Qualitative Analysis of Key Informant Interviews to Establish Barriers And Solutions for Diabetes Care In a Rural Bolivian Clinic

Background There is a large burden of diabetes mellitus in low and middle-income countries.  According the World Health Organization, 347 million people currently have diabetes, and 80% of them live in low- and middle-income countries.  Although the management of chronic disease in low-income areas is a complex challenge, regional solutions may have been developed; however, this knowledge may not have been disseminated widely. Therefore, the objective of this qualitative study was to evaluate the challenges and solutions to diabetic management that have been implemented in a rural Bolivian clinic.  Methods Face-to-face interviews were conducted with key informants at a rural Bolivian clinic using a semi-structured interview guide. Interviews were conducted until thematic saturation was reached. Answers were recorded verbatim and analyzed using content analysis with an inductive approach. Results Six core members of the clinic staff were interviewed. Their roles were: physician, nurse, pharmacist, social worker, community leader, and a health promoter( promotora ). Key themes in responses identified 1) challenges to diabetes care 2) solutions found by the clinic 3) evaluation of the promotora program, and 4) proposed future solutions to clinic challenges. Conclusions Our interviews highlighted the importance of organization and data accessibility in rural clinics working with chronic disease populations.   The induction of a health promoter system was viewed as very helpful by interviewees, although challenges remain in defining promoter’s proper role, responsibilities, and strategies for retention.  Future solutions offered by interviewees focused on tangible simple solutions to better track patient and community progress.