The impact of the COVID-19 pandemic on lifestyle behavior and accessibility to routine health care among people with type 2 diabetes mellitus: a qualitative study in urban slums of Hyderabad, India

Background Coronavirus disease (COVID-19) disproportionately impacted marginalized social groups globally, disrupting care access and the delivery of essential services. Few studies have qualitatively examined the experiences of individuals with type 2 diabetes mellitus (T2D) during the COVID-19 pandemic. This study aimed to qualitatively explore the experiences and perspectives of the urban poor with T2D, regarding the impact of the COVID-19 crisis on lifestyle behaviors, diabetic care, and self-management practices. Methods Individual, semi structured interviews about the experiences of patients with T2D on the implications of COVID-19 on lifestyle behaviors and routine diabetes care were conducted across two urban slums in Hyderabad, India. Guided by the framework of the Explanatory Model Interview Catalogue (EMIC), 25 semi structured interviews were conducted among purposively selected adults aged above 20 years with T2D, with participant recruitment facilitated by two female front-line community health workers. In addition, one focus group discussion of community health workers and four key informant interviews of healthcare providers ( n  = 4; 2 Medical officer, 1 Nurse NCD coordinator, 1 Health supervisor) who treated patients with T2D from two Urban Primary Health Centres (UPHC) were conducted. All interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis. Results Three main themes based on the EMIC Framework were: “Increased psychosocial distress” which captures the participants experiences of socio-economic hardships, and psychological well-being and experiences of social stigma and discrimination; “COVID-19 disruptions in routine healthcare services”, which highlights challenges in accessing to healthcare and diabetes care services; “Greater awareness about diabetes complications and management”, which describes the enhanced awareness of diabetes self-care practices, improved disease management and increased engagement in routine health check-ups and uptake of diabetes health screening among individuals with T2D. Conclusions The study’s results can support the development of effective community-based interventions aimed to improve the availability and integration of health care services for people with T2D at the community level. Such interventions can enhance on improving continuity in delivery of diabetes care and overcoming health inequities during future public health emergencies in India.