The majority of the patients in this study were females (62.5%). Moreover, 56.25% of the patients were in the age group of 40-60. Table 1 shows demographic characteristics of the participants. After analyzing the data, six main categories were identified; these categories included beliefs about medicinal plants, psychological factors, patients’ knowledge and awareness, accessibility and economic barriers, pressure imposed by the society, and the role of family culture (Table 2).
4.1. Beliefs about medicinal plants
This category includes five subcategories of trust in medical effects of medicinal plants in terms of biochemical indicators, the feeling of peace and freshness following the use of medicinal plants, trust in low complications of medicinal plants, patient compatibility with medicinal plants, and trust in the need for undergoing complementary therapies.
4.1.1. Trust in medical effects of medicinal plants in terms of biochemical indicators
Most participants believed that taking medicinal plants controlled their biochemical parameters, such as two-hour blood glucose and HbA1c (Hemoglobin A1c) levels. One of the participants stated, "When I eat nettle, I feel that my blood glucose level decreases. Besides, I measured it by a glucometer, and my blood glucose level decreased" (a 60-year-old man). Another participant stated, "I used to brew fenugreek three times a day for 20 days. The test showed that my blood glucose level was around 120, which was very interesting to me" (a 30-year-old woman).
Moreover, most of the participants who regularly used medicinal plants believed that they felt more fresh and cheerful after taking herbal medicines. They stated that diabetes made them feel lethargic and bored. However, according to them, their physical and mental conditions improved after using medicinal plants, and they could do their daily activities more efficiently. One of the participants stated, "Diabetes makes one get bored. When I drink herbal tea, I feel better and feel that I can do my daily chores much better" (a 62-year-old man).
Many patients believed in low complications of medicinal plants and their compatibility with these plants compared to other conventional drugs. They believed that medicinal plants were made of natural substances, so they were less harmful to the body and more compatible with it than conventional medicines. Besides, the participants believed that medicinal plants along with common drugs supplemented each other well and were effective in controlling their disease. For example, one of the participants stated, "When I found out that drugs prescribed by my specialist failed to control my disease, I felt the need for using herbal medicines; accordingly, I believe that taking herbal medicines along with the main drugs is very effective" (a 64-year-old woman).
4.2. Psychological factors
Psychological problems arising from the use of medicinal plants by the participants were regarded as the main obstacle to the use of medicinal plants.
A number of the patients stated that they rarely used medicinal plants. Accordingly, they stated they had experienced anxiety and uneasiness after using medicinal plants. Thus, they were not interested in reusing them. One of the participants said, "When I use brewed nettles, I feel distressed". Moreover, some of the participants expressed fears of hypoglycemia following the use of medicinal plants. Another participant said, "When I use colocynth (bitter cucumbers), my blood sugar drops abruptly. This scares me so much and makes me feel so worried that I do not want to use it anymore" (a 52-year-old man).
4.3. Patients’ knowledge and awareness
Patients' knowledge and awareness of the dose and preparation method of medicinal plants are among other causative factors in using them. Some of the participants stated that people using medicinal plants are required to be aware of their usage method and dose; according to them, the method used in preparing medicinal plants is highly effective in optimizing their effects. Thus, if there is no knowledge of the usage of medicinal plants, they will be harmful and likely to damage body organs. One of the participants stated, "If my wife does not prepare them for me, I will not use them on my own because I do not know how to brew them and how much of them to use" (a 46-year-old man).
4.4. Accessibility and economic barriers
Barriers to accessing common drugs and patients’ low purchasing capability are the two subcategories under this category. One of the participants stated, "Due to the sanctions imposed on our country, insulin pens have become scarce. Thus, I cannot buy them easily and have to use fenugreek, nettle, and cinnamon instead of insulin" (a 61-year-old woman). Moreover, a number of the participants stated that an increase in the price of the main drugs was the main reason for using medicinal plants. Accordingly, one of them said, "Sir, I only have a pickup truck and cannot buy fruit because it is too expensive. Thus, sometimes even when I know my blood sugar level is high, I use brewed thymes or fenugreek instead of insulin pens" (a 59-year-old man).
Another patient said, "Since I have studied more about harms and problems of medicinal plants than other people, I use them more cautiously" (a 35-year-old woman).
4.5. Pressure imposed by the society
Most of the participants observed promotion of medicinal plants and the emphasis put on their usage by herbal therapists, family members, relatives, and other diabetics as a pressure on the side of the society to use medicinal plants. A number of the participants reported that advices from their family and friends were the most important factor in increasing their willingness to use medicinal plants. As to the accepting or rejecting of the use of these plants, some other participants referred to the significant role of traditional medicine practitioners and apothecaries, as well as advices from diabetic patients. "I was persuaded to use thyme following one of the patients' recommendations. He said he had already used it, and it had good effects on improving his illness," one of the participants stated.
However, a number of the participants stated that they would not use medicinal plants because their specialists did not find them useful. Accordingly, one of the patients said, "Many of my relatives ask me to use medicinal plants as well, but my doctor does not recognize these plants at all. Thus, I do not use them either" (a 45-year-old woman).
4.5. The role of family culture
Lifestyles and institutionalized family behaviors were reported to be effective causative factors in using medicinal plants by a number of the participants. They stated that some families believe in the effects of medicinal plants and use them for treatment purposes when they become sick. Thus, they do not find it necessary to visit a doctor. One of the participants said, "In our family, when someone gets sick, my mother prepares some herbal medicines, so no one goes to see a doctor. Besides, my mother controls her diabetes with the same plants. I am very interested in these medicinal plants because our family has been using them for a long time" (a 36-year-old woman).