Awareness, Stigma, and Cultural Beliefs About Diabetes: A Qualitative Study of Somali Patients and Families.

Background: Diabetes mellitus is an escalating public health issue globally, with Africa facing a heavy burden due to weak health systems and scarce resources. In Somalia, limited data and deep-rooted cultural perceptions significantly influence disease understanding and management. Methods: A qualitative descriptive design was employed between March and May 2025. In-depth interviews were conducted with diabetic patients and their family members using a semi-structured guide. Data were transcribed, translated into English, and thematically analyzed following Braun and Clarke's framework. Results: Awareness of diabetes varied widely. While some participants identified heredity, diet, and inactivity as causes, others attributed the disease to divine punishment, witchcraft, or the "evil eye." Stigma was pervasive, with diabetes often compared to HIV/AIDS, resulting in concealment, social withdrawal, and delayed care-seeking. Cultural and spiritual beliefs strongly shaped treatment choices, with many resorting first to traditional healers, herbal remedies, or prayers. Families were both supportive and obstructive-offering care and financial aid but also perpetuating misconceptions and discouraging disclosure. Barriers to biomedical care included high insulin costs, medication shortages, long waiting times, and lack of culturally appropriate counselling. Participants expressed deep emotional distress, fear of complications, and loss of income due to illness. Conclusion: Diabetes management in Somalia is deeply influenced by stigma, culture, and family dynamics. Culturally tailored education, family engagement, collaboration with traditional leaders, and stronger health system support are vital to improving care and outcomes.