Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 6;13(1):e056913.
doi: 10.1136/bmjopen-2021-056913.

Qualitative study of pathways to care among adults with diabetes in rural Guatemala

Anita Nandkumar Chary  1   2 , Meghna Nandi  2   3 , David Flood  2   4 , Scott Tschida  2 , Katharine Wilcox  2   5 , Sophie Kurschner  2   6 , Pablo Garcia  2   7 , Peter Rohloff  2   8
Affiliations

Qualitative study of pathways to care among adults with diabetes in rural Guatemala

Anita Nandkumar Chary et al. BMJ Open. .

Abstract

Objective: The burden of diabetes mellitus is increasing in low-income and middle-income countries (LMICs). Few studies have explored pathways to care among individuals with diabetes in LMICs. This study evaluates care trajectories among adults with diabetes in rural Guatemala.

Design: A qualitative investigation was conducted as part of a population-based study assessing incidence and risk factors for chronic kidney disease in two rural sites in Guatemala. A random sample of 807 individuals had haemoglobin A1c (HbA1c) screening for diabetes in both sites. Based on results from the first 6 months of the population study, semistructured interviews were performed with 29 adults found to have an HbA1c≥6.5% and who reported a previous diagnosis of diabetes. Interviews explored pathways to and experiences of diabetes care. Detailed interview notes were coded using NVivo and used to construct diagrams depicting each participant's pathway to care and use of distinct healthcare sectors.

Results: Participants experienced fragmented care across multiple health sectors (97%), including government, private and non-governmental sectors. The majority of participants sought care with multiple providers for diabetes (90%), at times simultaneously and at times sequentially, and did not have longitudinal continuity of care with a single provider. Many participants experienced financial burden from out-of-pocket costs associated with diabetes care (66%) despite availability of free government sector care. Participants perceived government diabetes care as low-quality due to resource limitations and poor communication with providers, leading some to seek care in other health sectors.

Conclusions: This study highlights the fragmented, discontinuous nature of diabetes care in Guatemala across public, private and non-governmental health sectors. Strategies to improve diabetes care access in Guatemala and other LMICs should be multisectorial and occur through strengthened government primary care and innovative private and non-governmental organisation care models.

Keywords: anthropology; general diabetes; international health services; primary care; public health; qualitative research.

PubMed Disclaimer

Conflict of interest statement

Competing interests: PR is the principal investigator to receive the National Institutes of Health/Fogarty International Center grant (1R21TW010831-01) that funded this study. ANC receives support from the Houston Veterans Administration Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety (CIN13-413).

Figures

Figure 1
Figure 1
Composite care map—site 1. CAM, complementary and alternative medicine.
Figure 2
Figure 2
Participant care map, ID 31. This care map demonstrates simultaneous care-seeking by a woman in her 60s from site 1 over a period of 3.5 years. CAM, complementary and alternative medicine.
Figure 3
Figure 3
Participant care map, ID 237. A woman in her 50s from site 1 used the pharmacy as a regular source of medical care over the course of 3 years of diabetes care-seeking. CAM, complementary and alternative medicine.
Figure 4
Figure 4
Participant care map, ID 1266. A man in his 40s from site 2 sought diabetes care over 12 years. CAM, complementary and alternative medicine.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Cho NH, Shaw JE, Karuranga S, et al. IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract 2018;138:271–81. 10.1016/j.diabres.2018.02.023 - DOI - PubMed
    1. Allen LN. Financing national non-communicable disease responses. Glob Health Action 2017;10:1326687. 10.1080/16549716.2017.1326687 - DOI - PMC - PubMed
    1. Kankeu HT, Saksena P, Xu K, et al. The financial burden from non-communicable diseases in low- and middle-income countries: a literature review. Health Res Policy Syst 2013;11:31. 10.1186/1478-4505-11-31 - DOI - PMC - PubMed
    1. Soetedjo NNM, McAllister SM, Ugarte-Gil C, et al. Disease characteristics and treatment of patients with diabetes mellitus attending government health services in Indonesia, Peru, Romania and South Africa. Trop Med Int Health 2018;23:1118–28. 10.1111/tmi.13137 - DOI - PubMed
    1. Manne-Goehler J, Geldsetzer P, Agoudavi K, et al. Health system performance for people with diabetes in 28 low- and middle-income countries: a cross-sectional study of nationally representative surveys. PLoS Med 2019;16:e1002751. 10.1371/journal.pmed.1002751 - DOI - PMC - PubMed

Publication types

Substances