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Diabetes care in a complex humanitarian emergency setting: a qualitative evaluation
Open accessAbstract
BACKGROUND: Evidence is urgently needed from complex emergency settings to support efforts to respond to the increasing burden of diabetes mellitus (DM). We conducted a qualitative study of a new model of DM health care (Integrated Diabetic Clinic within an Outpatient Department [IDC-OPD]) implemented by Médecins Sans Frontières (MSF) in Mweso Hospital in eastern Democratic Republic of Congo (DRC). We aimed to explore patient and provider perspectives on the model in order to identify factors that may support or impede it. METHODS: We used focus group discussions (FGDs; two discussions, each with eight participants) and individual semi-structured qualitative interviews (seven patients and 10 staff) to explore experience of and perspectives on the IDC-OPD. Participants were recruited purposively to represent a range of DM disease severity and staff functions respectively, and to ensure the age and gender distribution was representative of the population of DM patients registered in the clinic. Data were coded in NVivo10© and analysed using an inductive thematic approach. RESULTS: There appears to be little awareness surrounding DM in patient communities, resulting in delays presenting to hospital. Patients describe their first reactions to symptoms as fear and confusion, often assuming symptoms are of another disease (e.g. HIV/AIDS). They often express disbelief that they could have DM (e.g. stating DM is a 'rich man's disease') and lack acceptance that there is no cure. Patients experienced difficulty travelling to appointments, exacerbated by flare-ups in the conflict. Providing psycho-social and sensitisation activities in a group setting appears to offer an opportunity for patients to support each other in their effort to adhere to drug treatment and follow-up appointments. All patients reported great difficulty in adhering to the recommended diet, which was viewed as unaffordable and unavailable, and fear that this would be the biggest obstacle to maintaining their drug treatment (as treatment must be taken with food). CONCLUSION: Our findings emphasize the importance of community awareness of DM and the value of treatment support, including psychosocial and educational support to DM patients and their families, and culturally sensitive, low-cost dietary advice, to ensuring the adoption and maintenance of DM treatment.
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Complicated multi-faceted intervention demands and fragmented, contradictory clinical guidance create widespread complexity barriers disrupting sustained diabetic dietary self-management, with distinct burdens observed in both high-income (HIC) and low- and middle-income (LMIC) populations.
“Complicated multi-faceted intervention demands and fragmented, contradictory clinical guidance create widespread complexity barriers disrupting sustained diabetic dietary self-management, with distinct burdens observed in both high-income (HIC) and low- and middle-income (LMIC) populations (40, 43, 70, 94).”
From Implementation and translation of evidence-based dietary strategies for type 2 diabetes in resource-limited settings: a scoping review based on the CFIR framework (2026) · cites this paper as [70]
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Experimental — accuracy not yet measuredIn conflict-affected Democratic Republic of the Congo, standard universal diabetes guidelines bring severe practical complexity to local patients.
“In conflict-affected Democratic Republic of the Congo, standard universal diabetes guidelines bring severe practical complexity to local patients.”
From Implementation and translation of evidence-based dietary strategies for type 2 diabetes in resource-limited settings: a scoping review based on the CFIR framework (2026) · cites this paper as [70]
The Results section reports that patients in conflict-affected eastern DRC had great difficulty following the clinic’s recommended diabetes diet because the foods were unaffordable or unavailable. The Conclusion calls for attention to the appropriateness of dietary guidelines. The paper does not identify those recommendations as standard universal diabetes guidelines or attribute the broader difficulties of diabetes care specifically to such guidelines. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn conflict-affected Democratic Republic of the Congo, widespread community misconceptions frame diabetes as a curable disease exclusive to wealthy groups, leading most residents to prioritise traditional healers over the complicated long-term chronic self-management regimens promoted by medical staff.
“Furthermore, widespread community misconceptions frame diabetes as a curable disease exclusive to wealthy groups, leading most residents to prioritise traditional healers over the complicated long-term chronic self-management regimens promoted by medical staff (70).”
From Implementation and translation of evidence-based dietary strategies for type 2 diabetes in resource-limited settings: a scoping review based on the CFIR framework (2026) · cites this paper as [70]
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Experimental — accuracy not yet measuredHealthcare system dependency on MSF support and lack of local health department ownership and sustained investment raise concerns about project sustainability.
“Healthcare system dependency: reliance on MSF (Médecins Sans Frontières) support; the local health department lacks ownership and sustained investment, raising concerns about project sustainability(p7-p8) (70)”
In conflict-affected Democratic Republic of the Congo, frequent food scarcity creates a vicious cycle where individuals skip prescribed medicines due to insufficient nutritional intake.
“Frequent food scarcity creates a vicious cycle where individuals skip prescribed medicines due to insufficient nutritional intake.”
In conflict-affected Democratic Republic of the Congo, nutritionally recommended healthy foods are costly and rarely accessible locally, creating extra financial pressure when patients attempt to prepare separate diabetic meals for household consumption.
“Nutritionally recommended healthy foods are costly and rarely accessible locally, creating extra financial pressure when patients attempt to prepare separate diabetic meals for household consumption.”
In conflict-affected Democratic Republic of the Congo, complex multi-task self-care burdens exacerbate the difficulty of adherence: patients need to combine rigorous diet restriction, repeated long-distance hospital visits amid regional instability and persistent medication taking.
“Complex multi-task self-care burdens exacerbate the difficulty of adherence: patients need to combine rigorous diet restriction, repeated long-distance hospital visits amid regional instability and persistent medication taking.”
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Shao, K., Lei, H., Zhu, J., Chen, X., Sina, Y., & Yao, R. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1870603
“…44, 46, 55, 64, 69, 80, 81, 84, 89, 99, 102–104, 107, 109, 112, 118, 120, 121); qualitative studies ( n = 20): (12, 20, 21, 28, 33, 34, 36, 41, 42, 50, 54, 57, 60, 63, 70, 73, 75, 77, 82, 86); mixed-methods studies ( n = 18) (13, 16, 32, 38, 43, 49, 51, 58, 72, 88, 90, 93–95, 97, 106, 110, 111).”
Aljadeeah, S., Nagel, E., & Wirtz, V. J. (2021) · Research Square · doi:10.21203/rs.3.rs-725149/v1
Assaf, S. A., Kleiner, D., Zelkó, R., & Hankó, B. (2023) · Healthcare · doi:10.3390/healthcare11121720
Ansbro, É., Homan, T., Qasem, J., Bil, K., Rasoul Tarawneh, M., Roberts, B., Perel, P., & Jobanputra, K. (2021) · Figshare · doi:10.6084/m9.figshare.14481947
Self-citationMurphy, A., Willis, R., Ansbro, É., Masri, S., Kabbara, N., Dabbousy, T., Bahous, S., Molfino, L., Perel, P., & Boulle, P. (2022) · Figshare · doi:10.6084/m9.figshare.20003674
Self-citationAljadeeah, S., Nagel, E., & Wirtz, V. J. (2021) · Figshare · doi:10.6084/m9.figshare.16807676
Aljadeeah, S., Nagel, E., & Wirtz, V. J. (2021) · Figshare · doi:10.6084/m9.figshare.16807673
Ansbro, É., Homan, T., Qasem, J., Bil, K., Rasoul Tarawneh, M., Roberts, B., Perel, P., & Jobanputra, K. (2021) · Figshare · doi:10.6084/m9.figshare.14481941
Self-citationAnsbro, É., Homan, T., Qasem, J., Bil, K., Rasoul Tarawneh, M., Roberts, B., Perel, P., & Jobanputra, K. (2021) · Figshare · doi:10.6084/m9.figshare.14481944
Self-citationAnsbro, É., Homan, T., Qasem, J., Bil, K., Rasoul Tarawneh, M., Roberts, B., Perel, P., & Jobanputra, K. (2021) · Figshare · doi:10.6084/m9.figshare.14481932
Self-citationAnsbro, É., Homan, T., Qasem, J., Bil, K., Rasoul Tarawneh, M., Roberts, B., Perel, P., & Jobanputra, K. (2021) · Figshare · doi:10.6084/m9.figshare.14481935
Self-citationMurphy, A., Willis, R., Ansbro, É., Masri, S., Kabbara, N., Dabbousy, T., Bahous, S., Molfino, L., Perel, P., & Boulle, P. (2022) · Figshare · doi:10.6084/m9.figshare.20003671
Self-citationAljadeeah, S., Nagel, E., & Wirtz, V. J. (2021) · Figshare · doi:10.6084/m9.figshare.16807679
Aljadeeah, S., Nagel, E., & Wirtz, V. J. (2021) · Figshare · doi:10.6084/m9.figshare.16807670
Shehab, B., & Sárváry, A. (2026) · Diabetes Obesity and Cardiometabolic CARE · doi:10.2337/doc26-0021
Seyam, M., Alhendawi, B. H. M., Nasr, M., Salah, M. A. A., Hamada, A., & Ansbro, É. (2026) · Research Square · doi:10.21203/rs.3.rs-10028618/v1
Metadata
- Authors
- Murphy, A., Biringanine, M., Roberts, B., Stringer, B., Perel, P., & Jobanputra, K.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Médecins Sans Frontières (GB)
- Corresponding author
- Murphy, Adrianna
- Venue
- BMC Health Services Research
- Published
- 2017-06-23
- Volume
- 17
- Issue
- 1
- Pages
- 431-431
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC5481869
- OpenAlex
- W2646296278
- Cited by
- 54
- References
- 49
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 2 · 2023: 6 · 2022: 11 · 2021: 19 · 2020: 5 · 2019: 3
- FWCI
- 1.73
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Medecins Sans Frontieres Field Research (Medecins Sans Frontieres) (submittedVersion)
- Funders
- Médecins Sans Frontières
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › General Health Professions › Health and Conflict Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- diabetes mellitus, humanitarian crisis, Médecins Sans Frontières, patient perspectives, provider perspectives, delayed presentation, medication adherence, psychosocial support, dietary recommendations, armed conflict, community awareness, Democratic Republic of the Congo
- MeSH terms
- Diet, Healthy, Assessment of Medication Adherence, Adolescent, Adult, Aged, Altruism, Ambulatory Care, Delivery of Health Care, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Emergency Treatment, Family Relations, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Patient Acceptance of Health Care, Patient Compliance, Travel, Democratic Republic of the Congo, Program Evaluation, Drug Monitoring, Focus Groups, Qualitative Research, Medication Adherence, Young Adult
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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