|A) Health care centre.||1) Infrastructure.||a) Shared rooms.||
• Providers cannot interview the patient independently.|
• Handle one patient at a time, which leads to waste of providers’ time.
|b) Shortage of computers.||
• Inefficient management.|
• Loss of patient data.
|c) Incompetent support system (IT).||
• Missing data for annual statistics.|
• Inefficient appointment system.
• Twenty-minutes allowance only for consultation.
• Overbooking system and follow-up failure.
|d) Shortage of providers.||
• Physicians have to perform other providers’ roles and manage all aspects of the illness.|
• Tasks are not distributed according to professional abilities, which increase the single physician approach.
• Physicians are tired and not focused.
• Inability for pharmacists to provide quality time for patients.
• Impossible to separate the hypertension and diabetes clinic.
• Cancelation of afternoon clinics.
|e) Non-Arabic speaking providers.||
• Communication barrier between provider and patient.|
• Increased number of defaulters and consequently discontinuity of care.
|2) Tools/technical/pharmaceutical resources.||a) Shortage of dieticians’ and health educators’ diagnostic and educational tools.||
• Patients not managed/educated properly at the centre.|
• Patients prefer to go to private clinics.
|b) Outdated diabetic drugs and a shortage of cardiovascular drugs.||
• Ineffective medical management.|
• Patients have to purchase the drugs from outside pharmacies.
|3) Interests/knowledge/skills.||a) Nurses interest in diabetes low.||
• Nurses not trained in diabetes care.|
• Loss of skill application in trained nurses.
• Non-focused nurses due to their distribution in different clinics.
|b) Low nurse knowledge and skills.||
• No delegation of work from physicians to nurses.|
• Low patient trust in nurses.
• Underutilized nurses.
|B) Community.||1) Cultural beliefs/traditions.||a) Listen to and trust friends/family more than health providers.||
• Seeking traditional treatment/healers.|
• Seeking second opinions.
• Low compliance with treatment.
• Increased defaulters.
|b) Non-commitment to appointment system.||
• Clinic crowdedness.|
• Disturbed providers.
|c) Sweet diet and sedentary lifestyle.||• Low compliance with healthy lifestyle.|
|2) Knowledge/awareness.||a) Lack of health and diabetes awareness.||
• Denial of diabetes.|
• Low compliance with medication.
• Low compliance with healthy lifestyle.
|3) Transportation.||a) Lack of (public) transportation (patients dependent on family support).||
• Increased defaulters.|
• Discontinuity of care.