Fatalism, faith and fear: A case study of self-care practice among adults with type 2 diabetes in urban Malaysia

AIMS AND OBJECTIVES: To explore self-care and self-care support in patients with Type 2 diabetes in urban Malaysia.
BACKGROUND: The prevalence of Type 2 diabetes in Malaysia and associated long-term and life-changing complications is increasing. With effective self-care and self-care support, severe complications of the condition can be avoided or reduced. Prior to this study, no evidence existed about Malaysian patients' management of the condition or support for self-care from the healthcare system.
DESIGN: A single embedded qualitative case study.
METHODS: Semistructured interviews with 18 patients with Type 2 diabetes aged 28-69 years, healthcare professionals (n = 19), observations (n = 13) of clinic appointments from two urban settings in Malaysia and a documentary analysis. Recordings were transcribed verbatim, field notes were made during observations and the data analysed and synthesised within and across case using Framework analysis.
FINDINGS: Three main themes explained self-care and self-care support in Malaysia: fatalism, faith and fear. Patients were fatalistic about developing diabetes - they perceived it as inevitable because it is so common in Malaysia. However, faith in God, coupled with fear of the consequences of diabetes, motivated them to engage in self-care practices. The fear was largely induced by diabetes healthcare professionals working in overcrowded clinics, and stretched thinly across the service, who used a direct and uncompromising approach to instil the importance of self-care to avoid severe long-term complications.
CONCLUSION: This study provided important insight on how people in Malaysia developed diabetes, their responses to the disease and the approach of healthcare professionals in supporting them to engage with self-care.
RELEVANCE TO CLINICAL PRACTICE: Any future development of self-care programmes in Malaysia needs to recognise the factors that motivate patients to self-care and include components that build self-efficacy.
Study site: three outpatient clinics (one in primary care and two in secondary care), Malaysia