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

Table 1 Key contextual factors that is expected to affect chronic care model adaptations for the development of a service delivery model for chronic conditions including type 2 diabetes mellitus

Key factors	Analysis based on context
Community-related
Policy	No specific policies on chronic care delivery exist at both national and local levels
Politics	Informal interviews with government officials suggested some awareness of chronic conditions such as DM type 2 and the needs that must be addressed for the care of chronic conditions in general and DM type 2 in particular in the political environment
Support	National support is limited mostly to prevention and one-day health promotion campaigns on specific chronic conditions
	Support from private organizations and civil societies is currently untapped
Awareness	Informal interviews with local government officials and community members suggested a low level of awareness of DM type 2, the care for DM type 2 and other associated factors, and the prevalence and burden of DM type 2 in the locality
Patient-related
Support	Informal interview with healthcare staff and people with diabetes gave an impression of low level of support given to people with diabetes by the community and health services
Awareness	Informal interview with healthcare staff and people with diabetes gave an impression of low level of knowledge on the condition and care for the condition
Perceived need	Informal interview with people with diabetes revealed a moderate level of perceived need to improve care delivery for their condition
Perceived benefits	Informal interview with people with diabetes revealed a moderate level of perceived benefits of improving care delivery for their condition
Self-efficacy	Informal interview with healthcare staff and people with diabetes suggested a low level of self-efficacy in managing the condition
Provider-related
Perceived need	Informal interview with healthcare staff revealed a high level of perceived need to improve primary care for chronic conditions
Perceived benefits	Informal interview with healthcare staff revealed a high level of perceived benefits of delivering good quality chronic care
Self-efficacy	Informal interview with healthcare staff suggested an impression of low level of self-efficacy in the provision of good quality chronic/diabetes care
Skill proficiency	Informal interview with healthcare staff suggested an impression of a need for skills and knowledge development regarding delivery of good quality chronic/diabetes care
Health service-related
Leadership	The (local) government leaders and health officers are supportive of project implementation
Shared vision	The health system has a shared vision in improving the quality of care for chronic conditions
Organizational norms regarding change	The healthcare workers may be open to small, incremental changes as long as these do not lead to a drastic increase in demands on resources and workload
Administrative support	Administrative support for the project is limited

DM: Diabetes mellitus.