Table 4.
Basic themes emerging from qualitative data analysis.
| Concepts basic (Open codes) Illustrative quotes | Organizing theme | Global theme |
|---|---|---|
| Lack of knowledge and understanding of the condition: “If I take sugar, I will drink bitter gourd juice, then I do not have to worry about my sugar. This was statement by one of my patients” (D18, 25yr, MBBS) | Knowledge distortion | Patient related |
| Belief in natural remedies alternative to medicine: “Modern medicine cannot cure diabetes or hypertension, but Ayureveda can. thats what most of the patients believe. In the initial stages, they want to go to these traditional practitioners” (D9, 60yrs, MD General Medicine) | ||
| Myths about diet: “Diabetics should not eat any fruits or rice, I do not know who gave them all these information” (D22, 50 yrs, MD OBG) | ||
| Resistance to start medications: “Once we start medicines, the body gets addicted to them, many patients believe like this.” (D6, 42, MD Pediatrics) | ||
| Lack of motivation: “There are some patients who are concerned about their health…and they trust us. Another set of patients are very difficult to handle.” (D3, 30 yrs, MD Medicine) | Attitude of patients | |
| Financial constraints: “Once you are a diabetic, they need to take medications lifelong. On an average, they have to spend at least Rs. 200 a month. They are not motivated to keep on spending this amount. Sometimes it's difficult when they have to decide between drugs and other things like food, education etc.” (D11, 62 yrs, MS Surgery) | Non adherence | |
| Self-management: “Once the sugar is normal or BP is normal with medications, many people will reduce or stop medications. They feel they can manage without drugs.” (D16, 50 yrs, MD Pathology) | ||
| Polypill: “Two for sugar, one for BP, one aspirin. you know too many medications. Sometimes its not surprising that they discontinue and try.” (D5, 58 yrs, MD Medicine) | ||
| Chronicity: “Diabetes is not like fever or diarrhoea. once a diabetic always a diabetic” (D27, 43 yrs, MS ENT) | Nature of disease | Condition related |
| No immediate effect if sugar is high: “No immediate consequence for noncompliance, unlike pain or something”…In a way, they are also correct, nothing happens to many: unexplained phenomenon.” (D19, 50 yrs, MBBS) | ||
| Confusion about guidelines: “The guidelines change very often, we passed out long back. Sometimes keeping up with the new trends is difficult.” (D31, 68 yrs, MBBS) | Competency | Provider related |
| Inadequate information sharing: “I will tell to exercise and reduce rice to all diabetics” (D10, 55 yrs, MD Medicine) |
The age and qualifications of the doctors are real.