Mendenhall Emily, McMurry H Stowe, Shivashankar Roopa, Narayan K M Venkat, Tandon Nikhil, Prabhakaran Dorairaj
a School of Foreign Service , Georgetown University , 37th & O Streets, NW, Washington , DC , 20057 , USA.
b COE-CARRS and Center for Control of Chronic Conditions , Public Health Foundation of India , Plot No 47, Sector 44, Institutional Area Gurgaon - 122002 , India.
Anthropol Med. 2016 Dec;23(3):295-310. doi: 10.1080/13648470.2016.1184010. Epub 2016 Jun 21.
The Type 2 diabetes epidemic in India poses challenges to the health system. Yet little is known about how urban Indians view treatment and self-care. Such views are important within the pluralistic healthcare landscape of India, bringing together allopathic and non-allopathic (or traditional) paradigms and practices. We used in-depth qualitative interviews to examine how people living with diabetes in India selectively engage with allopathic and non-allopathic Indian care paradigms. We propose a 'discourse marketplace' model that demonstrates competing ways in which people frame diabetes care-seeking in India's medical pluralism, which includes allopathic and traditional systems of care. Four major domains emerged from grounded theory analysis: (1) normalization of diabetes in social interactions; (2) stigma; (3) stress; and (4) decision-making with regard to diabetes treatment. We found that participants selectively engaged with aspects of allopathic and non-allopathic Indian illness paradigms to build personalized illness meanings and care plans that served psychological, physical, and social needs. Participants constructed illness narratives that emphasized the social-communal experience of diabetes and, as a result, reported less stigma and stress due to diabetes. These data suggest that the pro-social construction of diabetes in India is both helpful and harmful for patients - it provides psychological comfort, but also lessens the impetus for prevention and self-care. Clarifying the social constructions of diabetes and chronic disease in India and other medically pluralistic contexts is a crucial first step to designing locally situated treatment schemes.
印度的2型糖尿病流行给卫生系统带来了挑战。然而，对于印度城市居民如何看待治疗和自我护理，我们却知之甚少。在印度多元的医疗格局中，这些观点很重要，它融合了对抗疗法和非对抗疗法（或传统疗法）的范式与实践。我们采用深入的定性访谈来研究印度糖尿病患者如何有选择地采用对抗疗法和非对抗疗法的印度护理范式。我们提出了一种“话语市场”模型，该模型展示了在印度医学多元主义（包括对抗疗法和传统护理体系）中，人们寻求糖尿病护理的相互竞争方式。扎根理论分析得出了四个主要领域：（1）糖尿病在社交互动中的正常化；（2）耻辱感；（3）压力；（4）糖尿病治疗的决策。我们发现，参与者有选择地采用对抗疗法和非对抗疗法的印度疾病范式的各个方面，以构建满足心理、身体和社会需求的个性化疾病意义和护理计划。参与者构建的疾病叙事强调了糖尿病的社会群体体验，因此，他们报告因糖尿病而产生的耻辱感和压力较小。这些数据表明，印度糖尿病的亲社会建构对患者既有帮助也有危害——它提供了心理安慰，但也减少了预防和自我护理的动力。在印度和其他医学多元的背景下，阐明糖尿病和慢性病的社会建构是设计因地制宜治疗方案的关键第一步。
