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Table 1 Classification of main categories and subcategories

From: Perceptions among diabetic patients in the ultra-orthodox Jewish community regarding medication adherence: a qualitative study

Main categories Subcategories
“The disease as a secret”: Concealing the disease among patients with diabetes in ultra-orthodox society • Most patients never discuss their illness with relatives or members of the ultra-orthodox community
• These patients felt that diabetes is a personal and private matter
• They fear that if their disease became known people might describe the situation as worse than it is
• Patients whose parents have diabetes also described a similar pattern in which they acknowledge their disease but do not discuss it
• Their belief gives them strength and serves as a meaningful coping resource
“Between the sacred and the profane”: Weekdays are different from holidays and special events in how ultra-orthodox people with diabetes perceive treatment adherence • During the week they adhere to the guidelines, eat a healthy diet and avoid sweets
• Things are different on Shabbat, when the extended family gathers for extravagant meals that include a variety of sweets
• Special Shabbat delicacies are offered to them at the synagogue after the prayer service. Nothing suitable is available for people with diabetes
• The participants also described their problems in maintaining a healthy diet on Jewish holidays
• Benevolent organizations also are unaware of the need to provide food suitable for people with diabetes
“The rabbi is the address”: In dilemmas between religious law and doctors’ instructions, the rabbi decides • GP plays an important role for them, yet the rabbis have the final word on any question that may arise
• Patients in ultra-orthodox society believe that sickness and health are in God’s hands.
• The patients see the rabbis as the highest source of knowledge about the Torah. Even if the rabbis are not knowledgeable about a particular medical issue, they can provide comfort, encouragement and answers
• Measuring sugar levels and injecting insulin on Shabbat are not permitted, even if approved by the GP
• Especially on Yom Kippur, fasting, constant prayer and avoidance of food and drink are of major importance.