The Experiences and Beliefs Among Hill Tribespersons Living with Type 2 Diabetes Mellitus in Chiang Rai, Thailand: An Ethnographic Study

This research aims to explore the experiences and beliefs of hill tribespersons living with type 2 diabetes mellitus in Chiang Rai, Thailand. Also, how this group manage their disease, including the needs and barriers of a diabetes mellitus health promotion. A qualitative research, utilising an ethnographic study was adopted as the methodology of this research. A convenience sample of hill tribespersons with type 2 diabetes mellitus who have been receiving health care services in a diabetes clinic at a regional hospital in Chiang Rai was selected. Data elicited from the study included 16 in-depth interviews using a semi-structured interview schedule, participative observation of hill tribespersons in their community, and a focus group discussion with five health professionals and three in-depth interviews. These were audio recorded with verbatim transcription in Thai, which was translated into English. The study analysed data using content and thematic analysis and elicited themes via a thematic analysis network. The findings from the hill tribespersons were three major themes of their beliefs. Firstly, the causes of disease including heredity, over consumption of sugar, the use of agricultural chemicals and ‘Lom Pid Duan’ sickness, which is a cultural belief of following unofficial protocols after childbirth. Secondly, the perception of having diabetes mellitus including being different to others, normal like others, having bad blood and incurable disease. Finally, the beliefs of complications including perceived severity and perceived susceptibility. In terms of the experiences and self-management, this was divided into five themes, consisting of experiences of being diagnosed, dealing with diet and beverage, compliance with prescribed diabetes medication, exercise behaviour, and dealing with complications. This study found that both hill tribespersons and health professionals had a strong agreement that language was the most significant barrier to accessing health care services effectively. In addition, the barriers from the health professionals’ perspectives were categorised into two themes. The first one was the health care system itself, including staff shortages, financial constraints and discrepencies between the theoretical national standard guidelines and indicators and their practical application with this group. The second barrier was social and cultural including the culture of festivals, lifestyle, and social support from family. The requirements from the health professionals were; providing an adequate workforce, an appropriate media and health programme, a budget for developing diabetes care and cooperation from all sectors. These findings suggest health professionals and related sectors need to be culturally sensitive when dealing with this group and be aware of the barriers to information facing the hill tribespersons