Healthcare Providers' Perception of Healthcare System Factors Associated with Poor Glycemic Control among Type 2 Diabetes Patients in Fiji

Abstract

OBJECTIVE: This study aims to explore the perceptions and experiences of healthcare providers regarding the role of healthcare system factors on glycemic control among type 2 diabetes (T2D) patients in Fiji in 2018. METHODS: Nineteen healthcare providers (physicians and nurses) from three randomly selected urban healthcare centers in Suva, Fiji, were selected through purposive variation sampling to participate in three focus group discussions (FGDs). The participants in this study were healthcare providers working in diabetes clinics, and medical officers and nurse team leaders from the selected healthcare centers. The data were analyzed by means of thematic analysis using Attride-Stirling's thematic network analysis framework. RESULTS: The majority of the participants (52.6%) were nurses, most of them female (84.2%), with a mean age of 39 years (SD ±9.2). A large part of the participants had been working in the diabetes clinics for more than 5 years (52.6%) and had more than 10 years' experience (52.6%) in their current employment. Five main healthcare system factors that may affect glycemic control were identified during thematic analysis: 1. Healthcare workforce (shortage of staff, high workload). 2. Medicine, consumables, and equipment (regular stock-outs of basic diabetes medicines and consumables, poorly equipped diabetes clinics). 3. Service delivery (lack of effective diabetes service delivery, continuum of care). 4. Healthcare information system (inadequate, not fully functional, unreliable). 5. Infrastructure (lack of supportive diabetes clinic infrastructure and processes). CONCLUSIONS: Healthcare system factors influence glycemic control among T2D patients. Understanding these factors is important in order for healthcare providers to deliver an effective and efficient service for diabetes patients in Fiji.

Perceptions of patients on factors affecting diabetes self-management among type 2 diabetes mellitus (T2DM) patients in Fiji: A qualitative study

“…These challenges were compounded by the financial constraints and inadequate social welfare allowances needed to purchase medications from retail the pharmacy. These findings were consistent with other studies conducted by ( Romakin &Masoud, 2019 ; Ong et al., 2018 ). The patients had poor financial status, insufficient social welfare allowances and poor financial support from children.…”

Health Care Workers' Perceptions on Factors Affecting Diabetes Self-Management Among Type 2 Diabetes Mellitus Patients in Fiji: A Qualitative Study

“…Moreover, Lack of resources may allow patients to resort to other means of treatment such as herbal medicine and prompt patients to default clinics. Similar results were seen in a study conducted by Romakin and Mohammadnezhad ( 25 ). The approaches to address lack of resources has always been challenging especially for a developing country.…”

“…Lack of space and busy clinics may result in insufficient exchange of information between HCWs and patients. Other studies reported similar findings ( 23 – 25 ). Adequate supply of medications should be available through the current Fiji free medicine program where patients get medications for free at retail pharmacies.…”

Facilitators and barriers of herbal medicine use in diabetic patients: A qualitative study

“…One of the factors affecting failure to perform appropriate behavior expressed by patients or people in the community was lack of time. The reason for behaviors such as exercise, screening, and nutrition by people in the community has been reported “lack of time.”[ 22 23 24 25 ] Some studies on diabetic patients have reported “lack of patience and sufficient time” as an important factor responsible for noncompliance to drug and diet. [ 26 ] Lack of skills in preparing herbal medicines has been expressed as one of the factors associated with unwillingness to use herbal medicines.…”