Factors affecting the implementation of a complex health intervention to improve insulin management in primary care: A SWOT analysis
Background In South Africa, initiating and managing insulin in primary care for people living with type 2 diabetes (PLWD) is a major challenge. To address these challenges, a multidisciplinary team from the University of Pretoria (South Africa) developed the Tshwane Insulin project (TIP) interventio...
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| Published in: | African journal of primary health care & family medicine Vol. 14; no. 1; pp. e1 - e9 |
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| Language: | English |
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| Abstract | Background In South Africa, initiating and managing insulin in primary care for people living with type 2 diabetes (PLWD) is a major challenge. To address these challenges, a multidisciplinary team from the University of Pretoria (South Africa) developed the Tshwane Insulin project (TIP) intervention.Aim To determine internal and external factors, either facilitators or barriers, that could influence the implementation of the TIP intervention and propose strategies to ensure sustainability.Setting Tshwane District, Gauteng province, South Africa.Methods We used the SWOT framework to qualitatively analyse the strengths, weaknesses, opportunities, and threats influencing the implementation of the TIP intervention. Four field researchers and three managers from the TIP team participated in an online group discussion. We also conducted semi-structured interviews with healthcare providers (HCPs) (seven nurses, five doctors) and patients with type 2 diabetes (n = 13).Results Regardless of the identified weaknesses, the TIP intervention was accepted by PLWD and HCPs. Participants identified strengths including app-enabled insulin initiation and titration, pro-active patient follow-up, patient empowerment and provision of glucose monitoring devices. Participants viewed insulin resistance and the attitudes of HCPs as potential threats. Participants suggested that weaknesses and threats could be mitigated by translating education material into local languages and using the lived experiences of insulin-treated patients to address insulin resistance. The procurement of glucose monitoring devices by national authorities would promote the sustainability of the intervention.Conclusion Our findings may help decision-makers and health researchers to improve insulin management for PLWD in resource-constrained settings by using telehealth interventions. |
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| AbstractList | In South Africa, initiating and managing insulin in primary care for people living with type 2 diabetes (PLWD) is a major challenge. To address these challenges, a multidisciplinary team from the University of Pretoria (South Africa) developed the Tshwane Insulin project (TIP) intervention. To determine internal and external factors, either facilitators or barriers, that could influence the implementation of the TIP intervention and propose strategies to ensure sustainability. Tshwane District, Gauteng province, South Africa. We used the SWOT framework to qualitatively analyse the strengths, weaknesses, opportunities, and threats influencing the implementation of the TIP intervention. Four field researchers and three managers from the TIP team participated in an online group discussion. We also conducted semi-structured interviews with healthcare providers (HCPs) (seven nurses, five doctors) and patients with type 2 diabetes (n = 13). Regardless of the identified weaknesses, the TIP intervention was accepted by PLWD and HCPs. Participants identified strengths including app-enabled insulin initiation and titration, pro-active patient follow-up, patient empowerment and provision of glucose monitoring devices. Participants viewed insulin resistance and the attitudes of HCPs as potential threats. Participants suggested that weaknesses and threats could be mitigated by translating education material into local languages and using the lived experiences of insulin-treated patients to address insulin resistance. The procurement of glucose monitoring devices by national authorities would promote the sustainability of the intervention. Our findings may help decision-makers and health researchers to improve insulin management for PLWD in resource-constrained settings by using telehealth interventions. Background In South Africa, initiating and managing insulin in primary care for people living with type 2 diabetes (PLWD) is a major challenge. To address these challenges, a multidisciplinary team from the University of Pretoria (South Africa) developed the Tshwane Insulin project (TIP) intervention. Aim To determine internal and external factors, either facilitators or barriers, that could influence the implementation of the TIP intervention and propose strategies to ensure sustainability. Setting Tshwane District, Gauteng province, South Africa. Methods We used the SWOT framework to qualitatively analyse the strengths, weaknesses, opportunities, and threats influencing the implementation of the TIP intervention. Four field researchers and three managers from the TIP team participated in an online group discussion. We also conducted semi-structured interviews with healthcare providers (HCPs) (seven nurses, five doctors) and patients with type 2 diabetes (n = 13). Results Regardless of the identified weaknesses, the TIP intervention was accepted by PLWD and HCPs. Participants identified strengths including app-enabled insulin initiation and titration, pro-active patient follow-up, patient empowerment and provision of glucose monitoring devices. Participants viewed insulin resistance and the attitudes of HCPs as potential threats. Participants suggested that weaknesses and threats could be mitigated by translating education material into local languages and using the lived experiences of insulin-treated patients to address insulin resistance. The procurement of glucose monitoring devices by national authorities would promote the sustainability of the intervention. Conclusion Our findings may help decision-makers and health researchers to improve insulin management for PLWD in resource-constrained settings by using telehealth interventions. Background: In South Africa, initiating and managing insulin in primary care for people living with type 2 diabetes (PLWD) is a major challenge. To address these challenges, a multidisciplinary team from the University of Pretoria (South Africa) developed the Tshwane Insulin project (TIP) intervention. Aim: To determine internal and external factors, either facilitators or barriers, that could influence the implementation of the TIP intervention and propose strategies to ensure sustainability. Setting: Tshwane District, Gauteng province, South Africa. Methods: We used the SWOT framework to qualitatively analyse the strengths, weaknesses, opportunities, and threats influencing the implementation of the TIP intervention. Four field researchers and three managers from the TIP team participated in an online group discussion. We also conducted semi-structured interviews with healthcare providers (HCPs) (seven nurses, five doctors) and patients with type 2 diabetes (n = 13). Results: Regardless of the identified weaknesses, the TIP intervention was accepted by PLWD and HCPs. Participants identified strengths including app-enabled insulin initiation and titration, pro-active patient follow-up, patient empowerment and provision of glucose monitoring devices. Participants viewed insulin resistance and the attitudes of HCPs as potential threats. Participants suggested that weaknesses and threats could be mitigated by translating education material into local languages and using the lived experiences of insulin-treated patients to address insulin resistance. The procurement of glucose monitoring devices by national authorities would promote the sustainability of the intervention. Conclusion: Our findings may help decision-makers and health researchers to improve insulin management for PLWD in resource-constrained settings by using telehealth interventions. BACKGROUND: In South Africa, initiating and managing insulin in primary care for people living with type 2 diabetes (PLWD) is a major challenge. To address these challenges, a multidisciplinary team from the University of Pretoria (South Africa) developed the Tshwane Insulin project (TIP) intervention AIM: To determine internal and external factors, either facilitators or barriers, that could influence the implementation of the TIP intervention and propose strategies to ensure sustainability SETTING: Tshwane District, Gauteng province, South Africa METHODS: We used the SWOT framework to qualitatively analyse the strengths, weaknesses, opportunities, and threats influencing the implementation of the TIP intervention. Four field researchers and three managers from the TIP team participated in an online group discussion. We also conducted semi-structured interviews with healthcare providers (HCPs) (seven nurses, five doctors) and patients with type 2 diabetes (n = 13 RESULTS: Regardless of the identified weaknesses, the TIP intervention was accepted by PLWD and HCPs. Participants identified strengths including app-enabled insulin initiation and titration, pro-active patient follow-up, patient empowerment and provision of glucose monitoring devices. Participants viewed insulin resistance and the attitudes of HCPs as potential threats. Participants suggested that weaknesses and threats could be mitigated by translating education material into local languages and using the lived experiences of insulin-treated patients to address insulin resistance. The procurement of glucose monitoring devices by national authorities would promote the sustainability of the intervention CONCLUSION: Our findings may help decision-makers and health researchers to improve insulin management for PLWD in resource-constrained settings by using telehealth interventions Background: In South Africa, initiating and managing insulin in primary care for people living with type 2 diabetes (PLWD) is a major challenge. To address these challenges, a multidisciplinary team from the University of Pretoria (South Africa) developed the Tshwane Insulin project (TIP) intervention.Aim: To determine internal and external factors, either facilitators or barriers, that could influence the implementation of the TIP intervention and propose strategies to ensure sustainability.Setting: Tshwane District, Gauteng province, South Africa.Methods: We used the SWOT framework to qualitatively analyse the strengths, weaknesses, opportunities, and threats influencing the implementation of the TIP intervention. Four field researchers and three managers from the TIP team participated in an online group discussion. We also conducted semi-structured interviews with healthcare providers (HCPs) (seven nurses, five doctors) and patients with type 2 diabetes (n = 13).Results: Regardless of the identified weaknesses, the TIP intervention was accepted by PLWD and HCPs. Participants identified strengths including app-enabled insulin initiation and titration, pro-active patient follow-up, patient empowerment and provision of glucose monitoring devices. Participants viewed insulin resistance and the attitudes of HCPs as potential threats. Participants suggested that weaknesses and threats could be mitigated by translating education material into local languages and using the lived experiences of insulin-treated patients to address insulin resistance. The procurement of glucose monitoring devices by national authorities would promote the sustainability of the intervention.Conclusion: Our findings may help decision-makers and health researchers to improve insulin management for PLWD in resource-constrained settings by using telehealth interventions. |
| Audience | Academic |
| Author | Muchiri, Jane W. Webb, Elizabeth M. Segale, Amanda Zulu, Ntokozo Koenaite, Charles Mohlala, Maryangela G. Rheeder, Paul Filmalter, Celia Piotie, Patrick Ngassa |
| AuthorAffiliation | University of Pretoria |
| AuthorAffiliation_xml | – name: University of Pretoria |
| Author_xml | – sequence: 1 givenname: Patrick Ngassa orcidid: 0000-0002-4302-5940 surname: Piotie fullname: Piotie, Patrick Ngassa organization: School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa – sequence: 2 givenname: Celia surname: Filmalter fullname: Filmalter, Celia organization: Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa – sequence: 3 givenname: Maryangela G. orcidid: 0000-0003-4769-0611 surname: Mohlala fullname: Mohlala, Maryangela G. organization: School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa – sequence: 4 givenname: Ntokozo orcidid: 0000-0002-3267-8882 surname: Zulu fullname: Zulu, Ntokozo organization: School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa – sequence: 5 givenname: Amanda orcidid: 0000-0003-4916-4017 surname: Segale fullname: Segale, Amanda organization: School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa – sequence: 6 givenname: Charles orcidid: 0000-0002-8830-2884 surname: Koenaite fullname: Koenaite, Charles organization: School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa – sequence: 7 givenname: Jane W. surname: Muchiri fullname: Muchiri, Jane W. organization: Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa – sequence: 8 givenname: Elizabeth M. orcidid: 0000-0002-9627-3550 surname: Webb fullname: Webb, Elizabeth M. organization: School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa – sequence: 9 givenname: Paul orcidid: 0000-0002-1573-4985 surname: Rheeder fullname: Rheeder, Paul organization: University of Pretoria Diabetes Research Centre Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa |
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| Cites_doi | 10.1016/S0140-6736(12)60730-2 10.1136/bmj.321.7262.694 10.1108/17554251011064837 10.1007/s13300-020-00764-7 10.1007/s10488-013-0528-y 10.1371/journal.pone.0079246 10.1177/1099800418820170 10.1111/j.1742-1241.2009.02176.x 10.1016/S2213-8587(17)30181-X 10.1016/j.diabres.2020.108366 10.1111/ijcp.12691 10.1186/s12961-019-0523-1 10.1371/journal.pone.0032358 10.1503/cmaj.150885 10.1186/s13012-017-0635-3 10.3389/fphar.2020.00108 10.1016/j.pcd.2014.05.002 10.1080/20786204.2012.10874287 10.1007/s12325-021-01736-4 10.3399/bjgp16X683509 10.1111/ijcp.12973 10.1080/16089677.2022.2074122 10.1016/j.ijnurstu.2012.09.010 10.1016/S1751-9918(10)60003-4 10.1016/j.pcd.2021.06.005 10.2337/ds18-0005 10.1016/S2213-8587(15)00521-5 10.4102/phcfm.v11i1.2094 10.1016/j.amepre.2009.02.002 10.2196/16161 |
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| Keywords | type 2 diabetes health intervention telehealth SWOT analysis community health workers insulin management primary care diabetes |
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| Snippet | Background In South Africa, initiating and managing insulin in primary care for people living with type 2 diabetes (PLWD) is a major challenge. To address... Background: In South Africa, initiating and managing insulin in primary care for people living with type 2 diabetes (PLWD) is a major challenge. To address... In South Africa, initiating and managing insulin in primary care for people living with type 2 diabetes (PLWD) is a major challenge. To address these... BACKGROUND In South Africa, initiating and managing insulin in primary care for people living with type 2 diabetes (PLWD) is a major challenge. To address... BACKGROUND: In South Africa, initiating and managing insulin in primary care for people living with type 2 diabetes (PLWD) is a major challenge. To address... |
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| SubjectTerms | Analysis Biology Blood sugar monitoring Care and treatment Community health workers diabetes Diabetes therapy Health care industry Health Care Sciences & Services Health intervention Insulin Insulin management Insulin resistance Medicine, General & Internal Original Research Primary care SWOT analysis Telehealth Type 2 diabetes |
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| Title | Factors affecting the implementation of a complex health intervention to improve insulin management in primary care: A SWOT analysis |
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