Objectives: To explore how people in Bangkok, Thailand make sense of the challenges associated with living with type 2 diabetes.
Methods: Ethnographic research was conducted for a period of 18 months, and included participant observation, documentary analysis, and interviews with health providers, family members and 33 adults with type 2 diabetes. Interviews and analyses were iterative, with longitudinal data drawing attention to shifts in meaning in relation to identity construction and the relevance of this to disease management.
Results: People drew on cultural notions of social harmony and bodily imperfection, and ideas of the nature of diabetes as 'invisible' while blood sugar levels were controlled, to reconstruct their identity once diagnosed with diabetes. By maintaining their status as 'normal, but...', people could minimize disruptions in their everyday lives and in relation to others, due to both practices of management and their social effects. Their use of a qualification to their health status (but) explicitly acknowledged certain behavioural and dietary modifications that were necessary to manage their diabetes, but also emphasized their role in self-management.
Discussion: The diabetes qualification ('normal, but...') acted as a bridge between health and illness, enabling people to separate their physical health status, perceived as being particularly flawed by having diabetes, from their 'normal' social self. The sustained idea of the normality of the embodied and socially embedded self implied that the disease was under control, ensuring its minimal intrusion into social relationships and practical living.
Bennett PH , Rewer MJ , Knowler WCEpidemiology of diabetes mellitus. In: Porter D , Sherwin RS , eds. Diabetes mellitus, 5th edn. New York: Elsevier, 1997.
2.
World Health Organization.Prevalence of diabetes mellitus (per cent population) in the age range 30-65 years. Available at: http://www.who.int/ncd/databaseds2.htm (accessed July 2000).
3.
Vannasaeng S. , Viriyavejaku A. , Poungvarin N.Prevalence of diabetes in urban community of Thailand . J Med Assoc Thailand1986; 69: 131-8.
4.
Keesukphan P. , Chanprasertyothin S. , Fugpholngan V. , Puavilai G.Oral glucose tolerance test in a high-risk Thai population . Rama Med J1999; 22: 58-61.
5.
Ministry of Public Health.Thailand health statistics 1971-1997. Available at: http://www.moph.go.th (accessed June 2000).
6.
Wibulpolprasert S , ed. Thailand health profile 1999-2000. Bangkok: Bureau of Policy and Strategy, Ministry of Public Health, 2002.
7.
Ministry of Public Health.Health in Thailand 1995- 1996, Bangkok: Ministry of Public Health, 1997.
8.
Likitmasku S. , Kiattisathavee P. , Chaichanwatanakul K. , Punnakanta L. , Angsusingha K. , Tuchinda C.Increasing prevalence of type 2 diabetes mellitus in Thai children and adolescents associated with increasing prevalence of obesity . J. Pediatr Endocrinol Metab2003; 16: 71-7.
9.
Pagaiya N. , Garner P.Primary care nurses using guidelines in Thailand: a randomised controlled trial . Trop Med Int Health2005; 10: 471-7.
10.
Watanapahu S. , Saranop S.Factors affecting the control of blood glucose level of non-insulin dependent diabetic patients in Saruburi hospital . J Health Sci1997; 6: 613-22.
11.
Phromtha S.Buddhism philosophy. Human, social and morality problems (in Thai)., Bangkok: Chulalongkorn University, 1999.
12.
Bhavilai R.Buddhism in Thailand and a modern Thai's interpretation of Buddhism, Bangkok: South-East Asia Treaty Organization, 1967.
13.
Podhisita C.Buddhism and Thai world view. In: Social Research Institute , ed. Traditional and changing Thai world view . Bangkok: Chulalongkorn University , 1985.
14.
Tambiah SJWorld conqueror and world renouncer: a study of buddhism and polity in Thailand against a historical background, Cambridge: Cambridge University Press, 1976.
15.
Humphreys C.Buddhism: an introduction and guide, London: Penguin Books, 1990.
16.
Naemiratch B. , Manderson L.Lay explanations of type 2 diabetes among urban dwellers in Thailand . Anthropol Med2007; 14: 83-94.
17.
Keown D.Buddhism: a very short introduction, New York: Oxford University Press, 1996.
18.
Thailand, National Identity Board.Thailand in the 90s, revised edn. Bangkok , Thailand: Office of the Prime Minister , 1995.
19.
Komin S.Psychology of the Thai people: values and behavioural patterns, Bangkok: National Institute of Development Administration (NIDA), 1990.
20.
Winichakul T.Siam mapped: a history of the geo-body of a nation, Honolulu : University of Hawai'i Press, 1994 .
Csordas TJEmbodiment and experience: the existential ground of culture and self, New York: Cambridge University Press, 1994.
27.
Parsons T.The social system, London: Routledge , 1991.
28.
Strauss AL , Corbin JM , Fagerhaugh S. , et al. edn., Chronic illness and the quality of life, 2nd edn. St Louis, MO: CV Mosby Company, 1984.
29.
Register C.Living with chronic illness: days of patience and passion, New York: Free Press, 1987.
30.
Charmaz K.Loss of self: a fundamental form of suffering in the chronically ill . Sociol Health Illness1983; 5: 168-95.
31.
Naemiratch B. , Manderson L.Control and adherence: living with diabetes in Bangkok, Thailand . Soc Sci Med2006; 63: 1147-57.
32.
Anderson JM , Wiggins S. , Rajwani R. , Holbrook A. , Blue C. , Ng M.Living with a chronic illness: Chinese-Canadian and Euro-Canadian women with diabetes - exploring factors that influence management . Soc Sci Med1995; 41: 181-95.
33.
Peyrot M. , Rubin RRPsychosocial aspects of diabetes care. In: Leslie RDG , Robbins DC , eds. Diabetes clinical science in practice, Cambridge: Cambridge University Press, 1995.
34.
Rubin R. , Peyrot M.Psychological issues and treatments for people with diabetes . J Clin Psychol2001; 57: 457-78.
35.
Anderson RM , Donnelly MB , Davis WKControversial beliefs about diabetes and its care . Diabetes Care1992; 15: 589-63.
36.
Hunt LM , Arar NH , Larme ACPatients focus on integrating diabetes into their lives, while practitioners focus on glucose control . Western J Med1999 ; 171: 165-91.
37.
Loewe R. , Schwartzman J. , Freeman J. , Quinn L. , Zuckerman S.Doctor talk and diabetes: towards an analysis of the clinical construction of chronic illness . Soc Sci Med1998; 47: 1267-76.
38.
Kelleher D.Coming to terms with diabetes: coping strategies and non-compliance. In: Anderson R , Bury M , eds. Living with chronic illness, London: Unwin Hyman, 1988.
39.
Anderson RM , Fitzgerald JT , Oh MSThe relationship between diabetes-related attitudes and patients' self-reported adherence . Diabetes Educ1993; 19: 287-92.
40.
Broom D. , Whittaker A.Controlling diabetes, controlling diabetics: moral language in the management of diabetes type 2 . Soc Sci Med2004; 58: 2371-82.
41.
Daniulaityte R.Making sense of diabetes: cultural models, gender and individual adjustment to type 2 diabetes in a Mexican community . Soc Sci Med2004; 59: 1899-912.
42.
Price MJAn experiential model of learning diabetes self-management . Qual Health Res1993; 3: 29-54.
43.
Naemiratch B.Who is in control: The diabetic or diabetes? Lived experience of adults living with diabetes in Bangkok. Unpublished PhD dissertation. Brisbane: School of Population Health, The University of Queensland, 2005.
44.
Patton MQQualitative evaluation and research methods, Newbury Park, CA: Sage, 1990.
45.
Rice PL , Ezzy D.Qualitative research methods: a health focus, Melbourne : Oxford University Press, 1999.
46.
Kelly MP , Field D.Medical sociology, chronic illness and the body . Sociol Health Illness1996; 18: 241-57.
47.
Becker G.Disrupted lives: how people create meaning in a chaotic world, Berkeley, CA: University of California Press, 1997.
