Diabetes care in Samoa: Prevention as not-enough-care and the knowledge gaps it produces

This study examines diabetes care in Samoa, offering insights into global health challenges where most people with diabetes remain undiagnosed and prevention strategies fall short. Drawing on ethnographic interviews and freelist data from 212 participants, we identified three key themes: limited symptom knowledge delays care, traditional healers play a role in care-seeking, and diabetes is often managed through symptom-focused interventions rather than as a chronic condition. These findings highlight how prevention campaigns emphasising diet and exercise often exclude symptom recognition, leaving families to navigate care within fragmented systems. We propose prevention as not-enough-care to theorise the limitations of strategies prioritising behaviour change while neglecting relational and systemic approaches to chronic illness management. We propose a life-course approach integrating symptom knowledge while recognising the cumulative impact of social, biological, and environmental factors. Integrating traditional healers into formal healthcare systems also offers a culturally responsive pathway for earlier intervention. These suggestions aligns with Indigenous Pacific health models, such as Fonofale and Te Vaka Atafaga, which prioritise relational care. These findings advance a globally relevant critique of prevention frameworks, advocating relational, community-driven strategies to address knowledge gaps and reduce complications.