Needs and resources of people with type 2 diabetes in peri-urban Cochabamba, Bolivia: a people-centred perspective

Abstract

Background: The rising prevalence of type 2 diabetes results in a worldwide public healthcare crisis, especially in low- and middle-income countries (LMICs) with unprepared and overburdened health systems mainly focused on infectious diseases and maternal and child health. Studies regarding type 2 diabetes in LMICs describe specific interventions ignoring a comprehensive analysis of the local factors people see influential to their health. This study aims to meet this research gap by exploring what people with type 2 diabetes in Bolivia need to maintain or improve their health, how important they perceive those identified needs and to what extent these needs are met.

Methods: From March until May 2019, 33 persons with type 2 diabetes from three periurban municipalities of the department of Cochabamba participated in this study. The concept mapping methodology by Trochim, a highly structured qualitative brainstorming method, was used to generate and structure a broad range of perspectives on what the participants considered instrumental for their health.

Results: The brainstorming resulted in 156 original statements condensed into 72 conceptually different needs and resources, structured under nine conceptual clusters and four action domains. These domains illustrated with vital needs were: (1) self-management with use of plants and the possibility to measure sugar levels periodically; (2) healthcare providers with the need to trust and receive a uniform diagnosis and treatment plan; (3) health system with opportune access to care and (4) community with community participation in health and safety, including removal of stray dogs.

Conclusions: This study identifies mostly contextual factors like low literacy levels, linguistic problems in care, the need to articulate people's worldview including traditional use of natural remedies with the Bolivian health system and the lack of expertise on type 2 diabetes by primary health care providers. Understanding the needs and structuring them in different areas wherein action is required serves as a foundation for the planning and evaluation of an integrated people centred care program for people with type 2 diabetes. This participative method serves as a tool to implement the often theoretical concept of integrated people centred health care in health policy and program development.

Keywords: Bolivia; Community participation; Developing countries; Diabetes mellitus; Health literacy; Health planning; Long-term care; Patient-Centred care; Self-management.

Fig. 1

The Concept Mapping Process (Adapted from Leyns et al., 2018) [27]

Fig. 2

The concept map with 72 conceptually different statements represented by small black numbers, nine clusters indicated by larger white numbers and four action domains named with capital letters. Statements in a red circle are seeming anomalies that were moved to another cluster

Fig. 3

People-centred diabetes care model for recently urbanized regions in Cochabamba. Interdependent interventions at the level of the community, the health system and human resources based on the identified needs and resources in this study are presented. T2D = Type 2 diabetes; PHC = Primary health care