{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T01:46:15Z","timestamp":1794015975987,"version":"4.8.0"},"reference-count":71,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T00:00:00Z","timestamp":1704758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The burden of Non-Communicable Diseases (NCDs) in urban informal settlements across Lower and Middle Income Countries is increasing. In recognition, there has been interest in fine-tuning policies on NCDs to meet the unique needs of people living in these settlements. To inform such policy efforts, we studied the care-seeking journeys of people living in urban informal settlements for two NCDs\u2014diabetes and hypertension. The study was done in the Mumbai Metropolitan Region, India.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This qualitative study was based on interviews with patients having diabetes and hypertension, supplemented by interactions with the general community, private doctors, and public sector staff. We conducted a total of 47 interviews and 6 Focus Group Discussions. We synthesized data thematically and used the qualitative software NVivo Version 10.3 to aid the process. In this paper, we report on themes that we, as a team, interpreted as striking and policy-relevant features of peoples\u2019 journeys.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>People recounted having long and convoluted care-seeking journeys for the two NCDs we studied. There were several delays in diagnosis and treatment initiation. Most people\u2019s first point of contact for medical care were local physicians with a non-allopathic degree, who were not always able to diagnose the two NCDs. People reported seeking care from a multitude of healthcare providers (public and private), and repeatedly switched providers. Their stories often comprised multiple points of diagnosis, re-diagnosis, treatment initiation, and treatment adjustments. Advice from neighbors, friends, and family played an essential role in shaping the care-seeking process. Trade-offs between saving costs and obtaining relief from symptoms were made constantly.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our paper attempts to bring the voices of people to the forefront of policies on NCDs. People\u2019s convoluted journeys with numerous switches between providers indicate the need for trusted \u201cfirst-contact\u201d points for NCD care. Integrating care across providers\u2014public and private\u2014in urban informal settlements\u2014can go a long way in streamlining the NCD care-seeking process and making care more affordable for people. Educating the community on NCD prevention, screening, and treatment adherence; and establishing local support mechanisms (such as patient groups) may also help optimize people\u2019s care-seeking pathways.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1257226","type":"journal-article","created":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T04:17:37Z","timestamp":1704773857000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Many hops, many stops: care-seeking \u201cloops\u201d for diabetes and hypertension in three urban informal settlements in the Mumbai Metropolitan Region"],"prefix":"10.3389","volume":"11","author":[{"given":"Sudha","family":"Ramani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjula","family":"Bahuguna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Spencer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sweety","family":"Pathak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sushma","family":"Shende","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanti","family":"Pantvaidya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"D\u2019Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuja","family":"Jayaraman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,1,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1177\/193229681100500415","article-title":"Convergence of prevalence rates of diabetes and Cardiometabolic risk factors in middle and low income groups in urban India: 10-year follow-up of the Chennai urban population study","volume":"5","author":"Mohan","year":"2011","journal-title":"J Diabetes Sci Technol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1186\/1471-2458-13-371","article-title":"A population-based survey of prevalence of diabetes and correlates in an urban slum community in Nairobi, Kenya","volume":"13","author":"Ayah","year":"2013","journal-title":"BMC Public Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"47","DOI":"10.3390\/tropicalmed2030047","article-title":"Differences in the prevalence of non-communicable diseases between slum dwellers and the general population in a large urban area in Brazil","volume":"2","author":"Snyder","year":"2017","journal-title":"Tropic Med Infect Dis"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e0184967","DOI":"10.1371\/journal.pone.0184967","article-title":"Non-communicable disease (NCD) risk factors and diabetes among adults living in slum areas of Dhaka, Bangladesh. 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