Adapting chronic care models for diabetes care delivery in low-and-middle-income countries: A review

Table 2 Contextual analysis of key factors affecting adaptation of chronic care models and subsequent selection of CACCM elements for implementation making use of Oliver’s typology and characteristics enumerated by Greenhalgh et al[18]

CACCM- and project-related
Oliver’s dimensions
Social legitimacy	Improving care for chronic conditions and protection and promotion of the health and wellbeing of the LGU population enhances the social fitness of the LGHU and the local government
Economic efficiency	The introduction of additional activities in any organization entails additional expenses. Cost-effective or cost-saving innovations would be preferred
External dependence on institutional constituents	The LGHU are dependent on the LGU for funding; the LGU officials who decide on the allocation of these resources are dependent on the populace for their seats in office
Consistency with organizational goals	The primary goal of the LGHU is to provide good quality healthcare to the people
Discretionary constraints imposed on the organization	The LGHU expects full autonomy especially in substantive decision-making such as resource-allocation, resource acquisition, organizational administration, etc.
Voluntary diffusion of norms	A moderate to high degree of voluntary diffusion with some degree of pressure from the LGU officials to diffuse said norms may be most effective in promoting adoption of the intervention
Environmental interconnectedness	A certain degree of predictability of the environment is seen: the general population, especially the people with diabetes and their families will most likely appreciate the intervention. Such appreciation may be reflected on goodwill towards the LGU officials and consequently to the LGHU (for example additional budget allocated to health)
Greenhalgh’s characteristics
Relative advantage	Implementing a diabetes-care project gives the advantage of improving the care for this condition and a number of its comorbidities, but without reduction of other health benefits
Compatibility	Compatibility of the intervention with current/pre-existing activities in the LGHU and with the current duties, responsibilities and workload of the LGHU staff is sought
Simplicity	Simplicity and ease of use of the intervention favors adoption of the intervention
Trialability	Flexibility in accomplishing a number of tasks, i.e., giving leeway to the healthcare staff regarding performance of activities related to the intervention will increase acceptability of the intervention
Observability	Providing information to the intended adopters of the benefits of the intervention, e.g., improvements of glycemia, favors adoption of the intervention
Reinvention	Flexibility of the intervention allowing adaptation and refinement to suit the context, the needs of the individual person with diabetes and the capabilities of the healthcare provider favors its adoption
Risk	Based on outcomes of previous studies conducted on implementation of chronic care models and provision of self-management education, it is certain that the benefits far outweigh the risks
Task issues	Workable and easy to use interventions favor adoption Relevance of the intervention to the work of the staff and tasks that may contribute to the relevance of the work of the individual health care worker is preferred However, the intervention may also be interpreted as an added workload to the LGHU staff
Knowledge required	Knowledge and skills required for full implementation of the intervention need to be supplied/supplemented
Augmentation/support	Provision of a training workshop prior to implementation increases the probability of adoption of the intervention

LGHU: Local government health units; LGU: Local government units.