Understanding Type 2 Diabetes in Rural Thailand: Influences from Local Context(s)

Abstract

Type 2 diabetes (T2D) is a worldwide health issue that has adversely affected developing countries such as Thailand. A recent emergence of T2D in rural Thailand has questioned common perceptions of T2D being an urban health issue. This research seeks to understand this phenomenon through the following research questions: 1) How do local geographies of healthcare affect villagers’ access to, and their awareness of information on T2D and its contraction risks? 2) How do villagers in different contexts and places perceive and react to the healthcare and health education provided for them? In this thesis, I employ a conceptual framework consisting of structuration theory and the Knowledge, Attitudes and Practices (K.A.P.) model, constructed with reference to literature from health geography, medical geography and medical studies. The adopted research methodology comprises both quantitative (questionnaire surveys) and qualitative (semi-structured interviews) methods. Fieldwork was performed in three villages located in North and Northeast Thailand. In analysing fieldwork observations with the conceptual framework, I identify the pivotal role played by health volunteers within local geographies of healthcare in disseminating health information to the villagers. The unique local contexts within each village were found to have contributed to an inconsistent dissemination of health information, undermining the overall effectiveness of the provided health education. Similarly, the existing local contexts limited efforts to increase the villagers’ levels of physical activity and improve their diets, resulting in increasing obesity rates among villagers. Overall, I argue that context matters, as the influences brought about by the existing local conditions and constraints have resulted in a flow of misinformation, and undermined the villagers’ efforts to adopt healthier lifestyles, thus contributing to an increasing T2D prevalence in rural Thailand. Equipped with these findings, I have made contextualised recommendations to bolster current efforts in encouraging healthy lifestyles among the villagers.