Table 2 Contexts, categories, sub-categories and 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b) Outdated diabetic drugs and a shortage of cardiovascular drugs.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.