Sujata Sapkota, Jo-anne E Brien, Parisa Aslani

Perceptions and beliefs about treatment can influence patients' adherence to treatment regimens. Perceptions, in turn, are often shaped by patients' sociocultural context. Nepal and the Nepalese have unique sociocultural traditions and beliefs, and their perceptions of diabetes treatment remain largely unexplored. This study explored Nepalese participants' perceptions of diabetes treatment, and whether perceptions differed between the Nepalese living in Australia and Nepal. Face-to-face qualitative interviews (n=48) were conducted with Nepalese participants with type 2 diabetes in Sydney and Kathmandu. All interviews were audio-recorded, transcribed verbatim, and thematically analyzed. Perceptions of diabetes treatment were similar among Nepalese participants in Australia and Nepal. There was a general reluctance to start oral antidiabetic medications and an even greater reluctance to commence parenteral (insulin) therapy. Participants preferred to try lifestyle modifications and alternative treatments such as herbs and "traditional" medicines, particularly as a first step. Unwillingness to take medications was primarily associated with the belief that, once started, these medications needed to be taken for life, and perceptions of long-term harms caused by such medications. Even when commenced on medication, participants were averse to any type of therapy escalation, for example, moving to insulin therapy. Insulin was perceived as the "last option" available for diabetes treatment. Most participants, however, did not find medication taking challenging once they had commenced treatment. Antidiabetic medications were perceived to be harmful and unstoppable once initiated. These perceptions significantly impacted participants' willingness to commence antidiabetic medications and therefore have the potential to adversely affect their medication-taking behavior. This study therefore highlights the need to explore the impact of these perceptions on participants' medication-taking behavior, and the need to address patients' views of "modern" (commonly prescribed) and "traditional" (natural) medications through information and education, to ensure increased understanding of how medications are used for diabetes management.