Living Together with Chronic Disease: Informal Support for Diabetes Management in Vietnam (VALID I)
Global health is in transition: non-communicable diseases (NCDs) are currently posing new challenges to individuals, families and governments across the globe. As a case for addressing NCDs, this project focused on type 2 diabetes in Vietnam, explored the role of informal support in everyday disease management.
THE PROJECT IS COMPLETED
The prevalence of chronic health conditions such as cardiovascular diseases, cancers, chronic respiratory diseases and diabetes is currently rising dramatically across the world, with particularly severe consequences for low- and middle-income countries.
This research project was based on the assumption that informal support plays a significant, but under-recognized role in everyday lives with chronic disease and that more systematic knowledge of the role of informal forms of care can strengthen responses to the NCD epidemic, improving health systems’ capacities to address diabetes and other NCDs while also enhancing our understanding of the ways in which family and household dynamics shape the human impact of chronic health conditions.
In 2022, the VALID project received funding for a second phase which focuses on gestational diabetes mellitus and pregnant women’s self-care.
The project aimed to develop innovative models for active involvement of informal caregivers in day-to-day disease management, while also enhancing Vietnamese and Danish research capacities in the NCD field and generating new knowledge of the ways in which chronic health conditions are embedded in everyday forms of sociality.
ARTICLES IN INTERNATIONAL JOURNALS
Gammeltoft, T.M. and Dung Vu. (2024) “Generativity: A Life Story from Vietnam”. Accepted for publication in Living Well with Sugar: Flourishing with Diabetes Across Cultures. Jessica Hardin and Emily Mendenhall, eds. University of Toronto Press, forthcoming.
Dan Wolf Meyrowitsch, Ngoc Anh Thi Dang, Tuc Phong Vu, Nielsen Jannie, Jens Søndergaard, Cuong Nguyen Duy, Hieu Le Minh, Dung Vu Thi Kim, Ib Christian Bygbjerg, Tine M. Gammeltoft, Thanh Duc Nguyen (2024) “The effects of diabetes clubs on peer-support, disclosure of diabetes status, and sources of information regarding diabetes management: results of a pilot-intervention in rural Vietnam” in Public Health, Vol. 228, 171–177. Doi: 10.1016/j.puhe.2023.12.034. The article is open access.
Gammeltoft, T.M. (2024) “Calibrating Care: Family Caregiving and the Social Weight of Sympathy (Tình Cảm) in Vietnam” in American Anthropologist 1-12. https://doi.org/10.1111/aman.13993. The article is open access.
Dieu Huyen Thi Bui, Ai Thi Nguyen, Hieu Le Minh, Dung Vu Thi Kim, Tine M. Gammeltoft, Amalie Rørholm Vestergaard (2024) “Informal caregiving among people supporting a person with type 2 diabetes in rural communities of Northern Vietnam: A cross-sectional study of caregiver burdens” in PLoS ONE 19(5): e0304821. https://doi.org/10.1371/journal.pone.0304821. The article is open access.
Ngoc-Anh Thi Dang, Tuc Phong Vu, Tine M Gammeltoft, Ib Christian Bygbjerg, Dan W Meyrowitsch, Jens Søndergaard (2023) “Pre-/post-analyses of feasibility study of a peer-based club intervention among people living with type 2 diabetes in Vietnam’s rural communities” in PLoS ONE 18(11): e0290355. Doi:10.1371/journal.pone.0290355. The article is open access.
Dieu Bui Thi Huyen, Ai Nguyen Thi, Dung Vu Thi Kim, Hieu Le Minh, Tine Gammeltoft & Amalie Rørholm Vestergaard (2023) “Mobilizing morality: how caregivers in Vietnam handle the challenges of daily diabetes care” in BMC Public Health, Vol. 1744. Doi: 10.1186/s12889-023-16691-8. The article is open access.
Meyrowitsch DW, Nielsen J, Bygbjerg IC, Søndergaard J, Diep KT, Bui DHT, Gammeltoft TM, Nguyen TD (2023) “Unmet needs for informal care among people with type 2 diabetes in rural communities in Vietnam” in Public Health in Practice - download in pdf.
Gammeltoft TM, Dieu BTH, Dung VTK, Anh VD, Hieu LM, Ai NT (2022)“Existential vulnerability: An ethnographic study of everyday lives with diabetes in Vietnam” in Anthropology & Medicine, Vol. 29 (3). DOI:10.1080/13648470.2021.1994334. The article is open access.
Gammeltoft TM (2022) “The Force of Love: Type II Diabetes in Vietnam as Tentatively Transformative Experience” in Ethos: Journal of the Society for Psychological Anthropology, Vol. 49 (3) - download in pdf.
Gammeltoft TM (2022) “Everyday attentiveness: Understanding diabetes in Vietnam through literary displacement” in Journal of the Royal Anthropological Institute, Vol. 28 (2) - download in pdf.
Gammeltoft TM, Dieu BTH, Dung VTK, Anh VD, Hieu LM, Ai NT (2022) “Existential vulnerability: An ethnographic study of everyday lives with diabetes in Vietnam” in Anthropology & Medicine, Vol. 29 (3) - download in pdf.
Gammeltoft TM, Dieu BTH, Dung VTK, Anh VD, Ai NT, Hieu LM (2022) “Everyday disease diplomacy: An ethnographic study of diabetes self-care in Vietnam” in BMC Public Health Journal, Vol. 22 (828) - download in pdf.
Thi DK, Xuan BN, Le CD, Gammeltoft TM, Søndergaard J, Meyrowitsch DW, Bygbjerg IC, Nielsen J (2021) "Unmet needs for social support and diabetes-related distress among people living with type 2 diabetes in Thai Binh, Vietnam: a cross-sectional study" in BMC Public Health, Vol. 21:1532. https://doi.org/10.1186/s12889-021-11562-6 . The article is Open Access - download in pdf.
Bui DHT, Nguyen BX, Truong DC, Meyrowitsch DW, Søndergaard J, Gammeltoft T, Bygbjerg IC, Nielsen J (2021) "Polypharmacy among people living with type 2 diabetes mellitus in rural communes in Vietnam" in PLoS ONE 16(4): e0249849. https://doi.org/10.1371/journal.pone.0249849. The article is open access - download in pdf.
Nguyen TD, Bygbjerg IC, Meyrowitsch DW, Gammeltoft TM, Le CD, Nguyen AT, Søndergaard J (2021) "Perceived knowledge on type-2 diabetes of informal caregivers in rural communities of Thai Binh, Vietnam: Implications for health education" in Public Health in Practice, Vol. 2. https://doi.org/10.1016/j.puhip.2021.100210. The article is open access - download in pdf.
Gammeltoft TM (2020) "Waiting." Fictions, Fieldsights, in Cultural Anthropology. Open access at https://culanth.org/fieldsights/waiting.
ARTICLES PUBLISHED IN VIETNAMESE JOURNALS
Download the articles below in pdf (not available in English).
Anh DTN, Hieu LM, Anh VD, Binh VT, Dung PT, Søndergaard J, Gammeltoft TM, Tuc VP (2022) “Development of a health communication and education document set for type 2 diabetes patients at the grassroots level in rural Vietnam” in Thai Binh Journal of Medicine and Pharmacy, no. 1 - download in pdf.
Ai NT, Anh VD, Hieu LM, Dung VTK, Dieu BTH, Gammeltoft TM (2021) "Difficulties experienced by diabetes patients during the COVID-19 pandemic: A qualitative study from Vietnam" in Vietnam Journal of Preventive Medicine, Vol 31 (3). https://doi.org/10.51403/0868-2836/2021/314 - download in pdf.
Anh VD, Ai NT, Hieu LM, Dung VTK, Dieu BTH, Gammeltoft TM (2021) "Treatment compliance of diabetic patients during the COVID-19 epidemic: Qualitative research from the patient's perspective in Vietnam" in Vietnam Journal of Preventive Medicine, vol. 31 (2) - download in pdf
Thanh ND, Son LD, Bai NX (2021) “Actual accessibility to information on patient care via mobile phone used by formal caregivers for people with type 2 diabetes in Thai Binh province in 2019” in Vietnam Journal of Preventive Medicine, vol. 31 (9). https://doi.org/10.51403/0868-2836/2021/484 - download in pdf.
Ai NT, Dieu BTH, Dung VTK, Hanh PTM, Gammeltoft TM (2019) "Distress in diabetes patients: A study from Vietnam combining quantitative and qualitative methods" in Vietnam Medical Journal, no 1 - download in pdf.
Anh VD, Ai NT, Hieu LM, Hanh PTM, Gammeltoft TM (2019) “Challenges for regular checkup: a study of diabetes in Thai Binh” in Vietnam Medical Journal, no. 1 - download pdf.
Dieu BTH, Hieu LM, Anh VD, Hanh PTM, Gammeltoft TM (2019) "Non-using diabetic medication in health insurance - some reasons need special attention" in Vietnam Medical Journal, no 1 - download in pdf
Dung VTK, Ai NT, Anh ND, Hanh PTM, Gammeltoft TM (2019) "The diet regime for diabetes patients at Vietnam rural areas: The barriers from oneself, family and society" in Vietnam Medical Journal, no 1 - download in pdf
Hieu LM, Dung VTK, Dieu BTH, Hanh PTM, Gammeltoft TM et al. (2019) "Hypoglycemia: The perspectives of Patients with Type 2 diabetes" in Vietnam Journal of Preventive Medicine, vol. 10, no. 1 - download in pdf.
Hiếu LM, Ái NT, Dung VTK, Diệu BTH, Gammeltoft TM (2023) “CHĂM SÓC GIA ĐÌNH DÀNH CHO BỆNH NHÂN ĐÁI THÁO ĐƯỜNG TÍP 2: SỰ KHÁC BIỆT THEO MỨC ĐỘ NẶNG CỦA BỆNH“ in Vietnam Medical Journal, no 1A. - download in pdf
Dung VTK, Hiếu LM, Ái NT, Diệu BTH, Gammeltoft TM (2023) “HỖ TRỢ CỦA GIA ĐÌNH TRONG CHĂM SÓC NGƯỜI BỆNH ĐÁI THÁO ĐƯỜNG TÍP 2: BẠN ĐỜI NGƯỜI HỖ TRỢ QUAN TRỌNG NHẤT“ in Vietnam Medical Journal, no 1A. - download in pdf
Ái NT, Hiếu LM, Dung VTK, Diệu BTH, Gammeltoft TM (2023) “TRÁCH NHIỆM CỦA NGƯỜI HỖ TRỢ KHI CHĂM SÓC BỆNH NHÂN ĐÁI THÁO ĐƯỜNG TUÝP 2 TẠI GIA ĐÌNH: GIỚI TÍNH CỦA NGƯỜI HỖ TRỢ TẠO NÊN SỰ KHÁC BIỆT NHƯ THẾ NÀO?“ in Vietnam Medical Journal, no 1A. - download in pdf
Nguyễn Đức Thanh, Nguyễn Duy Cường, Nguyễn Xuân Bái, Trần Thị Hương, Vũ Phong Túc, Tine Gammeltoft (2023) Nghiên cứu hợp tác về quản lý bệnh đái tháo đường kinh nghiệm từ Thái Bình (Cooperative research on diabetes management: Experience from Thai Binh). Link: https://thaibinhjmp.vn/index.php/ojstbump/article/view/110/97
During the intervention various material was produced
- The VALID I pilot intervention project was selected as a case study for the "Partnering for Change" peer support handbook (2024) (see: https://www.humanitarianncdaction.org/wp-content/uploads/2024/05/P4C_Peer_Support_Handbook.pdf).
- The VALID I project formed the basis for an online lecture on the importance of informal support for patients living with cardiometabolic diseases, developed as part of the Novo Nordisk Foundation Partnership for Education of Health Professionals (2024).
Policy briefs:
Intervention material:
- An intervention manual
- Intervention educational sheets
- Documentary film, Phim tài liệu về Chương trình can thiệp, 2022
- 9 educational videos produced for the diabetes club intervention, 2022
Press reports in Vietnam:
https://baothaibinh.com.vn/tin-tuc/11/72874/truong-dai-hoc-y-duoc-thai-binh-tu-hao-nua-the-ky
News articles from Department of Anthropology, UCPH:
https://anthropology.ku.dk/dep/news/2024/vietnam-shows-new-ways-to-combat-diabetes/
The project is conducted in Vietnam’s Thai Binh province as an academic partnership between Thai Binh University of Medicine and Pharmacy (TBUMP) and the Universities of Copenhagen, UCPH, and Southern Denmark, SDU. (See news article)
The project is carried out in close collaboration with the Danish-Vietnamese Strategic Sector Cooperation (SSC) project: Strengthening the Frontline Grassroots Health Worker: Prevention and Management of NCDs at the Primary Health Care Level, with Novo Nordisk as private sector partner. The project places emphasis on research capacity building and includes a pilot intervention programme that introduces diabetes clubs and -classes as elements of diabetes care in Vietnam.
Foto: Signing ceremony in Thai Binh.
WRITING RETREAT
In July 2019, an ethnographic writing workshop was held in Thai Binh, and in November 2019, a joint scientific writing workshop (focusing on the cross-sectional surveys results) was held in Ninh Binh, Vietnam with the participation of four Danish researchers and 12 researchers from Thai Binh University of Medicine and Pharmacy.
Presentation at the Department of Public Health's Global Health Section, November 4, 2021 by Tine Gammeltoft, Dan Meyrowitsch and Ib Bygbjerg. "Writing Retreats for Research: Roles, Results and Reflections from the VALID Project in Vienam". Download in pdf.
PARTICIPATORY DESIGN WORKSHOP
A participatory design workshop was held in Thai Binh in October 2019 where the VALID I pilot intervention was designed and planned (see “Pilot Intervention”). Researchers, health providers, village health workers, and representatives for diabetes patients and family caregivers participated in the workshop.
STAKEHOLDER WORKSHOPS IN THAI BINH AND HANOI
In November 2022, two stakeholder workshops were held to disseminate the results of the VALID project. Participants from Thai Binh University of Medicine and Pharmacy (TBUMP), the University of Copenhagen, and the University of Southern Denmark were present as well as stakeholders interested in the results of the project. One workshop was held at TBUMP in Thai Binh and another was held in Hanoi.
Among the stakeholders were representatives from the WHO in Vietnam, The Embassy of Denmark in Vietnam, Novo Nordisk, Hanoi National University, FHI Solutions, as well as local and government officials.
HONORARY PROFESSORSHIP APPOINTMENT
On December 8, 2022, Thai Binh University of Medicine and Pharmacy (TBUMP) appointed Professor Tine M. Gammeltoft from the University of Copenhagen as an honorary professor in recognition of her special contributions to academic activities at TBUMP.
CLOSING CEREMONY
On March 5, 2024, the VALID I closing ceremony was held at Thai Binh University of Medicine and Pharmacy, with the participation of Danish Minister of Health Ms. Sophie Løhde, Ambassador Nicolai Prytz, and Vietnam’s vice-Minister of Health Mr. Tran Van Thuan.
After the closing ceremony, the delegation visited Vu Hoi commune health station and a VALID I diabetes club.
The pilot intervention that was planned during the participatory design workshop (see “Events”) was implemented from spring 2021. The intervention was based on peer support and included classes and clubs and drew on needs identified by VALID research. A pre-/post-study was conducted to assess the implications of the intervention for diabetes self-management and quality of life among the participants.
THE PRE-/POST-STUDY
A pre-/post-study was conducted to assess the implications of the intervention for diabetes self-management and quality of life among the participants.
CLASSES
Diabetes classes were held for village health workers as well as patient representatives, training them on selected diabetes self-care topics and supporting them in passing on their knowledge from the classes to diabetes clubs in their communities.
CLUBS
The second part of the intervention was the establishment of diabetes clubs in the villages of two communes, Viet Thuan and Vu Hoi, in Thai Binh. A total of 16 diabetes clubs were started during this part of the VALID project. Village health workers and patient representatives who participated in the diabetes classes ran the clubs. The diabetes clubs aimed to improve diabetes self-care as well as enhance peer support and decrease stigma around the disease.
THE INTERVENTION EXTENSION
In response to calls from pilot intervention participants for a continuation of the intervention, an intervention extension was launched in spring 2022. During the intervention extension, diabetes classes are offered online through a web-based platform, and the diabetes clubs continue to run with the guidance of village health workers.
Researchers
| Name | Title | Phone | |
|---|---|---|---|
| Search in Name | Search in Title | Search in Phone | |
| Dan Wolf Meyrowitsch | Professor | +4535327174 | |
| Ib Christian Bygbjerg | Emeritus | +4535327835 | |
| Jannie Nielsen | Associate Professor | +4535331262 | |
| Tine Mette Gammeltoft | Professor | +4535323474 |
Funded by:
The project has received funding from Ministry of Foreign Affairs of Denmark.
Project: VALID I - Living Together with Chronic Disease: Informal Support for Diabetes Management in Vietnam
Period: November 2018 - March 2024.
Phase II: VALID II - Living Together with Chronic Disease: Informal Support for Diabetes Management in Vietnam Phase II: Gestational Diabetes in Vietnam
Contact
Professor Tine Gammeltoft
Department of Anthropology
Mail: tine.gammeltoft@anthro.ku.dk
Phone: +45 35 32 34 74
Mobile: +45 61 86 08 83
External members:
| Name | Title |
|---|---|
| Professor Jens Søndergaard | Research Unit of General Practice, University of Southern Denmark |
| Dr Nguyen Xuan Bai | Vice-Rector at Thai Binh University of Medicine and Pharmacy |
| Dr Nguyen Duc Thanh | Head of International Department at Thai Binh University of Medicine and Pharmacy |