Adopting and implementing an innovative model to organize diabetes care within First Nations communities: A qualitative assessment

Abstract

Background Diabetes care remains suboptimal in First Nations populations. Innovative and culturally relevant approaches are needed to promote systematic and proactive organization of diabetes care for people living with diabetes on-reserve in Canada. The RADAR model is one strategy to improve care: an integrated disease registry paired with an electronic health record for local community healthcare providers with remote care coordination. We qualitatively assessed adoption and implementation of RADAR in First Nations communities in Alberta to inform its potential spread in the province. Methods We used the RE-AIM framework to evaluate adoption and implementation of RADAR in 6 First Nations communities. Using purposeful sampling, we recruited local healthcare providers and remote care coordinators involved in delivering RADAR to participate in telephone or in-person interviews at 6- and 24-months post-implementation. Interviews were digitally recorded, transcribed, and verified for accuracy. Data was analyzed using content analysis and managed using ATLAS.ti 8. Results In total, we conducted 21 semi-structured interviews (6 at 6-months; 15 at 24-months) with 11 participants. Participants included 3 care coordinators and 8 local healthcare providers, including registered nurses, licensed practical nurses, and registered dietitians. We found that adoption of RADAR was influenced by leadership as well as appropriateness, acceptability, and perceived value of the model. In addition, we found that implementation of RADAR was variable across communities regardless of implementation supports and appropriate community-specific adaptations. Conclusions The variable adoption and implementation of RADAR has implications for how likely it will achieve its anticipated outcomes. RADAR is well positioned for spread through continued appropriate community-based adaptations and by expanding the existing implementation supports, including dedicated human resources to support the delivery of RADAR and the provision of levels of RADAR based on existing or developed capacity among local HCPs. Trial registration Not applicable to this qualitative assessment. ISRCTN14359671.

Effectiveness of RADAR: An Innovative Model to Organize Diabetes Care in First Nations Communities

“…This is important because lack of adequate diabetes knowledge among local HCPs is a barrier to diabetes care and is largely affected by time/competing priorities, staff turnover, and changing guidelines ( 4 , 28 ). Furthermore, local HCPs, who are the experts in their communities, can apply RADAR, including enhanced knowledge of diabetes care, with local patients in appropriate ways that recognize contextual and cultural factors ( 12 ).…”

“…RADAR was implemented collaboratively with FN communities from Treaty 6, 7, and 8 territories in Alberta, Canada, where local HCPs found the model appropriate, acceptable, and valuable for both HCPs and patients ( 12 ). Here, we describe the effectiveness of RADAR with regard to patient outcomes and the organization of diabetes care in these communities.…”