Abstract
The purpose of this study was to explore the managing of Type 2 Diabetes Mellitus (T2DM) in the Saudi healthcare system. This country was chosen for examination because it has been undergoing major demographic, social and economic changes which have caused an increase in the prevalence of chronic diseases, including diabetes. This study adopted the World Health Organization's (WHO) Innovative Care for Chronic Conditions Framework (ICCCF). This framework provided a comprehensive basis for assessing the Saudi healthcare system by addressing its components at the macro (policy), meso (healthcare organizations and community), and micro (patient and family) levels. In accordance with these three health system strata, a flexible multimethod approach was adopted by using primary and secondary data in three phases. To explore the policy environment of the Saudi health care system, the first phase involved analysing 35 national and regional T2DM documents according to four dimensions of Walt and Gilson’s health policy analysis framework: content, actors, context, and process. The second phase aimed to explore healthcare professionals’ perceptions of the barriers and facilitators of an effective healthcare organization and of community partnerships to enable T2DM management. Semi-structured interviews were conducted with 33 participants from various healthcare fields and thematic analyses were applied. The third phase aimed to assess the patients’ experiences and their interactions with healthcare providers. In this phase, the Patient Assessment of Chronic Illness Care (PACIC) survey was translated into Arabic using the WHO Steps of Translation and Adaptation of Instruments, and distributed among 575 diabetes patients in four specialized diabetes clinics. Although T2DM has highly recognised at the macro level, several challenges were identified through the documents analysis and were also highlighted during the second phase of the study. These challenges included: unreliable health information systems, a lack of multisectoral collaboration, and a lack of public awareness. At the meso level, the interview data identified three themes: the cultural determinants of T2DM, the limitations of key support systems, and recommendations for improving the support systems for T2DM patients. Within the identified themes, a number of subthemes were identified, including: physical inactivity, reliance on traditional treatments, unhealthy dietary patterns, poor primary healthcare services, lack of reliable data, shortage of qualified staff, poor guidelines dissemination, enhancing the multisectorial collaboration, and community partnerships. At the micro level, the mean score of the PACIC survey was lower in comparison to similar studies conducted internationally (mean = 2.55 out of 5). Patients scored on average 2.69 for ‘patient activation’, 3.02 for ‘delivery system/practice design’, 2.29 for ‘goal setting/tailoring’, 2.10 for ‘follow-up/coordination’, and 2.84 for ‘problem solving/contextual domain’. In addition, the reported glycaemic control measures indicated that only 17% of participants had controlled blood glucose levels (≤ 7%) which is equivalent to 8.6 mmol/L. The ICCC framework was a useful tool for exploring the main weaknesses and strengths of the Saudi healthcare system. However, it was observed that the ICCC did not significantly recognize community sensitivity, particularly community culture, religion, norms, and beliefs. Nevertheless, this study generated new knowledge about T2DM management systems in Saudi Arabia by exploring how the performance of the healthcare system is shaped by the processes occurring at the different levels; therefore. It contributes to the body of knowledge on health system research.