Research design and setting
The phenomenological approach was used to explore the lived experiences of people with T2DM in Ghana during the COVID-19 pandemic. This approach aids in exploring a phenomenon from the perspective of those who experienced it; and the meaning of their experience (36). A semi-structured in-depth interview was used to gather in-depth information about how the participants made sense of their experiences without general assumptions (37). This study was conducted at the Korle-Bu Teaching Hospital (KBTH) in the Accra metropolis. This hospital is a premier healthcare facility in Ghana and a tertiary hospital located in Accra, the capital of Ghana. The hospital has 21 clinical and diagnostic departments and three centres of excellence. Participants were recruited from the National Diabetes Management and Research Centre (NDRC), a unit of the Department of Medicine. This Centre has a team of consultants, doctors, assistant physicians, dieticians, optometrists, nurses, psychologists, providing holistic treatment to patients with diabetes. This setting was chosen because it was situated in a ‘hotspot’ region (Accra) for COVID-19 infection and therefore, the rate of infection may have impacted patients directly or indirectly in terms of their diabetes management.
Participants
Ten participants were purposively and conveniently sampled for in-depth interviews to explore their experiences during the COVID-19 pandemic (38). These sampling approaches were used as they allowed the researchers to select participants who were able to provide information necessary to achieve the objectives of the study. Participants selected met the following inclusion criteria: 1) ≥ 40 years old and 2) diagnosed with diabetes for more than two years before the start of the COVID-19 pandemic. Participants with severe mental disorders or cognitive impairments as well as those who had changed their medication less than 6 months before the study were excluded from participating in the study.
Fifteen (15) patients were approached but 12 agreed to participate in the study. These prospective participants were screened for eligibility and even though all of them qualified to be tested, by the tenth participant, the researcher had reached saturation, and no new information was obtained (39). Out of the 10 participants, 5 were male and the remaining 5 were females. They were aged between 49 and 68 years, with an average age of 54 years; and their duration of diabetes diagnosis were between 3 and 23 years. Half of the participants interviewed had tertiary education and more than half of them were married. Most of the participants interviewed were Christians. Participants information are presented in Table 1.
Table 1
Demographic characteristics of participants
| Participant | Gender | Age | Duration of diagnosis | Educational level | Marital status | Religion |
| P1 | Female | 49 | 5 | SHS | Married | Christian |
| P2 | Female | 68 | 23 | Tertiary | Widowed | Christian |
| P3 | Female | 52 | 3 | SHS | Married | Christian |
| P4 | Male | 43 | 11 | JHS | Married | Christian |
| P5 | Male | 46 | 13 | Tertiary | Single | Muslim |
| P6 | Female | 53 | 9 | JHS | Married | Christian |
| P7 | Male | 40 | 10 | Tertiary | Single | Muslim |
| P8 | Male | 61 | 12 | Tertiary | Married | Christian |
| P9 | Female | 63 | 6 | Tertiary | Married | Christian |
| P10 | Male | 67 | 21 | SHS | Divorced | Christian |
[INSERT Table 1 HERE]
Measures
Semi-structured interview guide
A semi-structured interview guide was developed to explore the experiences of people living with T2DM during the COVID-19 pandemic. The guide was in four parts which focused on questions relating to 1) participants’ perceptions of COVID-19, 2) diabetes self-care management in the wake of the COVID-19 pandemic, 3) participants’ fears and anxiety about COVID-19 and 4) the coping strategies employed. Each of these parts had several questions with probes which served as prompts to elicit in-depth information from participants. Demographic information was also obtained from the participants. Some of the questions asked during the interview included: “How have you been managing your treatment of diabetes since the outbreak of COVID-19”? “How have you coped with any anxieties and fears related to COVID-19 pandemic” and “Generally, have you faced any difficulties in the period of pandemic with regards to your health”?
Ethics considerations
Ethics approval
was obtained first, from the Ethics Committee for Humanities (ECH 156/20–21) at the University of Ghana and second, from the Korle-Bu Teaching Hospital Institutional Review Board (KBTH-IRB 00039/2021) which permitted data collection at the National Diabetes and Research Centre (NDRC) in KBTH. The researchers observed the following key ethical principles; confidentiality, anonymity, voluntary participation, and written informed consent. COVID-19 protocols were also observed.
Procedure
The ethics approval letter from the KBTH Institutional Review Board was taken to the Medical Department and the National Diabetes Management and Research Centre, where the researchers further sought permission to recruit participants for the study. The first author (GG-M, a student) conducted the interviews. Data collection began with the researcher approaching patients in the waiting area of the clinic to explain the purpose of the study and solicit participation. Prospective participants were screened for eligibility, and those who qualified were interviewed. Participants were interviewed in English or Asante Twi depending on which they were comfortable communicating in. The interviews were audio recorded with the permission of the participants, and the duration of the interviews was between 25 and 45 minutes. Data collection lasted for four weeks.
Data analysis
Data was analysed using thematic analysis which involved six steps (40). First, the interviews were transcribed, and the researcher (GG-M) familiarized herself with the data by reading and re-reading the transcripts. Second, codes were formed from the data by putting raw data in a meaningful segment. Third, subthemes were generated out of the codes by assembling codes with similarities. The generated subthemes were then reviewed by all the researchers to eliminate overlaps. Fourth, the researchers reviewed the subthemes with their codes to ensure they were appropriate, and then categorized the subthemes into main themes. Fifth, themes and subthemes were re-defined and re-named to give them meaning. The sixth and final step in this analysis was producing a report based on the final representation of the results, accompanied with narratives from the transcripts.
Reflexivity and Trustworthiness
In qualitative research, the researcher is the main instrument for data collection and analysis which can be possibly influenced by his/ her opinions, biases, and experiences (41). It is therefore important for a researcher to consciously mitigate personal biases and judgments to ensure unbiased outcomes during research.
Every researcher involved in this study has encountered individuals who live with diabetes. Two researchers (MAP and KOA) have specifically conducted studies involving diabetes management, thus gaining insight into the strict treatment regimens these individuals follow. Additionally, the researcher (GG-M) completed her practicum at a diabetes centre, leading to her familiarity with their management protocols and daily routines. Despite the collective experience of the researchers with diabetes patients, they consciously set aside their preconceptions when approaching this research. The study was approached with a fresh perspective, treating each participant as if they had no prior knowledge about their condition. Throughout the interviews, the researchers maintained an open-minded stance, ensuring that the data collected remained uninfluenced by their personal experiences or opinions.
In this study, trustworthiness was maintained, by ensuring credibility, transferability, dependability, and confirmability (41). The researchers gave a detailed description of the phenomena under study and using the appropriate qualitative method, conducted in-depth interviews which were transcribed and analysed thoroughly. Personal beliefs and assumptions of the researchers were acknowledged and set aside in other to be objective during data collection and interpretation. The initial coding of transcripts was done by the first researcher (GG-M) and then evaluated by the other researchers, MAP and KOA. The researchers then developed the subthemes and themes, peer-reviewing them throughout the process to reduce subjectivity. The researchers provided findings directly from the data, by supporting the various themes and subthemes with quotes from the transcripts to ensure they were grounded in data.
RESULT
Analysis of transcripts yielded four themes, each with their sub-themes. These were: 1) Perception about COVID-19, 2. Challenges and changes in diabetes treatment, 3) Psychosocial impact of COVID-19, and 4) Coping with diabetes care during the pandemic. Themes and subthemes are presented in Table 2.
Table 2
Summary of Themes and Subthemes
| Themes | Subthemes |
| Perceptions about COVID-19 | • Vulnerability of weak immune systems, • Varying beliefs about COVID-19 • “Protocols are for protection” |
| Challenges and changes in diabetes treatment | • Disruption in self-care routines • Changes in clinical reviews • Improvement in management. |
| Psychosocial impact of COVID-19 | • Emotional distress of COVID-19 • Stigmatized as a diabetes patient |
| Coping with diabetes care during the pandemic | • Maintaining diabetes care • Psychosocial coping in the pandemic |
[INSERT Table 2 HERE]
Perceptions of COVID-19
This theme reflected the perception of COVID-19 among participants living with Type 2 Diabetes. They reported their thoughts about the disease, COVID-19, the heightened risks associated with being part of a vulnerable group, their beliefs regarding the origins and persistence of the virus and the importance of preventive measures to mitigate its spread. Subthemes within this theme included: 1) Vulnerability of weak immune systems, 2) Varying beliefs about COVID-19, and 3) “Protocols are for protection”.
Vulnerability of weak immune systems
Information about COVID-19 and its effect on the health of individuals who are infected was well known by participants. They were also aware that people with compromised immune systems were known to be at a higher risk of getting infected, severely being affected and having a high rate of mortality. This was expressed vividly by some participants as follows:
Okay, what I heard was that for those of us who have diabetes our immune systems are not as strong as those who do not have diabetes. So when you get COVID and someone without diabetes gets COVID too, you will die faster than the person because of your immune system (P.4, female, 46 years).
From my understanding, if you are diabetic, you are very prone to get COVID-19 because your immune system is low. I was also made to understand that with that disease [COVID-19] and diabetes, they are very close. If you are diabetic, it is easy for you to get the virus and die (P.7, Male, 40 years).
These quotes reflected participants’ heightened awareness of the potential health complications associated with contracting COVID-19, due to their pre-existing medical condition (diabetes). It indicated the education participants had received and their knowledge and awareness about being a vulnerable population. While some participants believed that having diabetes automatically meant being infected with COVID-19, others understood their illness increased their susceptibility to severe COVID-19 infection or mortality.
Varying beliefs about COVID-19
Participants held varying beliefs about COVID-19 due to the various conspiracy theories and information that emerged about the pandemic when it began. In this study, some participants viewed the pandemic from a religious perspective, while others held the view that people in some parts of the world were more vulnerable to the infection than others from other parts of the world, such as Ghana. As some reported,
The truth is that, if COVID will go it is all up to God. Whether it will stay forever or not, everyone is just saying. But for me, I saw life to be one that, meant man cannot do much except God (P.1, Female, 49 years).
You know over there, their low temperate zone- it was easier for them to catch it. But when it came here, it was confusing at first because we thought the climate here made it not possible to get it, but it still came. I almost did not believe it till I heard doctors advising people with diabetes (P.8, male, 61 years)
One participant, however, was of the view that the pandemic, like some other pandemics was going to “stay” forever but could eventually be prevented. As he reported,
For me, I saw that it’s going to stay with us forever. This disease is not going to go. Since it’s a virus and it is spreading, there’s no way it’s going to go. It is just like malaria and HIV when it started, we now have medications that will prevent them (P.7, Male, 40 years).
Participants' perception of COVID-19, shaped their beliefs regarding the pandemic. Some participants viewed the pandemic through a religious lens, believing that only divine intervention could end it, while others believed, similar to previous pandemics, it would dissipate with the availability of medications. Regardless of the different beliefs they held, participants’ beliefs also influenced their reactions to the pandemic, including how they chose to protect themselves.
“Protocols are for protection”.
Participants reported the COVID-19 preventive measures were beneficial to them, given their heightened susceptibility to COVID-19. These protocols were deemed essential as they represented the primary mode for reducing their risk of infection, especially in the absence of a cure. The excerpts below reflect this.
Well, it was difficult for me to adhere to the protocols because we were not used to them. But later I saw that no, if I don’t do that it will rather disturb me since I am vulnerable like they say (P.9, Female, 67 years).
The other day I cautioned someone without a nose mask in a car and she told me that ‘I am the one who is afraid so I should wear mine’. So, someone may contract it but may not die but if I contract it, I will die because of my sickness. So, I will take caution before it is too late for me (P.2, Female, 68 years).
Protecting themselves by following the preventive measures and maintaining health behaviours was seen as important, as several (seven) participants reported they had the duty to protect themselves by strictly observing all the protocols. Also, participants reported it was their responsibility to ensure people around them observed the protocols too. Unfortunately, not all participants could consistently follow the COVID-19 preventive protocols because they felt they had no choice. As one participant indicated,
I still went to the market to sell. I go around with my phone cards to get some coins. So, the 3 weeks of lockups in Kasoa [a suburb of the central Region of Ghana], I didn’t observe [the protocols] because I had to force myself to get my daily bread. It was a decision I had to make because I could have died from hunger then (P.8, male, 61 years).
Despite being aware that disregarding the protocols increased his risk, this participant had a difficult choice of adhering to the lockdown and not being able to earn an income to feed himself or breaking the rules to be able to feed himself. From his report, he chose to prioritize going out to earn an income to meet his daily meals as a person managing diabetes.
Thus, the emergence of COVID-19 and its preventive measures led to participants making some pertinent decisions as well as lifestyle changes. These changes may have had positive or negative effects on the lives of the participants, especially their diabetes management.
Challenges and changes in diabetes treatment
This theme reflects the varied effects of the pandemic on the health of individuals living with Type 2 Diabetes (T2D). Participants in the study reported both positive and negative impacts from their experiences during the pandemic. The three subthemes under this theme are 1) Disruption of self-care routines, 2) Changes in clinical reviews, and 3) Improvement in management.
Disruption in self-care routines
People with T2D are expected to manage their glycemic levels by taking their medications as prescribed, monitoring their glucose levels, engaging in physical exercise and adhering to a dietary plan. However, all 10 participants reported they had had disruption in their self-care routines. This was as a result of how challenging their diabetes management had become, due to the COVID-19 pandemic, and the measures to curb infection rates in Ghana. The excerpt below illustrates some disruptions in their self-care routine.
There were times in the morning for instance I took yam [starch tuber like potato], which increases my sugar level. But that is the only thing available. If it was plantain, my sugar level will have gone down. I took yam in the morning. In the afternoon, there was nothing, so I took rice. Rice also raises my sugar level. All these foods are not good for me ( P.8, Male, 61 years).
First, I used to go to the gym as I said earlier, it was every Saturday morning for training. When the lockdown happened, the gym I was going to shut down. After the ban, one has still not been able to open and that is the one close to me too. So the lockdown affected my training and after the lockdown, I become too lazy to go back to the gym (P.6, female, 53 years).
Since COVID started till now, last month was when I checked my sugar, it had gone up to 8.5. I was not happy with myself at all because I could not tell what led to that 8.5. I had been recording around 4 even sometimes 3.8 …I am very careful because if you joke with your sugar level it will joke with you (P.9. female, 63 years).
The COVID-19 pandemic disrupted the daily self-care routines of participants, which were essential for managing their health condition. Restrictions such as lockdowns and social distancing measures hindered physical activities, as participants sought to avoid crowded places.
Not only were participants’ self-care routines disrupted, but additionally, most of them had their clinical appointment dates/ or processes changed, while a few skipped their appointments out of fear of being infected. This is reflected in the next subtheme.
Changes to clinical reviews
Anxieties surrounding the pandemic led some participants to avoid attending clinical reviews, particularly at facilities such as the Korle-Bu Teaching Hospital (the study site), which was designated as a COVID-19 isolation centre.
Yes, it [COVID-19] changed it [diabetes management]. I was not coming, I avoided coming to the clinic for one year. I had my appointments, but I did not come. That was when my daughter told me that the COVID- you cannot tell who has it. It could even be that the doctor/nurse you are going to see has some of the COVID-19. So I did not come (P.3, female, 52 years).
For some participants also, the processes for their clinical appointment was truncated as they simply saw a nurse, collected their prescriptions and departed from the clinic. Thus, their clinic visits did not entail the comprehensive routine examinations, including glucose monitoring, ketone testing, and blood pressure checks or even consultations with doctors.
The change that happened was that when COVID-19 was severe, I remember when I came, I did not even get to see the doctor because they said I had no issue. When you come for review, they were not checking your sugar level. Whether it is high or low they were not doing it. They were not checking the urinal or anything. They will just write medication and give you 6 months. So that is what we have been doing for the past year (P.10, Male, 67 years).
Other participants also lamented about how their monthly clinical appointments had now been prolonged to three months or even six months in some cases.
It was during COVID-19 that the schedule was from monthly to six months.… but six months is a long time so you consume a lot of food that will raise your sugar level and you won’t even know it (P.3, female, 52 years)
I had some soreness with my foot… nothing pricked me, but the thing was swelling, so I noticed there was something wrong with the tissue. I reported to a pharmacy… I came to see the doctor for proper medication after 4 months of treating the sore on my own (P.2, Female, 68 years)
Though participants reported challenges with their self-care routines and clinical appointments, the effect of COVID-19 was not all negative. Participants reported some positive effects that COVID-19 had had on their diabetes management.
Improvement in self-management
Some participants acknowledged that the lockdown during the initial period of COVID-19 in Ghana, gave them enough time to take good care of themselves and improve their diabetes management. Thus, they were quick to report the positive impact that the pandemic had on their health. One participant for instance had been non-adherent with his treatment regimen until the emergence of the pandemic and its preventive measures, which forced him to resolve to be adherent with his treatment regimen.
It has also helped me to now take control of my health, you know as I speak to you, I wouldn’t have requested to see a specialist at the diabetic clinic, I wouldn’t have because I would have been busy or on a work trip, you know. So, the impact is positive like I said. For me, the pandemic has given me much time to make resolutions and take proper care of my diabetes (P.5, Male, 46 years).
Another participant reported the pandemic gave him enough time to adhere to a good dietary plan and maintain his other treatment regimens.
Before COVID-19 sometimes when I’m busy my diet changed. I can be so busy I don’t take my breakfast. Sometimes I’ll wait till when it’s 2 o’clock before I take lunch. Sometimes after I take lunch then that’s all. So, the lockdown was of great help to me because I got time to rest, exercise and manage my diet well. After all, I was at home. I also told myself this is the time to eat well and get some good records of my sugar level, and it has helped me a lot (P.7, Male, 40 years).
Amidst the disruptions caused by the pandemic, the lockdown period provided participants with a valuable opportunity to dedicate ample time to themselves and focus more on adhering to their treatment regimen. With their usual activities temporarily halted, participants were able to prioritize their healthcare routines, even though this did not necessarily take away the negative impact the pandemic was having on them.
Psychosocial Impact of COVID-19
Participants reported the impact of COVID-19 on their mental health as they struggled to live with the pandemic amidst managing their diabetes. Juggling their diabetes self-care and preventing the infection of COVID-19, put a toll on the participants both psychologically and socially. This theme had the following subthemes 1) Emotional distress of COVID-19, 2) Stigmatized as a diabetes patient.
Emotional distress of COVID-19
Concerning the impact of COVID-19 on their mental health, most participants mentioned experiencing emotional distress at the onset of COVID-19 in Ghana and when parts of the country were under lockdown. The common distress expressed among these participants were uncertainties, worry and sadness, though the cause of worry for each participant was different. One participant expressed his worry in the narrative below:
For example, even after lockdown here, my trip to India was cancelled because of the COVID-19 situation there. Not only that but other work appointments were cancelled, and it was tough on me. I’m a single man so my work is all I have. At a point I left my hair [unkempt], people were wondering what was happening. But I’d even forgotten I needed to shave and barber all because I was stressed (P.5, male, 46 years).
I was disturbed, I kept asking myself, are we ever going to go back? How long will we stay home? So, it got me to think a lot…. yes, it affected my sleep a little. My husband was even complaining about why I was over worrying (P.4, female, 46 years).
I mostly end my day sitting in a lounge with my friends. We meet to discuss all manner of things. You know, as retired people this is one of the ways to keep us going. During COVID-19 we could not meet as we used to meet. After 2 weeks, I realized I had lost something that kept me going. I felt sad and lonely and maybe it is also because I live alone (P.8, male,61 years).
Going about their daily routines and socializing with friends gave participants a sense of purpose and belongingness, but this was unexpectedly taken away by the COVID-19 restrictions and ban on social gatherings by the government, to curb the spread of infection and prevent deaths. For instance, for participant 8, being a retired person and living alone, he had nothing to occupy him, save his social interactions with his friends. Hence, these COVID-19 restrictions had a great impact on his psychological well-being, and this was also obvious for other participants as depicted in the quotes above.
Most of the participants experienced COVID-19-related fears and uncertainties due to their vulnerability to its infection and the possibility of serious illness or death should they get infected with the virus.
Yeah, COVID-19 brought me a lot of fear at the beginning. A sickness that was killing people at that rate is something to fear. I could not tell where and how I can get infected, and if I will survive it, so it made me restrict myself from a lot of things (P.9, female, 63 years).
I had to be admitted to the hospital for one week, I think. I was very afraid all the time I was in the hospital… anytime the doctors asked for a lab test to be done, I get so anxious and when the results are in, I always wanted to find out what is in the result because I wanted to know if COVID-19 test was part of it. I have not lived in fear like that before (P.7, male, 40 years).
While some participants lived in fear, others were able to overcome their fears so that instead of fretting, they chose to take precautions to protect themselves by staying home. As one participant reported:
I do not think about COVID-19 because they told us that because of our diabetes, we should not think a lot, because it is not good for your health. Thinking too much can affect your health. So, after some time, I was not thinking of COVID-19 at all. Also, I do not go out a lot, so I was not scared (P.2, female, 68 years).
Stigmatized as a Diabetes Patient
The knowledge that most people dying from COVID-19 infection were individuals living with chronic illnesses such as diabetes, hypertension, cardiovascular disease, etc., led to some form of stigmatization in society. For some participants whose family members and other individuals were aware of their condition, these persons made them (participants) feel unwelcome in their presences, causing participants to isolate themselves or feel isolated.
The first time I got back from the diabetic clinic when COVID-19 started, I did not like how my family treated me. It’s like they are coming close but giving some distance too. They were afraid I will get COVID-19 and transmit it to them. So, I stayed in my room no matter what was happening to me, I was sad (P.2, female, 68 years).
I was not attending anything not because I didn’t want to, but because the way some people behaved when I was around them made me sad. I decided not to go to any gathering in the area because I am at risk, but they rather made me feel like I am bringing something to them. (P.6, female,53 years).
This stigmatisation affected one participant to the extent that her diabetes care was negatively impacted, resulting in increased gylcemic levels.
I told you my grandchildren had been restricted from me and so I was a bit sad and lonely and that affected my routine. I wasn’t doing the right thing. I was not even coming out to the yard to stretch like I used to do. It disturbed my management and today I am still trying to get the sugar to go down (P.9. female, 63 years).
Coping with diabetes care during the Pandemic
As a result of changes in work routines, social interactions, and healthcare accessibility for COVID-19 treatment, participants had to adjust their lifestyles to align with the demands of the pandemic era. They recounted their strategies for maintaining both physical and mental wellbeing amidst these changes, recognizing the need to manage their diabetes. The subthemes which culminated into this theme are 1) maintaining diabetes care, 2) psychosocial coping in the pandemic.
Maintaining diabetes care
According to the participants, their awareness that diabetes makes them susceptible to serious illness or death propelled them to engage in healthy behaviours such as monitoring their blood sugar and blood pressure levels. Additionally, they made conscious efforts to engage in some form of physical activity to control their glycemic levels, while coping with the restrictions of the pandemic.
We have all the machines. The BP machine and the sugar machine so I was controlling my diabetes even though I was not coming to the clinic. Every week we check. Even my daughter wished it was more than once a week, but I am afraid of the needle, so I do it once. I knew since I was doing what I was supposed to do, there is no way I had to be afraid of getting COVID-19 (P.3, female,52 years).
If I don’t engage in physical activity, my blood sugar fluctuates. So, after some time I realized I was doing more harm to myself by being affected by the COVID restrictions. So, I decided to engage in physical activities so I can cope well. So, I started a small garden behind my house and that kept me active in the mornings and it helped me (P. 8, male, 61 years).
Psychosocial coping in the pandemic
To maintain good glycemic levels for physical health and sound mental health during the COVID-19 pandemic, participants used different coping strategies, such as engaging in activities to feel relaxed, and helped them to cope as best as they could. Some participants reported engaging in recreational activities as depicted in the extracts below:
I love to sing and dance. This helped to take the pressure away from me. It is something that helps me. I am also a chorister, so I sing praises a lot. All these helped me to relax- forget about all the scary and sad things that were happening during the pandemic (P. 1, female, 49 years).
I did watch a lot of videos on interesting topics, and it helped me relax. I also have a very big screen, so I love to watch movies, these are what kept me calm when we were on lockdown (P.5, male, 46 years).
Other participants reported coping through religious means. They reported praying to God as a means of dealing with their fear of COVID-19 and also praying for God’s protection against the deadly virus. This gave them hope and calmed them down during this challenging period of their lives.
I had faith and prayed all the time when this COVID started that nothing can come and add up to my diabetes, as I am there right now my only hope is God, that He will protect me and my family. I have faith in God (P.1, female, 49 years).
As a Christian when you pray you feel okay and encouraged so we were praying. Because this thing only God knows when it will go for things to become normal (P.8, male, 61 years).
I prayed that God would continue to have mercy and rescue us. Doing that helped me not to be afraid because I believed God was protecting me (P.10, male, 67 year).
Participants further shared how family and friends helped alleviate the stress and fear they had about getting infected with COVID-19 by keeping them company, helping them keep up with their diabetes management and strictly adhering to preventive protocols while resorting to their own COVID-19 remedies as family members. Some of the narratives are shown below:
Sometimes being home with the whole family was helpful. There are people to talk to and all. My family and I used to watch movies together and talk and laugh and I think that helped. Even though some things were taken away, my family was always there. Their company helped me to cope (P.4, female, 46 years).
They know about my diabetes, and they also heard about the woman whose husband infected her and she died instead. So, they all protected themselves. They were always in their nose mask when they are going out, but they were not going out anyhow too. They were also chewing some ginger and herbs. Everyone was doing it to help themselves. So, I will say they helped me (P.6, female, 53 years).
The results showed that as people living with diabetes, the participants put in measures to combat the distress that came with the pandemic. As reported above, knowing they were susceptible to the infection of COVID-19 which also made them vulnerable to death, participants resorted to their own ways of coping in order to stay in good health.