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

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. (Int J Circumpolar Health 2011; 70(5):552-563)