title: Providers' perceptions of barriers to the management of type 2 diabetes in remote Aboriginal settings.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5B 1M8, Canada. BhattacharyyaO@smh.ca
authors: Onil K
authors: OK
authors: Bhattacharyya
authors: Elizabeth A
authors: EA
authors: Estey
authors: Irit R
authors: IR
authors: Rasooly
authors: Stewart
authors: S
authors: Harris
authors: Merrick
authors: M
authors: Zwarenstein
authors: Jan
authors: J
authors: Barnsley
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D003144:Communication Barriers; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000628:therapy*; D017598:Efficiency, Organizational; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000458:organization & administration; D006303:Health Services, Indigenous / Q000458:organization & administration; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011361:Professional Competence; D011369:Professional-Patient Relations; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires