“Diabetes is death”: Perceptions and care experiences of people living with type 2 diabetes in urban and rural settings in Central Uganda

Background Type 2 diabetes is among the leading causes of death globally, with the highest burden in low-income countries, where misconceptions about its causes and management remain widespread. This study explored the perceptions and lived experiences of adults with newly diagnosed type 2 diabetes in Central Uganda. Methods Thirty participants diagnosed 2 years prior were purposively enrolled in a longitudinal qualitative study in Kalungu and Masaka districts, Central Uganda. Each participant had two repeat in-depth interviews, and the data were analyzed thematically using the Health Belief Model constructs. Results Participants attributed type 2 diabetes to unhealthy lifestyles (e.g, alcohol use, processed sugars, oily fast food), family history, and (¼ of participants) spiritual causes. Signs and symptoms were classified as either less severe (e.g, sweating, urination, fatigue) or more severe (e.g, thirst, infections, vision issues, stiffness, paralysis, dizziness, low libido). Perceived signs and symptom severity and anticipated benefits influenced care-seeking decisions. Most participants reported using multiple care types, including biomedical, herbal, and spiritual. Care type choice was guided by expected health benefit regardless of sex or location. Conclusions In Central Uganda, newly diagnosed adults categorize diabetes signs and symptoms by severity, which shapes their health-seeking behaviour. The decision to seek a specific care type, biomedical, spiritual, or herbal, was influenced by perceived signs and symptom severity and expected benefit, not by demographic differences. These insights should guide the development of tailored diabetes education interventions.