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. 2022 Sep 14;17(9):e0268559.
doi: 10.1371/journal.pone.0268559. eCollection 2022.

The influence of patriarchy on Nepali-speaking Bhutanese women's diabetes self-management

Aditi Sharma  1 , Heather Stuckey  2   3 , Megan Mendez-Miller  4 , Yendelela Cuffee  5 , Aubrey J Juris  6 , Jennifer S McCall-Hosenfeld  2   3
Affiliations

The influence of patriarchy on Nepali-speaking Bhutanese women's diabetes self-management

Aditi Sharma et al. PLoS One. .

Abstract

Introduction: The Nepali-speaking Bhutanese (NSB) community is a rapidly growing population in Central Pennsylvania. A community-based diabetes education pilot program found a large gender disparity with fewer women in attendance; participants reported that primary household cooks and caretakers were women. This may be an indication of women's status in the NSB community, their healthcare access, autonomy, and ability to manage their diabetes. Hence, this study aims to understand the manifestations of patriarchy and its impact on NSB women's diabetes self-management employing a conceptual framework based on Walby's structures of patriarchy.

Methods: An exploratory feminist qualitative inquiry was conducted. Fifteen NSB women with Type 2 Diabetes were interviewed about their diabetes self-management. Transcripts were coded for key concepts that emerged from the data. A thematic analysis was conducted. Themes were developed inductively through those categories as well as through an a priori approach using the conceptual framework.

Results: Cultural influences such as family structure, religious beliefs, traditional healthcare and gender roles determined NSB women's patriarchal upbringing and lifestyle. Unpaid household production was largely dependent on women. Multiple immigrations led to poor socioeconomic indicators and marginalization of NSB women. Women's access to healthcare (including diabetes) was entirely reliant on other family members due to poor autonomy. Women experienced adverse physical and emotional symptoms related to diabetes and their ability and attempts to maintain a healthy diabetes lifestyle was determined by their physical health condition, knowledge regarding good dietary practices and self-efficacy.

Conclusion: Patriarchal practices that start early on within women's lives, such as child marriage, religious restrictions as well as women's access to education and autonomy impacted NSB women's access to healthcare, knowledge regarding their diabetes and self-efficacy. Future interventions tailored for diabetes prevention and self-management among NSB women should factor in patriarchy as an important social determinant of health.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Conceptual framework.
Fig 2
Fig 2. Summarizing the referral and recruitment details of the study.
Fig 3
Fig 3. Themes and categories represented within the conceptual framework.
See this image and copyright information in PMC

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