Gedif, Teferi(PhD)Boon, Heather (Professor)Messele, Bruck2018-06-212023-11-062018-06-212023-11-062017-06http://etd.aau.edu.et/handle/123456789/2540Introduction: Type 2 diabetes, which is increasingly becoming a public health problem in developing economies including Ethiopia, is associated with a high level of microvascular and macrovascular complications. Evidence from the Western world indicates that gaining an understanding of patient perceptions and experiences would serve as useful inputs in the design of effective strategies aimed at improving their care and health outcomes. This research project utilized different theoretical models, namely Kleinman’s explanatory model, Horne’s necessity-concerns framework as well as de Haes and Bensings’ medical communication model to explore the illness and treatment experiences of patients with type 2 diabetes in selected hospital settings in Addis Ababa and Butajira. Methods: Qualitative interviews were held with 39 purposively sampled patients with type 2 diabetes who were selected to represent varied socio-demographic and a range of illness and treatment experiences. Interviews were conducted until saturation of key themes. The analysis and interpretation was carried out using a thematic analysis approach. Findings: The findings from this study revealed that participants’ explanatory frameworks were influenced by the biomedical and traditional models (including cultural and religious influences). It was also apparent that participants’ biomedical knowledge was low which was expected given their low formal education status. Cultural influences were apparent for instance in the manner that participants labelled their illness as ‘sugar disease’ and their perception of suitable treatment strategies. Religion likewise exerted its own influence with respect to the perceptions of causation and the appropriateness of treatments. With regards to the anti-diabetes medication, findings indicated that participants’ perceptions revolved around their necessity and concerns which were also indicative of the utility of the Horne’s necessity-concerns framework. In this regard participants’ concerns about their iii medications were not that much different to those of their Western counterparts in certain aspects (e.g., about the adverse effects and the number of medications) while they differed in others (e.g., associating diabetes-related complications such as eye problems to medication adverse effects) which seem to be influenced by their socio-cultural and low educational backgrounds. Perceptions about the necessity of their medications were however given less attention as compared to the concerns about safety issues. Though participants’ concerns were mostly about adverse effects, inconveniences in handling and accessing their medications were also found to be sources of concern. It was also apparent that some of the participants’ concerns were quite strong or not based on evidence but may nevertheless potentially affect adherence to prescribed medications. Findings with regards to participants’ perception towards their healthcare providers were organized following de Haes and Bensings’ communication model. Perceptions focused on fostering the relationship and the provision and gathering of information aspects. By and large, participants detailed their suboptimal experiences in the care provided by their healthcare providers that were below their expectations. Participants’ adherence to prescribed anti-diabetes medications were negatively affected by a range of factors that included: perceptions about their illness especially related to symptoms and hope for a cure, perceptions about prescribed medications especially related to concerns, their relation to the healthcare providers and the health system factors such as the provision of diabetes education and availability of medications and religious healing practices especially use of holy water and religious duties. Factors that served as facilitators to adherence included the presence of diabetes complications and perceived health benefits that enhanced medication necessity perceptions, religious practices and social support. On the other hand, some of the participants reported using medicinal plants such as Shiferaw (Moringa spp.) and Anamuro (Ajuga spp) in a complementary manner to their biomedical regimens. While their use did not seem to negatively affect adherence, some participants reported adverse effects which led to discontinuation of these medicinal plants. Different factors influenced the use of medicinal plants including perceptions that bitter things were good for diabetes, claimed or experienced efficacies and mass media messages. Findings also revealed that the use of medicinal plants was occuring in the context of limited information which may further result in suboptimal health outcomes. iv Conclusion: The perceptions held by the study participants towards their illness and its treatment were found to negatively influence their experience and adherence to prescribed anti-diabetes medications. The suboptimal care provision experienced by these participants appears to be another factor that contributes to the nonadherence issue. It is therefore recommended that a chronic care model be implemented that incorporates current care standards, strengthened and context specific diabetes education and adherence support programs. Key words: Type 2 diabetes, Kleinman’s model, Horne’s Necessity-Concerns model, de Haes and Bensing Medical Communication model, Adherence to Anti-diabetes Medications, Qualitative research, Ethiopia, Addis Ababa, ButajiraenType 2 diabetes, Kleinman’s model; Horne’s Necessity-Concerns model; De Haes and Bensing Medical Communication model; Adherence to Anti-diabetes Medications; Qualitative researchThesis