Working towards a better understanding of type 2 diabetes care organization with First Nations communities: a qualitative assessment

Abstract

Background: Diabetes care is suboptimal in First Nations populations. Innovative and culturally-relevant approaches are needed to promote proactive organization of diabetes care for diabetes patients on-reserve in Canada. The Reorganizing the Approach to Diabetes care through the Application of Registries (RADAR) model is one strategy to improve care: an integrated disease registry and electronic health record for community healthcare workers with centralized care coordination. The aim of this study was to qualitatively assess the organization of type 2 diabetes care in participating communities in Alberta, Canada, at baseline prior to implementing RADAR.Methods: Using qualitative description, we purposefully sampled healthcare workers involved in diabetes care at each health center. We used the 5Rs framework (i.e., Recognize, Register, Resource, Relay, Recall) to inform the baseline assessment and conducted group interviews in 6 communities with 16 healthcare workers. Detailed notes were taken and validated by participants. Data was managed using ATLAS.ti 8 and analyzed using content analysis. Results: We found strong commitment and effort by local healthcare workers to support people living with type 2 diabetes in their communities. However, healthcare workers were limited in their ability to identify (i.e., recognize), track (i.e., register and relay) and manage (i.e., resource and recall) people with type 2 diabetes as proposed by the 5Rs framework. The organization of diabetes care was often reactive and dependent on patients' abilities to navigate the health system. Interestingly, participants talked about the 5Rs in relationship to one another, not in a linear or isolated manner. Conclusions: Overall, the organization of diabetes care in participating communities did not align with the recommended approach of the 5Rs framework. In addition, we propose "reimagining" the 5Rs to reflect the interdependence and mediation of components situated within human and financial resources. This will better equip healthcare workers to assess, plan and execute organized and proactive diabetes care. However, the onus on people living with type 2 diabetes to engage with healthcare services remains a concern. Trial registration: ISRCTN.com, ISRCTN14359671.

Patient perspective on barriers in type 2 diabetes self‐management: A qualitative study

“…Where the clinics were found, they lacked the necessary material and human resources to adequately cater for people with diabetes. The finding aligns with the work of Wozniak et al ( 2020 ) who found limited financial and human resources as a hallmark issue such that healthcare workers could not undertake even screening at the health centres to identify people with T2D and therefore had to rely on the referral system. In addition, concerns have been raised about the capacity of community health workers to effectively handle people with diabetes due to the nature of their training; meanwhile, they remain instrumental in the prevention of T2D (Gore et al, 2020 ).…”

“…Where the clinics were found, they lacked the necessary material and human resources to adequately cater for people with diabetes. The finding aligns with the work of Wozniak et al (2020) who found limited financial and human resources as a hallmark issue such that healthcare workers could not undertake even screening at the health centres to identify people with T2D and therefore had to rely on the referral system. In…”

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

“…Tools, like Mapping the System, can be used to help understand participants' values as well as potential losses and benefits as a result of implementing a new model, process, or intervention [35]. In the case of RADAR, targeted messaging for community leaders and health centre staff, might include reframing diabetes care from reactive and episodic to proactive and preventative [8]. Messaging could capitalize on health directors' and local HCPs' focus on traditional public health, such as immunizations, to prevent disease and reframe diabetes care similarly as prevention of chronic disease [37].…”

“…These issues are compounded by suboptimal diabetes care, particularly in rural or remote settings where many First Nations people live [2,[4][5][6]. In Canada, diabetes care in First Nations communities is delivered through federally-funded nurse-led homecare, community health, and diabetes programs with limited access to primary care physicians and specialists [7] Additionally, healthcare providers in some First Nations communities in Alberta feel limited in their ability to identify, track, and manage patients with type 2 diabetes; therefore, care was typically reactive and dependent on patients' abilities to navigate the health system [8]. Clearly, there is a need for innovative and culturallyrelevant approaches to promote systematic and proactive organization of diabetes care for First Nations people living with diabetes on-reserve in Canada [9,10].…”

Adopting and Implementing an Innovative Model to Organize Diabetes Care Within First Nations Communities: A Qualitative Assessment

“…(33) In the case of RADAR, targeted messaging for community leaders and health centre staff, might include reframing diabetes care from reactive and episodic to proactive and preventative. (8) Messaging could capitalize on health directors' and local HCPs' focus on traditional public health, such as immunizations, to prevent disease and reframe diabetes care similarly as prevention of chronic disease. (35) To increase its potential to achieve outcomes, the spread (i.e.…”