Navigating tradition and treatment: cultural identity, social expectations, and type 1 diabetes self-management among young Saudi adults-a qualitative narrative inquiry.

BACKGROUND: Type 1 diabetes (T1D) requires lifelong, intensive self-management that intersects with cultural practice in collectivistic societies, where communal food traditions, religious observance, and family expectations shape daily routines. Despite an estimated incidence of 18-20 per 100,000 annually in Saudi Arabia, qualitative evidence examining how young adults navigate disease management alongside cultural identity remains limited. OBJECTIVE: This study explored how young Saudi adults with T1D experience and negotiate the interplay between cultural traditions, social expectations, and diabetes self-management in everyday life. METHODS: A qualitative narrative inquiry design was employed. Fourteen Saudi adults (aged 18-30 years) with a confirmed T1D diagnosis of at least 1 year were recruited through purposive and snowball sampling. Semi-structured interviews were conducted in Arabic, translated using a forward-backward protocol, and analyzed through reflexive thematic analysis. Reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS: Five interconnected themes emerged: (1) the invisible struggle of managing a hidden condition; (2) cultural food negotiations within social contexts; (3) Ramadan as a spiritual and medical challenge; (4) social camouflage and disclosure dilemmas; and (5) resilience through cultural innovation. Three narrative identity patterns, namely Journey, Warrior, and Bridge-Builder, further characterized how participants made meaning of their experiences. Deviant cases revealed family conflict, unsuccessful fasting attempts, and persistent concealment that participants described as harmful to their self-management. CONCLUSION: Young Saudi adults with T1D exercise genuine cultural agency in integrating traditional practices with biomedical management. These findings support culturally responsive care models that treat cultural knowledge as a clinical resource rather than a barrier, and point to the need for family-inclusive diabetes education and collaborative pre-Ramadan planning. Future research should use longitudinal designs, incorporate clinical outcome measures, and extend inquiry to rural Saudi and Gulf Cooperation Council populations.