Frontline community health care workers’ intervention for diabetes management in resource limited settings: a qualitative study on perspectives of key stakeholders

Amudha Poobalan, Emma Whiteley, Bhavya Balsubramanya, Sam Philip, Paul Jebaraj, BV Balaji , Oommen John, Nihal Thomas, Prakash Abraham, Rita Isaac* (Corresponding Author)

*Corresponding author for this work

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Diabetes mellitus (DM) is a global public health concern, with significant increase in the transitioning low- and middle-income countries (LMICs), such as India, with limited resources and poor health care systems. Recognising the need for innovative, feasible, targeted interventions for diabetes care, a non-randomized, controlled, phase II clinical trial was conducted in a rural revenue block in Tamil Nadu, India. This pilot trial tested the non-inferiority of the trained community health workers (CHWs) in delivering education, screening for diabetes complications using a protocol-based referral for physician consultation for management, assisted by an android application (App) for patient tracking. Understanding the perceptions of key stakeholders including patients and health workers is crucial for upscaling and sustaining these novel interventions for
diabetes care. This study explored the perspectives and views of patients with DM and diabetes CHWs who participated in the pilot trial.
Using qualitative research methodology, individual in-depth interviews were conducted in the local vernacular (Tamil) language among the two diabetes CHWs and purposively chosen 24 patients until the data saturation was reached. Participant information sheets, consent forms and a detailed topic guide were developed. Interviews were transcribed verbatim, translated into English and thematic analysis was conducted.
Five main themes emerged during interviews with diabetes CHWs: deeper understanding of the disease; belonging and strengthening; ease of use of digital technology and a timesaver for patient tracking; cultural sensitivity; stigma and change in attitudes over time. Interviews with patients highlighted four major themes: convenience; cost reduction; improved knowledge and perceptions on health. Benefits were perceived by both patients and diabetes CHWs, in the domains of convenience, access, cost and knowledge. Perceptions of changes in health were mixed with room for improvement in the digital App.
Training CHWs in resource limited settings in supporting community diabetes care, assisted by digital technology for tracking is acceptable to the patients and will help shift the care pathway for Diabetes closer to the patients in a rural setting. This qualitative study identified a number of areas for improvement and potential barriers that will need
Original languageEnglish
Article numbere2021046
Number of pages8
JournalJournal of Global Health Reports
Early online date18 Jun 2021
Publication statusPublished - 18 Jun 2021

Bibliographical note

We would like to acknowledge the patients with diabetes and the diabetes community health workers who participated in the lengthy interviews despite their busy schedules. We thank the translators who were well versed in both
languages in supporting the researchers during data collection. We would like to thank the whole team in completing the study on time by travelling to the homes of patients in rural and remote areas.
We acknowledge the funding received from Friends of Vellore, UK and NHS Grampian Endowment fund, University of Aberdeen- Approval Number: EA0852


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