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Table 2 Contexts, categories, sub-categories and outcomes

From: Care providers’ perceptions towards challenges and opportunities for service improvement at diabetes management clinics in public primary health care in Muscat, Oman: a qualitative study

Contexts Categories Sub-categories Outcomes
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b) Outdated diabetic drugs and a shortage of cardiovascular drugs.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.