The participants of this study included 19 people (14 type-II diabetes patients and five of their family members). The patients were aged 37 to 69 years, with a mean age of 50.86 ± 10.40 years. The family members were aged 25 to 42 years, with a mean age of 33.40 ± 6.98 years. Tables 1 and 2 present participants’ demographic details.
Table 1
Demographic data of the patients (n = 14)
Age
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37 to 69 years, with a mean of 52.86 years
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Sex
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Female (n = 7) / male (n = 7)
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Marriage
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Married (n = 12) / widowed (n = 2)
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Place of residence
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Village (n = 6) / city (n = 8)
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Diabetes duration/year
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5 to 15 years, with a mean of 9.21 years
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Income
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Not adequate (n = 14)
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Occupation
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Farmer (n = 4) / housewife (n = 5) / retired (n = 2) / corporate job (n = 1) / self-employed (n = 2)
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Education
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Illiterate (n = 2) / primary school (n = 4) / high school diploma (n = 4) / academic education (n = 4)
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Table 2
Demographic data of the family members (n = 5)
Age
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25 to 42 years, with a mean of 33.40 years
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Sex
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Female (n = 3) / male (n = 2)
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Marriage
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Married (n = 2) / single (n = 3)
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Place of residence
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Village (n = 2) / city (n = 3)
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Occupation
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Corporate job (n = 2) / self-employed (n = 1) / student (n = 2)
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Education
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High school diploma (n = 1) / academic education (n = 4)
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Relationship with the patient
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Brother (n = 1) / spouse (n = 2) / child (n = 2)
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After the analysis of the interviews and the extraction, review, and abstraction of the codes, the subcategories and categories were named based on their nature. Ultimately, two themes emerged from the nature and dimensions of participants’ perceptions of their disease support sources, including care incentives and support strategies (Table 3).
Table 3
The themes, main categories and sub-categories
Theme
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Category
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Subcategory
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Codes
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Care incentives
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Influential supporters
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Support received from formal care providers
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Community health worker support
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Effective presence of the health house physician
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Ease of access to GPs
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Preferring to visit a specialist
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Continuity of care with diabetes care providers
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Surrounding support networks
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Supportive family
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Social support
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Volunteer support
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Efficient organizations
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Receiving healthcare
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Assurance resulting from access to health houses
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Comforting diabets centers
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Easy access to medical services
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Ease of access to clinics
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Prompt emergency services
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Support strategies
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Technology scope
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Good communication tools
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Opportunities provided by the virtual space
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Telephone support
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Improving care knowledge
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Dietary guidelines
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Insulin injection skills
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Economic support
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-
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Clinic’s inexpensive specialized services
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Free care in diabetes centers
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1. Care Incentives
Support incentives were support sources within the two categories of ‘influential supporters’ and ‘efficient organizations’.
1.1. Influential Supporters
Influential supporters include people who support the patients, and can either be formal caregivers or from surrounding support networks. Formal caregivers are usually found in the most accessible health centers and include community health workers, health house physicians, diabetes caregivers, general practitioners, and specialists. With regard to the cooperation of health workers, participant 11 said: “We have health house in our villages, and I go to them for my insulin injection”. Regarding the ease of access to GPs, participant 4 said: “I go to a general doctor when I need a drug. The clinics always have a general practitioner on site, who writes me a prescription. I don’t have to wait or pay for a specialist. It gets my work done quickly”.
Other influential supporters of diabetes patients include surrounding support networks, which included a supportive family, social support, and volunteering supports in this study. According to diabetic patients, family members are one of their main sources of support for this group, which include the spouse, children, and parents of the patient. Family caregiver 5 explained: “I myself and my sister and brother are often with my parents and do whatever there is to do. I know how to do injections, and I can do it if needed. We also have a blood sugar tester at home and a blood pressur emonitor too, which I control and note every day”. Family members’ support of diabetic patients can be both emotional and functional. Family caregiver 2 said: “My mother is so very careful with my father’s diet. We don’t even buy the stuff my father likes but are bad for him, so he wouldn’t crave them. Because of his poor sight, we have created a safe environment at home for him, so he won’t fall down God forbid”. Also, participant 6 explained: “My spouse as well as my children are all worried about me, and constantly ask if I’ve had my insulin injection and my medications”.
The patients’ social supporters, who are developed according to their lifestyle and social characteristics, have an important role in supporting the patients. These social supporters include neighbors, acquaintances, friends, colleagues, and also those acquaintances of diabetic patients who work in health centers. According to the participants, these people can also provide patients with emotional and functional support. About support from the neigbors, participant 14 said: “My neighbors know I have diabetes, and when my husband is not around, they look out for me and ask after my health”. About colleagues’ support, participant 6 said: “My colleagues look out for me, and look after me when I’m not well, and run my class for me”. About support from acquaintances working in health centers, participant 7 explained: “When I’m unwell, I visit one of my relatives and his wife, who are health system retirees, and they test my glucose there and do my insulin injection for me”.
Another group of support sources for diabetic patients are volunteering supports. Although they have a weaker relationship with the patient, because of their special advantages, such as education or special facilities at their disposal, they vulontarily support the patients. The existence of these sources of support and access to them depend on the patient’s social networks. Participant 4 explained: “The village teacher looks after us, and always asks my son about my health. He visits me at home and talks to me, and asks if I want him to bring me medications from the city if I need something”. Also, participant 1 said: “Sometimes when it’s cold, snowing, or raining and the road is blocked and it is difficult to come and go and the way is far, I either join a neighbor who has a car and wants to go to town or ask them to buy us our medications and bring them for us”.
1.2. Efficient Organizations
Some support is provided to patients through organizations. These sources can support the patients by delivering healthcare and medical services. Healthcare centers such as health houses are regarded as the first link in the support chain for patients living in villages. The existence of health houses made the patients feel reassured, and participant 9 said: “There is the health house, and it is better than not having anything. It is reassuring when its doors are open”. Diabetes centers are other settings responsible for diabetic patients primary care. As such, family caregiver 4 noted that her mother visited the diabetes center because it made her feel good, and further argued about diabetes centers being comforting and said: “Although we have the device at home and my mother controls her blood glucose herself, but if the diabetes center tells her that her glucose is OK, it’s like it’s different for her. Somehow it is comforting for her, the fact that she has somewhere to go to as a diabetic patient”.
In participants’ statements, medical support sources include public and emergency clinics. About the ease of access to these clinics, participant 7 explained: “I visit the clinic’s specialist when I feel unwell. Sometimes specialists come to the clinic from other towns and we don’t have to travel to nearby cities to see a doctor any more”. About emergency services’ prompt delivery of services, participant 11, who lived in a village, said: “It is very good now. Sometimes when you don’t feel well and the roads are blocked, an emergency chopper comes to bring a doctor or take the patient to a hospital, so we no longer worry about the roads being blocked”. Recalling seeking help from emergency line 115, participant 8 said: “I go to the hospital when I’m not well, the emergency department, and I’m usually take care of quickly”. Family caregiver 3 said: “My father’s blood glucose had dropped so badly once that he passed out, and as I did not have a car myself, I called 115, and they came and quickly transferred him to the hospital”.
2. Support Strategies
The support strategies theme involves tangible support services. These strategies consisted of the ‘economic support’ and ‘technological scope’ categories.
2.1. Economic Support
One of the important diabetes care and treatment issues is the cost incurred. Some participants revealed that they mostly went to centers where specialist’s fees were cheaper. About the inexpensive specialist services in the clinic, participant 13 exlained: “I come to the clinic because visiting a specialist here is cheaper. He does the same thing as in his office”. About the free care available in diabetes centers, participant 1 noted: “This diabetes center they’ve set up, which is free, is very good for me, since I’m not well off, and I get to know how I’m doing”. Participant 10 said: “I always come here to get free care. The lady nurse takes my blood pressure and measures my weight, and if they have needles, they measure my blood sugar too. Knowing that my blood glucose or pressure is OK is good enough, and I don’t have to go to a laboratory and pay, which is a lot of help”.
2.2. Technological Scope
This category includes methods of accessing the knowledge and information needed for care in type-II diabetic patients. Based on the present findings, the technological scope included the context of electronic communication and improving care knowledge.
The context of electronic communication facilitates patients’ access to information and supports them by increasing their knowledge. The virtual space opportunities include the possibility of access to communication networks through the internet that encompass a variety of information about diabetes. Regarding the virtual space opportunities, participant 3 explained: “I sometimes search the web for diabetes physical activities and diet, and sometimes use the information I get”. Family caregiver 5 said: “I subscribed to one or two nutrition channels on Telegram, which have good stuff, and I can ask any question I have about the diabetes diet”.
According to the participants, using the telephone is also a source of support for diabetic patients to obtain information, communicate with the medical team, and follow-up treatment. About telephone support, family caregiver 2 explained: “My father controls his blood sugar, blood pressure, and weight at home and sends the info to a specialist in another town who knows him, and he tells us whatever is necessary for us to do”.
Another aspect of the technological scope of support sources in patients with chronic diabetes is care knowledge support and promotion through patient education in various ways. According to the patients, these instructions are focused on dietary guidelines and insulin injection skills in patients on insulin therapy. About dietary guidelines, participant 13 said: “There is a nutritionist in this hospital too, and he talked to me about the diabetes diet, and I observe many of them”. About insulin injection skills, participant 12 said: “The day I wanted to start getting on insulin at the hospital, the nurse taught me how to do injections, and practiced with me a few times until I was able to do it myself. They also showed me an instructional video”.