Stakeholder Perspectives Regarding the Acceptability and Sustainability of a Multi-Component Diabetes Care Strategy in South Asia: A Longitudinal Qualitative Analysis

Abstract

South Asia has the highest worldwide burden of diabetes, yet little is known about how to promote the sustainability of diabetes quality improvement care models in South Asia and how these approaches are viewed by health service users. The present study evaluates how organizational features influence sustainability of the CARRS Trial intervention and assesses patient’s acceptability of the care model. In-depth interviews with clinical stakeholders were conducted pre-implementation (physicians, n = 19), during late-implementation, after 2.5 years of supported intervention (physicians, n = 9), and two years post-implementation (care coordinators, n = 3; patients, n = 34). The consolidated framework for implementation research (CFIR) was used to code transcriptions and conduct a thematic analysis. Prior to implementation, physicians perceived the care model as an opportunity to enhance the quality of diabetes care. By late-implementation, physicians reported alignment between intervention care components and clinics’ needs and work cultures. However, physicians felt that additional cost- and clinical effectiveness data would be needed to assess intervention sustainability. Patients perceived the intervention as acceptable because care coordination facilitated more responsive and efficient clinic services. Efforts to scale-up and scale-out this intervention should focus on ensuring the care components are compatible with clinics’ priority needs and identify how the care coordinator’s role will integrate into existing clinical workflows.