Towards the holistic management of diabetes in Saudi Arabia : a multi-method study
Towards the holistic management of diabetes in Saudi Arabia : a multi-method study
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沙特阿拉伯糖尿病的整体管理：一项多方法研究
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发表时间：
2018
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通讯作者：
N. Alharbi
中科院分区：
文献类型：
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作者：
N. Alharbi
本研究的目的是探索沙特医疗保健系统中 2 型糖尿病 (T2DM) 的管理。选择这个国家进行检查是因为该国正在经历重大的人口、社会和经济变化，导致包括糖尿病在内的慢性病患病率增加。本研究采用了世界卫生组织 (WHO) 慢性病创新护理框架 (ICCCF)。该框架通过解决宏观（政策）、中观（医疗保健组织和社区）和微观（患者和家庭）层面的组成部分，为评估沙特医疗保健系统提供了全面的基础。根据这三个卫生系统层次，采取了灵活的多方法方法，分三个阶段使用第一手和第二手数据。为了探索沙特医疗保健系统的政策环境，第一阶段涉及根据 Walt 和 Gilson 卫生政策分析框架的四个维度：内容、参与者、背景和流程，分析 35 个国家和地区 T2DM 文件。第二阶段旨在探讨医疗保健专业人员对有效医疗保健组织和社区合作伙伴关系的障碍和促进因素的看法，以实现 T2DM 管理。对来自不同医疗保健领域的 33 名参与者进行了半结构化访谈，并进行了主题分析。第三阶段旨在评估患者的经历以及他们与医疗保健提供者的互动。在此阶段，慢性病护理患者评估 (PACIC) 调查使用世界卫生组织翻译和工具调整步骤翻译成阿拉伯语，并分发给四个专门糖尿病诊所的 575 名糖尿病患者。尽管T2DM在宏观层面得到了高度认可，但通过文献分析发现了一些挑战，并在研究的第二阶段也强调了一些挑战。这些挑战包括：不可靠的卫生信息系统、缺乏多部门合作以及缺乏公众意识。在中观层面，访谈数据确定了三个主题：T2DM的文化决定因素、关键支持系统的局限性以及改善T2DM患者支持系统的建议。在已确定的主题中，确定了一些次主题，包括：缺乏身体活动、依赖传统治疗、不健康的饮食模式、初级卫生保健服务差、缺乏可靠数据、缺乏合格的工作人员、指南传播不力、加强多部门合作和社区伙伴关系。在微观层面，PACIC 调查的平均得分低于国际上进行的类似研究（平均值 = 2.55，满分 5 分）。患者在“患者激活”方面的平均得分为2.69，“交付系统/实践设计”的平均得分为3.02，“目标设定/定制”的平均得分为2.29，“随访/协调”的平均得分为2.10，“问题解决/背景领域”的平均得分为2.84。此外，报告的血糖控制措施表明，只有 17% 的参与者控制了血糖水平（≤ 7%），相当于 8.6 mmol/L。 ICCC 框架是探索沙特医疗保健系统主要弱点和优势的有用工具。然而，据观察，ICCC 并未明显认识到社区敏感性，特别是社区文化、宗教、规范和信仰。尽管如此，这项研究通过探索不同级别的流程如何塑造医疗保健系统的绩效，产生了有关沙特阿拉伯 T2DM 管理系统的新知识；所以。它有助于丰富卫生系统研究的知识体系。
The purpose of this study was to explore the managing of Type 2 Diabetes Mellitus (T2DM) in the Saudi healthcare system. This country was chosen for examination because it has been undergoing major demographic, social and economic changes which have caused an increase in the prevalence of chronic diseases, including diabetes. This study adopted the World Health Organization's (WHO) Innovative Care for Chronic Conditions Framework (ICCCF). This framework provided a comprehensive basis for assessing the Saudi healthcare system by addressing its components at the macro (policy), meso (healthcare organizations and community), and micro (patient and family) levels. In accordance with these three health system strata, a flexible multimethod approach was adopted by using primary and secondary data in three phases. To explore the policy environment of the Saudi health care system, the first phase involved analysing 35 national and regional T2DM documents according to four dimensions of Walt and Gilson’s health policy analysis framework: content, actors, context, and process. The second phase aimed to explore healthcare professionals’ perceptions of the barriers and facilitators of an effective healthcare organization and of community partnerships to enable T2DM management. Semi-structured interviews were conducted with 33 participants from various healthcare fields and thematic analyses were applied. The third phase aimed to assess the patients’ experiences and their interactions with healthcare providers. In this phase, the Patient Assessment of Chronic Illness Care (PACIC) survey was translated into Arabic using the WHO Steps of Translation and Adaptation of Instruments, and distributed among 575 diabetes patients in four specialized diabetes clinics. Although T2DM has highly recognised at the macro level, several challenges were identified through the documents analysis and were also highlighted during the second phase of the study. These challenges included: unreliable health information systems, a lack of multisectoral collaboration, and a lack of public awareness. At the meso level, the interview data identified three themes: the cultural determinants of T2DM, the limitations of key support systems, and recommendations for improving the support systems for T2DM patients. Within the identified themes, a number of subthemes were identified, including: physical inactivity, reliance on traditional treatments, unhealthy dietary patterns, poor primary healthcare services, lack of reliable data, shortage of qualified staff, poor guidelines dissemination, enhancing the multisectorial collaboration, and community partnerships. At the micro level, the mean score of the PACIC survey was lower in comparison to similar studies conducted internationally (mean = 2.55 out of 5). Patients scored on average 2.69 for ‘patient activation’, 3.02 for ‘delivery system/practice design’, 2.29 for ‘goal setting/tailoring’, 2.10 for ‘follow-up/coordination’, and 2.84 for ‘problem solving/contextual domain’. In addition, the reported glycaemic control measures indicated that only 17% of participants had controlled blood glucose levels (≤ 7%) which is equivalent to 8.6 mmol/L. The ICCC framework was a useful tool for exploring the main weaknesses and strengths of the Saudi healthcare system. However, it was observed that the ICCC did not significantly recognize community sensitivity, particularly community culture, religion, norms, and beliefs. Nevertheless, this study generated new knowledge about T2DM management systems in Saudi Arabia by exploring how the performance of the healthcare system is shaped by the processes occurring at the different levels; therefore. It contributes to the body of knowledge on health system research.