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Team-Based Approach in the Management of Diabetes at Primary Health Care Level in Muscat, Oman Challenges and Opportunities

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Team-Based Approach in the Management of Diabetes at Primary Health Care Level in Muscat, Oman Challenges and Opportunities Team-based Approach in the Management of Diabetes at Primary Health Care Level in Muscat, Oman Challenges and Opportunities Kamila Al Alawi Team-based Approach in the Management of Diabetes at Primary Health Care Level in Muscat, Oman: Challenges and Opportunities Kamila Al Alawi Department of Epidemiology and Global Health Umeå University Umeå 2019 This work is protected by the Swedish Copyright Legislation (Act 1960:729) Dissertation for PhD ISBN: 978-91-7855-042-5 ISSN: 0346-6612 New Series No. 2025 Cover design by: Reem Al-Sabti, Ali Al-Sabti, Noor Al-Sabti and Marwa Al-Sabti Electronic version available at: http://umu.diva-portal.org/ Printed by: Cityprint i Norr AB Umeå University, Sweden 2019 “And say, oh my Lord increase my knowledge” Surah Taha - verse 114 Table of Contents List of Tables .................................................................................. vii List of Figures ................................................................................. ix Abbreviations ................................................................................. xi Abstract ........................................................................................ xiii Summary of the PhD Project in Arabic Language ........................... xv Original Papers ............................................................................ xvii Prologue ....................................................................................... xix Introduction .................................................................................... 1 Type 2 diabetes and its global spread ................................................................................. 1 Type 2 diabetes in the Middle East ..................................................................................... 1 Chronic care model ............................................................................................................. 2 Team-based approach in diabetes management ............................................................... 3 Oman and Type 2 diabetes management situation ........................................................... 7 Oman’s geography and demography ................................................................................... 7 Omani people’s lifestyle ........................................................................................................ 9 Type 2 diabetes epidemic .....................................................................................................10 The health care system ........................................................................................................10 The team-based approach in diabetes management clinics in the public primary health care system................................................................................................................ 11 Knowledge gap and contribution of this PhD project ......................................................12 Main and specific aims of the studies ............................................................................... 13 Main aim .............................................................................................................................. 13 Specific aims ......................................................................................................................... 13 Materials and Methods ................................................................... 15 General project design .......................................................................................................15 Project setting and sample selection ................................................................................ 18 Studies’ Methods .............................................................................................................. 19 Cross-sectional survey (Study 1) ......................................................................................... 19 Qualitative non-participant observations of diabetes consultations (Study 2) .............. 22 Qualitative interviews with health care providers (Studies 2 and 3) .............................. 23 Qualitative interviews with type 2 diabetic patients (Study 4) ....................................... 24 Studies’ data analysis ........................................................................................................ 25 Statistical analysis (Study 1) .............................................................................................. 25 Descriptive summaries and qualitative content analysis (Study 2) ................................ 25 Qualitative thematic analysis (Studies 3 and 4) ............................................................... 26 Ethical considerations ...................................................................................................... 27 v Results ........................................................................................... 29 Competencies, values, skills and resources related to the team–based approach: PHCPs’ perceptions (Study 1) .......................................................................................... 29 PHCPs’ self-perceived competencies .................................................................................. 30 PHCPs’ self-perceived values .............................................................................................. 30 PHCPs’ self-perceived team-related skills ......................................................................... 30 PHCPs’ self-perceived support/resources .......................................................................... 31 Challenges and opportunities for improvement in diabetes management: PHCPs’ perceptions (Study 2) ........................................................................................................31 Team-based approach within different models of service delivery at diabetes management clinics ............................................................................................................. 31 Challenges exposed during the interviews ........................................................................ 32 Task-sharing mechanism and its complete implementation: PHCPs’ perception (Study 3) ............................................................................................................................ 34 The current diabetes service and nurse-led clinics: Type 2 diabetes patients’ opinions. ........................................................................................................................... 36 Dissemination of results ................................................................................................... 37 Discussion ..................................................................................... 39 The current situation (Studies 1 and 2) ........................................................................... 39 Understanding of the team kinetics (Studies 1, 2, and 3) ............................................... 40 The missing link of the team (Studies 1, 2, and 3) .......................................................... 41 Type 2 diabetes patients and nurse-led clinics (Studies 3 and 4) .......................................... 42 Methodological considerations ........................................................................................ 43 Conclusions and Recommendations .............................................. 47 Conclusions and contribution of this thesis .................................................................... 47 Recommendations for future research ............................................................................ 47 Acknowledgments .......................................................................... 49 References ..................................................................................... 53 Appendix ....................................................................................... 61 vi List of Tables Table 1. Thesis at a glance Table 2. Provinces of Muscat Governorate and their populations Table 3. Participants in the qualitative studies Table 4. The four themes, including the 31 categorized items Table 5. Example of the coding process Table 6. Task-sharing preferability, positive outcomes, worries and requirements vii viii List of Figures Figure 1. The chronic care model Figure 2. A continuum of team health care practice models Figure 3. Key contributors to a successful interdisciplinary team in diabetes care Figure 4. Map of Oman Figure 5. Map of Muscat Governorate Figure 6. PHCPs’ tasks and roles Figure 7. Interview in progress with PHCP Figure 8. Poster presentation at 20th European Congress of Endocrinology Figure 9. Published scientific papers (1 and 2) ix x Abbreviations CCM Chronic Care Model GCCs Gulf Council Countries GDP Gross Domestic Product HRH Human Resources for Health MOH Ministry of Health NCDs Non-Communicable Diseases PHCC Primary Health Care Centre PHCP Primary Health Care Provider WHO World Health Organization xi xii Abstract 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
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