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Care providers' perceptions towards challenges and opportunities for service improvement at diabetes management clinics in public primary health care in Muscat, Oman: a qualitative study
Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Training and Studies, Royal Hospital, Ministry of Health, Muscat, Oman.
Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
2019 (Engelska)Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, artikel-id 18Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BackgroundThe literature has described several challenges related to the quality of diabetes management clinics in public primary health care centres in Oman. These clinics continue to face challenges due to the continuous growth of individuals diagnosed with type 2 diabetes. We sought to explore the challenges faced in these clinics and discuss opportunities for improvement in Oman.MethodsThis qualitative study was designed to include non-participant observations of diabetic patients and care providers during service provision at diabetes management clinics, as well as semi-structured interviews with care providers, at five purposively selected public primary health care centres. Care providers included physicians, nurses, dieticians, health educators, pharmacists, an assistant pharmacist, a psychologist, and a medical orderly. The data were analysed using qualitative content analysis.ResultsThe study disclosed three different models of service delivery at diabetes management clinics, which, to varying degrees, face challenges related to health centre infrastructure, technical and pharmaceutical support, and care providers' interests, knowledge, and skills. Challenges related to the community were also found in terms of cultural beliefs, traditions, health awareness, and public transportation.ConclusionThe challenges encountered in diabetes management clinics fall within two contexts: health care centres and community. Although many challenges exist, opportunities for improvement are available. However, improvements in the quality of diabetic clinics in primary health care centres might take time and require extensive involvement, shared responsibilities, and implications from the government, health care centres, and community.

Ort, förlag, år, upplaga, sidor
BioMed Central, 2019. Vol. 19, artikel-id 18
Nyckelord [en]
Oman, Primary health care, Health service challenges, Type 2 diabetes, Health care providers
Nationell ämneskategori
Omvårdnad Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
URN: urn:nbn:se:umu:diva-155965DOI: 10.1186/s12913-019-3866-yISI: 000455209900007PubMedID: 30621675OAI: oai:DiVA.org:umu-155965DiVA, id: diva2:1286762
Tillgänglig från: 2019-02-07 Skapad: 2019-02-07 Senast uppdaterad: 2019-04-02Bibliografiskt granskad
Ingår i avhandling
1. Team-based approach in the management of diabetes at primary health care level in Muscat, Oman: challenges and opportunities
Öppna denna publikation i ny flik eller fönster >>Team-based approach in the management of diabetes at primary health care level in Muscat, Oman: challenges and opportunities
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Alternativ titel[sv]
Teambaserad diabetesvård i primärvården i Muscat, Oman : utmaningar och möjligheter
Abstract [en]

Introduction: The growth of type 2 diabetes is considered an alarming epidemic in Oman. The efficient team-based approach to diabetes management in primary health care is an essential component for providing ideal diabetic care. This thesis aimed to explore the current situation related to team-based management of type 2 diabetes in public Primary Health Care Centres (PHCCs) under the Ministry of Health (MOH) in Oman, including the various challenges associated with diabetes management and the most preferable Human Resources for Health (HRH) management mechanism, and to examine how this could be optimized from provider and patient perspectives.

Materials and methods: The entire project was conducted in Muscat Governorate and was based on one quantitative and three qualitative studies. In the quantitative study, 26 public PHCCs were approached through cross-sectional study. The core diabetes management team recommended by the MOH for PHCCs in Oman was explored in terms of their competencies, values, skills, and resources related to the team-based approach to diabetes management. For the qualitative studies, five public purposely-selected PHCCs were approached. The diabetes consultations conducted by the core members and other supportive members involved in diabetes management were observed and later the Primary Health Care Providers (PHCPs) were interviewed. The different approaches explored challenges related to diabetes management and the most preferable HRH mechanism by PHCPs. Seven type 2 diabetes patients with different gender, employment status, and education were consequently interviewed to explore their perceptions towards the current diabetes management service and their opinions towards nurse-led clinics.

Results: The survey provided significant and diverse perceptions of PHCPs towards their competencies, values, skills, and resources related to diabetes management. Physicians considered themselves to have better competencies than nurses and dieticians. Physicians also scored higher on team-related skills and values compared with health educators. In terms of team-related skills, the difference between physicians and nurses was statistically significant and showed that physicians perceived themselves to have better skills than nurses. Confusion about the leadership concept among PHCPs with a lack of pharmacological, technical, and human resources was also reported. The observations and interviews with PHCPs disclosed three different models of service delivery at diabetes management clinics. The challenges explored involved PHCCs’ infrastructure, nurses’ knowledge, skills, and non-availability of technical and pharmaceutical support. Other challenges that evolved into the community were cultural beliefs, traditions, health awareness, and public transportation. Complete implementation of task-sharing mechanisms within the team-based approach was selected by all PHCPs as the most preferable HRH mechanism. The selection was discussed in the context of positive outcomes, worries, and future requirements. The physicians stated that nurses’ weak contribution to the team within the selected mechanism could be the most significant aspect. Other members supported the task-sharing mechanism between physicians and nurses. However, type 2 diabetes patients’ non-acceptance of a service provided by the nurses created worries for the nurses. The interviews with type 2 diabetes patients disclosed positive perceptions towards the current diabetes management visits; however, opinions towards nurse-led clinics varied among the patients.

Conclusions and recommendations: The team-based approach at diabetes management clinics in public PHCCs in Oman requires thoughtful attention. Diverse presence of the team members can form challenges during service delivery. Clear roles for team members must be outlined through a solid HRH management mechanism in the context of a sharp leadership concept. Nurse-led clinics are an important concept within the team; however, their implementation requires further investigation. The concept must involve clear understandings of independence and interdependence by the team members, who must be educated to provide a strong gain for team-based service delivery.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet, 2019. s. 81
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2025
Nyckelord
Challenges, Health care providers, Oman, Perceptions, Primary health care, Team-based approach, Type 2 diabetes, Nurse-led clinics.
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Forskningsämne
folkhälsa
Identifikatorer
urn:nbn:se:umu:diva-157728 (URN)978-91-7855-042-5 (ISBN)
Disputation
2019-04-26, Sal E04, Norrlands universitetssjukhus, Umeå, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2019-04-05 Skapad: 2019-04-02 Senast uppdaterad: 2019-04-04Bibliografiskt granskad

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Al-Alawi, KamilaJohansson, Helene

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