Table 2.

Factors That Affect Self-Management of Diabetes.

Themes	Subthemes	Ethnographic Descriptions
Economic factors	Poverty	“Because of poverty, I end up eating whatever I get.” “I don’t have regular food . . . somedays I get to eat and somedays I don’t get.” “I probably stay for two days without medications.”
	Biomedical care is costly	“[Medications at] pharmacy are costly, we cannot afford them.” “I get my medications from Mombasa, here [in Lamu town] is very expensive.”
	Poor access to eye care	“[eye care] . . . I keep rescheduling my appointments because I cannot afford travelling [to Mombasa].”
	No access to refrigeration	“. . . I was then told that the insulin will trouble you because you do not have refrigeration, and that is why they change to pills.”
Educational factors—(limited knowledge and misconceptions of DM)	DM is curable	“It is possible that you can be cured and it leaves you.” “There are herbals that can totally clear you of diabetes.” “There is one man in Malindi, I have heard that he prepares herbs for diabetes. There are several people, like ten people have been cured of diabetes.”
	Misconceptions about causes of DM	“I was informed yesterday that diabetes is infectious.” “Yes, you can infect someone. Because I did not have diabetes, my husband is the one who had diabetes. Why did I then get diabetes?” “One big thing that I have read in Arabic books is that ice water can cause diabetes and I have investigated and I have observed it.”
	Misconceptions about DM self-management (exercise, diet)	“House chores are my only exercise.” “[Describes daily chores] . . . these are not small exercise.” “I for example, sometimes these days I do not eat breakfast because I think after dinner I’m satisfied until lunch.”
Religious factors	Fasting during the holy month of Ramadan	“My fasting goes very well during Ramadan.” “Some days I fast, some days I cannot because it is difficult.” “Ramadan is more difficult than any other times . . . It gives me plenty of problems.”
Social factors and kinship	Family factors	“You cannot tell your wife [family] that these days do not prepare this. Because you are the only one with diabetes . . . You must be flexible…the issue of dietary restrictions is problematic.” “You cannot cook your own food, until you cook food for others in the family . . . this is what I find to be difficult.”
	Ritual obligations (wedding and social events)	“I do not eat the food . . . I do not stress the host of the event [about my food choices] . . . I excuse myself and sit somewhere until [when the event is over] I return home . . . ” “Most likely when I attend social events is to please the hosts instead of pleasing myself . . . the reason is when people drink soda, I do not . . . in Islamic religion to attend social events when you are invited is an obligation.”
Cultural values and belief systems	Pervasive use of non-biomedical remedies	“Yes, [aloe] I use it to lower my blood sugar.” “And for local medicine, I drink boiled papaya leaves.”
	Fear and mistrust of medications (biomedical therapies)	“I have purchased medicines that were fake . . . it is known that some make fake drugs so they can make lots of quick cash.” “When they prescribe me pharmaceutical drugs, I refuse, because I have heard that once you are used to the medicine, you have to take them everyday.” “Others have told me that I should not take pharmaceutical drugs. I should only stick with dietary restrictions.”
	Defeatist belief toward diabetes	“There are several people that I have met who do not care [about diabetes]. During social events such as wedding, prayers, or funeral, you will see them over eat . . . they tell me . . . you only die once.”