Objectives: Importance of HSB is increasing being recognized in understanding patient compliance, adequacy of followup, and seeking of alternative therapies (AT), which impact glycemic control. We looked at HSB of T1D caregivers.
Methods: 56 families: Child's T1D duration >1 y, were interviewed: 49 coming to a private clinic, 7 in government hospitals. SES was low in 20, upper/middle ("non-poor") in 36.
Results: After diagnosis, 24/56 (43%) had consulted 2-10 (mean 3.3) doctors - 6/20 (30%) poor families, 18/ 36 (50%) non-poor. Conversely 11: 7 poor (35%) and 4/36 (11%) non-poor families consulted no doctor for 1-3 y (mean 1.25 y) after diagnosis. easons given: "nothing new to learn, can manage dose adjustment ourselves": 8; "did not know we were supposed to follow up": 2; "shifted out of Delhi, couldn't find pediatric endocrinologist": 1. During this gap, there were 3 admissions for hyperglycemia; and 5 episodes of severe hypoglycemia managed at home. AT was tried by 35/56 (62%: Ayurveda by 8, Homeopathy 10, Naturopathy/Home remedies 17 [bitter gourd, neem juice, fenugreek, jamun]): 40% AT triers were poor, 60% non-poor. Reasons given: Own beliefs, experiences of other diabetics, television, internet, social groups, magazines and seminars. Reasons for choosing medical provider: Doctor treating or referred to during admission: 26; own financial status: 11, distance: 7, their experience and level of satisfaction with doctor: 12. Of clinic patients, 25/49 have regular followup, 16 irregular, and 8 had no visits in the past year. SES-wise, 18/36 (50%) non-poor, 7/20 (35%) poor families have regular followup.
Conclusions: Doctor shopping, erratic followup, trying AT, are common problems, and need to be proactively discussed with families to find solutions. HSB is only partly determined by SES: Non-poor families did somewhat more doctor shopping; poor families had more irregular followup.