Table 2 Summary of results, emerging sub-themes and themes

“Being well means you don’t have illnesses…. no source of pain in the whole body” (FGD, Community members, Male)

“If you don’t have money, you can’t afford….necessities; therefore you cannot feel well” (Person with Diabetes, Male)

“(When) There is nothing disturbing my mind. I have no fear or worries…my life is at peace” (FGD community members, Female)

• Wellbeing is defined in three main notions of increasing complexity: 1) Physical health/pain, 2) socio-economic status and 3) aspirational fulfilment.

√

√

√

Notions attached to wellbeing

How individuals define wellbeing

“Pressure has affected me a lot. Small things frighten me. I get headache….. I also get stomach pain, chest pain and others. When I walk a small distance, I get tired, I get palpitations.” (FGD People at Risk, Female)

• Among participants at higher risk of diabetes:

Some risk factors affect subjective wellbeing; others do not

 o The majority of overweight participants feel weight does not affect their wellbeing

√

 o Those with hypertension report pains indicative of potentially severe disease

√

“With HIV you can feel well. Not with diabetes! Even if you are happy now, there is pain underneath because sickness can happen anytime. (KI, Male with diabetes).”

“Diabetes doesn’t mix with parties. A little alcohol and you collapse…You have to watch as your friends enjoy. What kind of life is this?” (FGD, Diabetes, Female).

“If you follow the guidelines, your glucose will balance… people will doubt whether you have diabetes.” (FGD, Person with diabetes, Male)

“We are happy if we get all the medicines. We can’t afford them…we don’t bother buying them” (FGD, Person with diabetes, Male)

• Participants attach two sub-notions to being well when one has diabetes:

Notions attached to well-being with diabetes

Relationship of wellbeing to having diabetes

 o Diabetes as a ‘static state’: Regardless of treatment, a person with diabetes cannot be well

√

√

√

 o Diabetes as a ‘dynamic state’: People with diabetes get long periods in which they feel well

√

• However, wellbeing with diabetes is conditional to assurance of continuity of services and availability of medicines

√

“You go back home with deep thoughts; Because you cannot get healed, you feel powerless. Thoughts are more painful than the disease.” (FGD, Person with diabetes, Female)

• Many people with diabetes seemed deeply bothered by thoughts, which severely impacted on their current and future wellbeing.

√

Psychosocial well-being a key factor

“It’s important to be well so you can plan for your children….that the plans I have today are realized in the future” (FGD, PAR Male)

“Diabetes is a normal disease but it is not like malaria which goes away. If you prepare your body to prevent future illnesses, future life will be sweeter” (FGD, Person with Diabetes, Female)

• People without diabetes: motivation for future wellbeing is from ability to fulfil future plans

√

√

Differing motivators for well-being

Concern about future wellbeing

• People with diabetes: Future health is central to future wellbeing.

√

“I have high hopes…am not going to die. I have lived with diabetes for 10 years. When I had just contracted it, I felt so bad. But since I started coming to the hospital, I am fine” (FGD, Person with diabetes, Male)

“Although I am young, my hope for a healthy future reduced; .nothing to look forward to…A friend who had diabetes for only a few months passed away; I lost hope” (FGD, People with Diabetes, Female)

• Many people with diabetes were optimistic about the future.

√

Optimism about the future differs

• However, older people/people who have lived with diabetes longer had a more positive attitude

√

• On the other hand, several younger people with diabetes had lost hope in the future.

√

“We have to work for our children. I am planting trees, coffee; constructing rentals. Even if I become weak, these can pay school fees and feed me.” (FGD Community members)

“I follow the regulations. I cut the sugar. I eat lot of greens. I eat some starchy foods. Plus eating in time. When hungry, I eat something small. I don’t walk like others - I walk fast!” (FGD People with diabetes)

• Regarding actions for future wellbeing:

Actions for future wellbeing differ

Actions to promote future well being

 o People without diabetes tended to suggest investments for future economic wellbeing.

√

√

 o People with diabetes on the other hand cited adherence to medication and healthy lifestyles

√

“We have not been sensitized enough about the way we should behave” (FGD Community Member)

“Health workers told us: Don’t eat sweet potatoes, sweet bananas and mangos. But when we went to Mulago, they told us that fruits are good for the body but don’t eat to get satisfied.” (FGD People with diabetes)

• Barriers to future wellbeing with diabetes: Lack of knowledge, stockouts of drugs in health facilities, inability to afford healthier food, and contradictory messages from health workers as.

√

Barriers to future wellbeing