Journal of Integrative Nursing · Published 2026-04-01 · DOI 10.4103/jin.jin_14_26
Objective: To explore the lived experiences and interpretive meanings of social capital and spiritual negotiation in dietary self-management among patients with type 2 diabetes mellitus (T2DM) within the merit-making culture of Lower Northern Thailand. Materials and Methods: This interpretive phenomenological study recruited 15 T2DM patients active in Buddhist merit-making traditions in Phitsanulok Province via purposive sampling. Data were collected between December 2024 and February 2025 through in-depth interviews and participant observations. Analysis followed Van Manen’s approach, integrated with the social structural factors of Leininger’s Culture Care Theory (Sunrise Enabler Model) to ensure a holistic transcultural perspective. Results: Three core themes emerged: (1) food as social capital and the reciprocal obligation of “Nam Jai”: patients prioritize “relational equilibrium” over clinical glycemic targets to maintain community identity; (2) spiritual negotiation – merit over clinical outcomes: the consumption of “sacred” temple leftovers (Khao Kon Bat) is resignified as spiritual medicine (Ya Jai), where the pursuit of merit (accumulating Barami) outweighs physiological data; and (3) dynamics of cultural care negotiation: patients act as proactive negotiators using strategies of cultural portioning, community-based recipe restructuring, and postevent compensatory behaviors to harmonize medical regimens with cultural imperatives. Conclusion: Dietary self-management is a complex cultural phenomenon where food intersects medical science, social capital, and spiritual faith. Sustainable management requires a paradigm shift from authoritative clinical instruction to “Cultural Health Negotiation,” facilitating care that is congruent with the patient’s authentic life world.
Abstract from DOAJ. Public domain (CC0 1.0).
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