Lived Experiences and Influencing Factors in Type 2 Diabetes Management Among Nepali Speaking Bhutanese Americans

Lived Experiences and Influencing Factors in Type 2 Diabetes Management Among Nepali Speaking Bhutanese Americans | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Lived Experiences and Influencing Factors in Type 2 Diabetes Management Among Nepali Speaking Bhutanese Americans Bhuwan Gautam, Rochelle Frounfelker, Erika Vandyke, Ariana Pichardo-Lowden, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7565082/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Type 2 diabetes is a significant health concern among Nepali-speaking Bhutanese (NSB) individuals, a resettled refugee population in the U.S. However, limited research exists on the challenges and experiences of this group in managing their diabetes, particularly within a cultural context. Objective This study aims to understand the lived experiences of NSB patients self-managing type 2 diabetes and identify the barriers, facilitators, and recommendations for healthcare providers and community organizations. Methods This qualitative phenomenological study used semi-structured, in-person interviews with six NSB adults with type 2 diabetes in the Greater Harrisburg area of Pennsylvania (August–November 2024). A native Nepali-speaking researcher conducted the interviews to understand their lived experience self-managing their type 2 diabetes. Audio recordings were transcribed, translated, and analyzed using inductive thematic analysis in MAXQDA 24, with intercoder reliability of (κ = 0.76). Results Six Nepali-speaking Bhutanese adults (four females, two males; ages 45–75+) participated in this qualitative study. Most had no formal education (n=5), limited literacy, and minimal English proficiency. Five were unemployed and covered by Medicaid; one was employed with employer-based insurance. Participants had lived with type 2 diabetes for two to fifteen years. Five themes emerged: (1) participants described an emotional trajectory from fear and misinformation at diagnosis to gradual acceptance and self-efficacy; (2) multiple barriers—language, transportation, physical limitations, and competing responsibilities—hindered self-management, though culturally familiar practices and personal motivation facilitated adaptation; (3) trust in healthcare providers was fostered through education and nurse outreach but undermined by communication gaps, cultural disconnects, and inconsistent follow-up; (4) participants recommended culturally and linguistically tailored resources, simplified interpretation services, and user-friendly diabetes technologies; and (5) community organizations and religious/cultural spaces were identified as critical venues for outreach, education, and navigation support. Conclusion Despite significant barriers, NSB individuals demonstrate a strong commitment to diabetes self-management. Culturally and linguistically responsive care is essential to reduce disparities and improve outcomes in this underserved group. Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 14 Nov, 2025 Reviews received at journal 03 Nov, 2025 Reviews received at journal 01 Nov, 2025 Reviewers agreed at journal 28 Oct, 2025 Reviewers agreed at journal 24 Oct, 2025 Reviewers agreed at journal 23 Oct, 2025 Reviewers invited by journal 23 Oct, 2025 Editor assigned by journal 23 Oct, 2025 Editor invited by journal 06 Oct, 2025 Submission checks completed at journal 27 Sep, 2025 First submitted to journal 27 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7565082","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":539314348,"identity":"aa7447d0-f5de-4b40-a0fe-639802d1453e","order_by":0,"name":"Bhuwan 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Americans","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover 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Pennsylvania (August–November 2024). A native Nepali-speaking researcher conducted the interviews to understand their lived experience self-managing their type 2 diabetes. Audio recordings were transcribed, translated, and analyzed using inductive thematic analysis in MAXQDA 24, with intercoder reliability of (κ = 0.76).\n\nResults\nSix Nepali-speaking Bhutanese adults (four females, two males; ages 45–75+) participated in this qualitative study. Most had no formal education (n=5), limited literacy, and minimal English proficiency. Five were unemployed and covered by Medicaid; one was employed with employer-based insurance. 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Culturally and linguistically responsive care is essential to reduce disparities and improve outcomes in this underserved group.","manuscriptTitle":"Lived Experiences and Influencing Factors in Type 2 Diabetes Management Among Nepali Speaking Bhutanese Americans","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-04 04:37:44","doi":"10.21203/rs.3.rs-7565082/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-14T13:05:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-03T15:45:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-02T03:18:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"59485550764782750193160527232804762844","date":"2025-10-28T21:35:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"302538009787120449285000956773736830673","date":"2025-10-24T14:41:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"262113538628745624447110229862757563645","date":"2025-10-24T03:59:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-23T16:42:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-23T16:34:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-06T20:07:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-27T14:17:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-09-27T14:16:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dbc89cb1-bf51-411d-b8c6-6219f0dd32c9","owner":[],"postedDate":"November 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-19T00:23:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-04 04:37:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7565082","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7565082","identity":"rs-7565082","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}