Table 1 Classification of main categories and 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.