Table 3 Personal Challenges: Themes and Exemplar Coded Statements

Cultural beliefs

Believe medicine will fix diabetes

Believe stress causes diabetes

Believe insulin causes blindness

Believe that diabetes is not something controllable

Patients believe T2D caused by ‘susto’

Patients believe home remedies will cure diabetes

Patients believe insulin doesn’t work. Causes blindness

Patients relate diabetes to death

Lack of resources

Not enough money to buy vegetables

Have to buy different food from family

Not enough money for diabetes supplies

Lack funds to purchase adequate food

Unable to see nutritionist due to cost

Eat many tortillas as they are inexpensive

Patient can’t afford syringes/glucometer strips

Challenges of living in poverty

Lifestyle change

Unable to understand educational materials

Have a hard time giving up favorite foods

Like feeling full and diabetes diet isn’t satisfying

Work schedule makes it hard to eat healthy

Forget to take medication

Follow diabetes care only when feeling sick

Unable to read/write

Difficult to stop drinking soda

Misinformation/lack of information about diabetes

Lots of events with opportunity to eat poorly

Many work and eat food from street vendors

Prioritize other activities

Lack of family support

Make foods to please family not self

Family request unhealthy food at the store

Family does not support lifestyle change

Family too busy to help with diabetes care

Lack of family support to help with health

Machismo can be issue for some families

Many patients abandoned by family

Don’t have family support for lifestyle change

Mental health

Feels depressed/sees life as ending

Believe diagnosis was a death sentence

No longer feels like same person – impotent

Feels hopeless

Depression makes adherence/attendance difficult

Many barriers to psychological care

Considerable stigma to psychological care

Patients not aware of value they have as person, in family, and community