Providers’ perceptions of barriers to the management of type 2 diabetes in remote Aboriginal settings

Abstract

Objectives. To examine providers' perspectives of the barriers to providing diabetes care in remote First Nation communities in the Sioux Lookout Zone (SLZ) of Northwestern Ontario, Canada. Study design. A qualitative study involving key informant interviews and focus groups was conducted with health care providers working in remote First Nation communities in SLZ. Methods. Twenty-four nurses, doctors, diabetes educators and community health representatives (CHRs) participated in qualitative interviews and focus groups. Data collected from the interviews and focus groups was coded and thematically analysed using NVIVO software. Results. Barriers to diabetes care were grouped into patient, clinic and system factors. Providers' perceptions of patient factors were divided between those advocating for a patient-provider partnership and those advocating for greater patient responsibility. Clinic-related barriers such as short staffing, staff turnover and system fragmentation were discussed, but were often overshadowed by a focus on patient factors and a general sense of frustration among providers. Cultural awareness and issues with clinic management were not mentioned, though they are both within the providers' control. Conclusions. This study characterizes a range of barriers to diabetes care and shows that patient-related factors are of primary concern for many providers. We conclude that patient-focused interventions and cultural competence training may help improve patient-provider partnerships. Funding and supporting quality improvement initiatives and clinic reorganization may increase the providers' knowledge of the potential for clinical strategies to improve patient outcomes and focus attention on those factors that providers can change. Future research into the factors driving quality of care and strategies that can improve care in Aboriginal communities should be a high priority in addressing the rising burden of diabetes and related complications.

Pharmaceutical health care and Inuit language communications in Nunavut, Canada

“…nursing staff rotations) have been identified as a challenge in remote Aboriginal communities. Specifically, continuity of care is necessary for the establishment of relationships beneficial to chronic care management and cultural awareness (10). Health centres in fly-in communities have access to a basic dispensary from which pharmaceuticals are available for urgent-care or temporary needs.…”

“…Translating evidence-based medical knowledge into linguistically understandable and culturally meaningful patient information has been identified as an essential component of effective health care in Aboriginal communities (8–10). The most recognizable communication barrier in North America is patient–provider language differences, often when predominantly English-speaking health care providers are serving non-English speaking patients.…”

Acesso dos usuários indígenas aos serviços de saúde de Cuiabá, Mato Grosso, Brasil

“…Os autores asseveram que os profissionais desconheciam o quanto pode ser significativo o aspecto cultural na discussão da saúde indígena. Segundo eles, faz-se então necessário implantar uma educação e treinamento sobre o tema da interculturalidade e serviços culturalmente seguros para os profissionais de saúde 33 .…”

The association between the number of office visits and the control of cardiovascular risk factors in Iranian patients with type2 diabetes

“…Therefore, when elderly patients make office visits every 3 to 6 months, the partial therapeutic changes applied during these visits are often insufficient for achieving glycemic control [22]. In a clinical trial that investigated the barriers to optimizing the management of elderly patients with diabetes, the most frequently encountered factor was insufficient treatment, which was initially due to patients’ desire to avoid changing the insulin dosage during the intervals between office visits or at times of depressed mood [23]. Given the above-mentioned points, the mean age of the patients in our study was relatively high.…”