk Factors and Incident Cardiovascular Disease in Europeans, South Asians, and African Caribbeans:SABRE (Southall and Brent Revisited)—A Prospective Population-Based Study. J. Am. Coll. Cardiol. 2013, 61, 1777–1786. [Google Scholar] [CrossRef] [PubMed]
- Wohland, P.; Rees, P.; Nazroo, J.; Jagger, C. Inequalities in healthy life expectancy between ethnic groups in England and Wales in 2001. Ethn. Health 2015, 20, 341–353. [Google Scholar] [CrossRef] [PubMed]
- Claydon, A.; Campbell-Richards, D.; Hill, M. Living with diabetes: A qualitative review of minority ethnic groups in a deprived London borough. J. Diabetes Nurs. 2013, 17, 95–100. [Google Scholar]
- Alloh, F.; Hemingway, A.; Turner-Wilson, A.L. Systematic review of diabetes management among black African immigrants, white and South Asian populations. J. Glob. Heath Rep. 2019, 3, e2019020. [Google Scholar] [CrossRef]
- Fedeli, U.; Casotto, V.; Ferroni, E.; Saugo, M.; Targher, G.; Zoppini, G. Prevalence of diabetes across different immigrant groups in North-eastern Italy. Nutr. Metab. Cardiovasc. Dis. 2015, 25, 924–930. [Google Scholar] [CrossRef] [PubMed]
- National Institute for Health and Care Excellence. Type 2 Diabetes: Prevention in People at High Risk. Available online: https://www.nice.org.uk/guidance/ph38/resources/type-2-diabetes-prevention-in-people-at-high-risk-1996304192197 (accessed on 2 June 2018).
- Brown, K.; Avis, M.; Hubbard, M. Health beliefs of African-Caribbean people with type 2 diabetes: A qualitative study. Br. J. Gen. Pract. 2007, 57, 461–469. [Google Scholar]
- Ochieng, B.M.N. Black African migrants: The barriers with accessing and utilizing health promotion services in the UK. Eur. J. Public Health 2013, 23, 265–269. [Google Scholar] [CrossRef] [PubMed]
- Alloh, F. Improving Diabetes Outcome: A Need to Understand Management among Africans Living with Diabetes in the UK. J. Prim. Health Care Gen. Pract. 2018, 2, 2. [Google Scholar]
- Starks, H.; Trinidad, B.S. Choose Your Method: A Comparison of Phenomenology, Discourse Analysis, and Grounded Theory. Qual. Health Res. 2007, 17, 9. [Google Scholar] [CrossRef] [PubMed]
- Gelling, L. Qualitative research. Nurs. Stand. 2015, 29, 43–47. [Google Scholar] [CrossRef] [PubMed]
- Chamberlain-Salaun, J.; Mills, J.; Usher, K. Linking Symbolic Interactionism and Grounded Theory Methods in a Research Design: From Corbin and Strauss’ assumptions to action. Sage Open 2013, 3, 2158244013505757. [Google Scholar] [CrossRef]
- Charmaz, K. Constructing Grounded Theory, 2nd ed.; Sage: New York, NY, USA, 2014. [Google Scholar]
- London Strategic Clinical Networks. Improving the Management of Diabetes Care: A Toolkit for London Clinical Commissioning Groups. Available online: http://www.londonscn.nhs.uk/wp-content/uploads/2015/06/dia-moc-toolkit-062015.pdf (accessed on 18 October 2018).
- Verma, A. Diabetes Care Report London Borough of Harrow. Available online: https://www.healthwatch.co.uk/sites/healthwatch.co.uk/files/reports-library/20180611_Harrow_Primary%20Care%20Diabetes%20Care%20Report%20May%202018%20Final_0.pdf (accessed on 22 March 2019).
- Bryant, A.; Charmaz, K. The Sage Handbook of Grounded Theory; Sage: New York, NY, USA, 2007. [Google Scholar]
- Charmaz, K. Grounded theory: Objectivist and contructivist methods. In The Handbook of Qualitative Research; Denzin, K., Lincoln, Y., Eds.; Sage Publications: Thousand Oaks, CA, USA, 2000; p. 31. [Google Scholar]
- QSR International Pty Ltd. NVIVO. Available online: https://www.qsrinternational.com/nvivo/home (accessed on 14 May 2018).
- Charmaz, K. Constructing Grounded Theory: A practical Guide Through Qualitative Analysis; Sage: New York, NY, USA, 2006. [Google Scholar]
- Deng, F.; Zhang, A.; Chan, C.B. Acculturation, dietary acceptability, and diabetes management among Chinese in North America. Front. Endocrinol. (Lausanne) 2013, 4, 108. [Google Scholar] [CrossRef] [PubMed]
- Misra, A.; Ganda, O.P. Migration and its impact on adiposity and type 2 diabetes. Nutrition 2007, 23, 696–708. [Google Scholar] [CrossRef] [PubMed]
- Owen, J.; Thimont Jack, M.; Iacobov, A.; Christensen, E. Managing migration after Brexit. Institute for Government. Available online: https://www.instituteforgovernment.org.uk/publications/managing-migration-after-brexit (accessed on 22 March 2019).
- Langøien, L.J.; Terragni, L.; Rugseth, G.; Nicolaou, M.; Holdsworth, M.; Stronks, K.; Lien, N.; Roos, G. Systematic mapping review of the factors influencing physical activity and sedentary behaviour in ethnic minority groups in Europe: A DEDIPAC study. Int. J. Behav. Nutr. Phys. Act. 2017, 14, 99. [Google Scholar] [CrossRef] [PubMed]
- Agyemang, C.; van den Born, B.J. Non-communicable diseases in migrants: An expert review. J. Travel. Med. 2019, 26, tay107. [Google Scholar] [CrossRef] [PubMed]
- Cook, C.B.; Wellik, K.E.; Fowke, M. Geoenvironmental diabetology. J. Diabetes Sci. Technol. 2011, 5, 834–842. [Google Scholar] [CrossRef]
- Moonaghi, H.K.; Areshtanab, H.N.; Jouybari, L.; Bostanabad, M.A.; McDonald, H. Facilitators and barriers of adaptation to diabetes: Experiences of Iranian patients. J. Diabetes Metab. Disord. 2014, 13, 17. [Google Scholar] [CrossRef]
- Weinert, C.; Cudney, S.; Spring, A. Evolution of a conceptual model for adaptation to chronic illness. J. Nurs. Scholarsh. 2008, 40, 364–372. [Google Scholar] [CrossRef]
- Savickas, M.L.; Porfeli, E.J. Career Adapt-Abilities Scale: Construction, reliability, and measurement equivalence across 13 countries. J. Vocat. Behav. 2012, 80, 661–673. [Google Scholar] [CrossRef]
- Maslow, A.H. Maslow’s Hierarchy of Needs. Available online: http://www.researchhistory.org/2012/06/16/maslows-hierarchy-of-needs/ (accessed on 25 June 2019).
- McLeod, S. Maslow’s Hierarchy of Needs. Available online: https://www.simplypsychology.org/maslow.html (accessed on 20 March 2019).
- Avneet, K. Maslow’s Need Hierarchy Theory: Applications and Criticisms. Global Glob. J. Manage. Bus. Stud. 2013, 3, 4. [Google Scholar]
- Golics, C.J.; Basra, M.K.; Salek, M.S.; Finlay, A.Y. The impact of patients’ chronic disease on family quality of life: An experience from 26 specialties. Int. J. Gen. Med. 2013, 6, 787–798. [Google Scholar] [CrossRef] [PubMed]
- Miller, T.A.; DiMatteo, M.R. Importance of family/social support and impact on adherence to diabetic therapy. Diabetes Metab. Syndr. Obes. Targets Ther. 2013, 6, 421. [Google Scholar] [CrossRef] [PubMed]
- Jackson, J.C.; Santoro, M.J.; Ely, T.M.; Boehm, L.; Kiehl, A.L.; Anderson, L.S.; Ely, E.W. Improving patient care through the prism of psychology: Application of Maslow’s hierarchy to sedation, delirium, and early mobility in the intensive care unit. J. Crit. Care 2014, 29, 438–444. [Google Scholar] [CrossRef] [PubMed]
- Ajrouch, K.J.; Blandon, A.Y.; Antonucci, T.C. Social networks among men and women: The effects of age and socioeconomic status. J. Gerontol. B 2005, 60, S311–S317. [Google Scholar] [CrossRef]
- Gierveld, J.D.J.; Van der Pas, S.; Keating, N. Loneliness of older immigrant groups in Canada: Effects of ethnic-cultural background. J. Cross. Cult. Gerontol. 2015, 30, 251–268. [Google Scholar] [CrossRef]
- Kana’Iaupuni, S.M.; Donato, K.M.; Thompson-Colon, T.; Stainback, M. Counting on Kin: Social Networks, Social Support, and Child Health Status. Soc. Forces 2004, 83, 1137–1164. [Google Scholar] [CrossRef]
- Houle, J.; Lauzier-Jobin, F.; Beaulieu, M.D.; Meunier, S.; Coulombe, S.; Côté, J.; Lespérance, F.; Chiasson, J.L.; Bherer, L.; Lambert, J. Socioeconomic status and glycemic control in adult patients with type 2 diabetes: A mediation analysis. BMJ Open Diabetes Res. Care 2016, 4, e000184. [Google Scholar] [CrossRef]
- Gazard, B.; Frissa, S.; Nellums, L.; Hotopf, M.; Hatch, S.L. Challenges in researching migration status, health and health service use: An intersectional analysis of a South London community. Ethn. Health 2015, 20, 564–593. [Google Scholar] [CrossRef]
- Ejebu, O.Z.; Whybrow, S.; Mckenzie, L.; Dowler, E.; Garcia, A.; Ludbrook, A.; Barton, K.; Wrieden, W.; Douglas, F. What can secondary data tell us about household food insecurity in a high-income country context? Int. J. Environ. Res. Public Health 2019, 16, 82. [Google Scholar] [CrossRef] [PubMed]
- Osei-Kwasi, H.A.; Powell, K.; Nicolaou, M.; Holdsworth, M. The influence of migration on dietary practices of Ghanaians living in the United Kingdom: A qualitative study. Ann. Hum. Biol. 2017, 44, 454–463. [Google Scholar] [CrossRef] [PubMed]
- Forouhi, N.G.; Misra, A.; Mohan, V.; Taylor, R.; Yancy, W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ 2018, 361, k2234. [Google Scholar] [CrossRef] [PubMed]
- Singh, G.; Newton, C.; O’Sullivan, K.; Soundy, A.; Heneghan, N.R. Exploring the lived experience and chronic low back pain beliefs of English-speaking Punjabi and white British people: A qualitative study within the NHS. BMJ Open 2018, 8, e020108. [Google Scholar] [CrossRef] [PubMed]
- Kagawa-Singer, M. Impact of culture on health outcomes. J. Pediatr. Hematol. Oncol. 2011, 33, S90–S95. [Google Scholar] [CrossRef] [PubMed]
- Williams, L.B.; Sattin, R.W.; Dias, J.; Garvin, J.T.; Marion, L.; Joshua, T.; Kriska, A.; Kramer, M.K.; Echouffo-Tcheugui, J.B.; Freeman, A.; et al. Design of a cluster-randomized controlled trial of a diabetes prevention program within African–American churches: The Fit Body and Soul study. Contemp. Clin. Trials 2013, 34, 336–347. [Google Scholar] [CrossRef] [PubMed]
- Oleribe, E.O.O.; Alasia, D.D. Culture and health: The effect of Nupe cultural practice on the health of Nupe people. Niger. J. Med. 2006, 15, 325–328. [Google Scholar]
- Doherty, M.L.; Owusu-Dabo, E.; Kantanka, O.S.; Brawer, R.O.; Plumb, J.D. Type 2 diabetes in a rapidly urbanizing region of Ghana, West Africa: A qualitative study of dietary preferences, knowledge and practices. BMC Public Health 2014, 14, 1069. [Google Scholar] [CrossRef]
- Mogre, V.; Nsoh, J.A.; Wanaba, P.; Apala, P. Demographic factors, weight management behaviours, receipt of healthcare professional’s counselling and having knowledge in basic anthropometric measurements associated with underassessment of weight status in overweight and obese type 2 diabetes patients. Obes. Res. Clin. Pract. 2016, 10, 381–389. [Google Scholar] [CrossRef]
- Obirikorang, Y.; Obirikorang, C.; Odame Anto, E.; Acheampong, E.; Dzah, N.; Akosah, C.N.; Nsenbah, E.B. Knowledge and lifestyle-associated prevalence of obesity among newly diagnosed type II diabetes mellitus patients attending diabetic clinic at komfo anokye teaching hospital, kumasi, ghana: A hospital-based cross-sectional study. J. Diabetes Res. 2016, 2016, 9759241. [Google Scholar] [CrossRef]
- de-Graft Aikins, A.; Awuah, R.B.; Pera, T.A.; Mendez, M.; Ogedegbe, G. Explanatory models of diabetes in urban poor communities in Accra, Ghana. Ethn. Health 2015, 20, 391–408. [Google Scholar] [CrossRef] [PubMed]
- Hjelm, K.; Mufunda, E. Zimbabwean diabetics’ beliefs about health and illness: An interview study. BMC Int. Health Hum. Rights 2010, 10, 7. [Google Scholar] [CrossRef]
- Adisa, R.; Fakeye, T.O.; Fasanmade, A. Medication adherence among ambulatory patients with type 2 diabetes in a tertiary healthcare setting in southwestern Nigeria. Pharm. Pract. (Granada) 2011, 9, 72. [Google Scholar] [CrossRef] [PubMed]
- Stephani, V.; Opoku, D.; Beran, D. Self-management of diabetes in Sub-Saharan Africa: a systematic review. BMC Public Health 2018, 18, 1148. [Google Scholar] [CrossRef] [PubMed]
- Haque, M.; Navsa, M.; Emerson, S.H.; Dennison, C.R.; Levitt, N.S. Barriers to initiating insulin therapy in patients with type 2 diabetes mellitus in public-sector primary health care centres in Cape Town. J. Endocrinol. Metab. Diabetes S. Afr. 2005, 10, 94–99. [Google Scholar] [CrossRef]
- Awodele, O.; Akinyede, A.; Awodele, D.F.; Dolapo, D.C. The knowledge and attitude towards childhood immunization among mothers attending antenatal clinic in Lagos University Teaching Hospital, Nigeria. Tanzan. J. Health Res. 2010, 12. [Google Scholar] [CrossRef]
- Hjelm, K.; Nambozi, G. Beliefs about health and illness: A comparison between Ugandan men and women living with diabetes mellitus. Int. Nurs. Rev. 2008, 55, 434–441. [Google Scholar] [CrossRef] [PubMed]
- Nthangeni, G.; Steyn, N.P.; Alberts, M.; Steyn, K.; Levitt, N.S.; Laubscher, R.; Bourne, L.; Dick, J.; Temple, N. Dietary intake and barriers to dietary compliance in black type 2 diabetic patients attending primary health-care services. Public Health Nutr. 2002, 5, 329–338. [Google Scholar] [CrossRef]
- Alemu, G.; Stevens, B.; Ross, P.; Chandler, J. The Use of a Constructivist Grounded Theory Method to Explore the Role of Socially-Constructed Metadata (Web 2.0) Approaches. Qual. Quant. Methods Libr. 2015, 4, 517–540. [Google Scholar]
|Study Sites||Location||Interaction||Participants Recruited|
|Diabetes management support groups||London area||Presentation by researcher||24|
|Community||Church||Discussions with congregation||7|
|Mosque||Imam introduced researcher to potential participants||3|
|Data||Type of Data||Sources|
|Female, n = 19||Male, n = 15|
|Retired/out of job||7||9|
|Place of diagnosis|
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).