Barriers and Facilitators of Management of Type-1 Diabetes in Children: A Socio-Cultural Enquiry of Caregivers' Perspectives Living in Resource-Constrained Settings.

Abstract

Purpose: Caregivers are key stakeholders in management of children with Type 1 Diabetes (T1D), but their perspectives have remained understudied, especially in the developing countries. This study explores their perspectives on the barriers and facilitators of management of a child with T1D in a resource-constrained setting.

Methods: This qualitative study, conducted in a tertiary level diabetes clinic in India, included parents of children with T1D, selected from subgroups varying in disease duration, education, habitat, and socioeconomic status, who participated in one of the five Focused Group Discussions (FGDs) of 60-90 min duration. The topic guide included questions like "What are the barriers you face related to diabetes care of your child at home or school?" and "What do you think helps you in managing a child with diabetes?" FGDs were audio-recorded, transcribed verbatim, and inductive coding was done independently by two authors.

Results: Twenty-eight parents (nineteen mothers and nine fathers, mean age: 35.1 years) of children aged between 2-13 years, were recruited till data saturation. Themes related to barriers of management were, 'balancing nutrition and glycemic control is challenging', 'diabetes management involves psychological burden' and 'operational challenges'. Parents opined that family support, gaining decision-making and problem-solving attitude and optimal school-time management helped.

Conclusion: Parents living in resource-constrained circumstances perceive unique challenges during management of T1D in their children like social stigma, illiteracy, financial and logistic issues like procuring and storing essential supplies. A better understanding of these factors can aid healthcare professionals in managing them.