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Primary care management of diabetes in a low/middle income country: A multi-method, qualitative study of barriers and facilitators to care

Lookup NU author(s): Professor Hugh Alberti



Background. The management of patients with diabetes mellitus is complex. Some research has been done in developed countries to attempt to determine the factors that influence quality of care of patients with diabetes: Factors thus far postulated are usually categorised into patient, clinician and organisational factors. Our study sought to discover the main barriers and facilitators to care in the management of diabetes in primary care in a low/middle income country. Methods. A qualitative study, based on reflexive ethnography using participant observation, semi-structured interviews of clinicians (10) and group interviews with paramedical staff (4) and patients (12) in three purposively sampled health centres, along with informal observation and discussions at over 50 other health centres throughout Tunisia. A content analysis of the data was performed. Results. Over 400 potential barriers or facilitators to care of patients with diabetes in primary care in Tunisia emerged. Overall, the most common cited factor was the availability of medication at the health centre. Other frequently observed organisational factors were the existence of chronic disease clinics and clinicians workload. The most commonly mentioned health professional factor was doctor motivation. Frequently cited patient factors were financial issues, patient education and compliance and attendance issues. There were notable differences in the priority given to the various factors by the researcher, physicians, paramedical staff and the patients. Conclusion. We have discovered a large number of potential barriers and facilitators to care that may potentially be influencing the care of patients with diabetes within primary care in Tunisia, a low/middle income country. An appreciation and understanding of these factors is essential in order to develop culturally appropriate interventions to improve the care of people with diabetes. © 2007 Alberti et al; licensee BioMed Central Ltd.

Publication metadata

Author(s): Alberti H, Boudriga N, Nabli M

Publication type: Article

Publication status: Published

Journal: BMC Family Practice

Year: 2007

Volume: 8

Issue: 63

Print publication date: 09/11/2007

ISSN (electronic): 1471-2296

Publisher: BioMed Central Ltd.


DOI: 10.1186/1471-2296-8-63

PubMed id: 17996084


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