Describing the Experiences of Health-care Providers Who Supported an Outreach Program to Deliver Point-of-care Screening in Adults With Type 1 and Type 2 Diabetes Who Are Experiencing Homelessness in Calgary, Canada: A Qualitative Analysis.

OBJECTIVES

Unstable housing and homelessness are associated with increased risks of diabetes-related morbidity and mortality. Concordantly, as few as 12% to 30% of people with lived experience of homelessness (PWLEH) complete recommended screening for microvascular complications of diabetes. Innovative models of care delivery are needed to address this disparity. We recently piloted a novel, community-based point-of-care screening program for diabetes complications (the SAFER model of care, i.e. screening for glycated hemoglobin, feet, eyes, and renal function) in Calgary, Alberta. Herein we describe the experiences of providers who supported the implementation of SAFER to explore factors that influenced the adoption and maintenance of this innovative model.

METHODS

Complete details of the intervention have been reported elsewhere. Semistructured interviews were conducted with service providers and clinic managers at sites that hosted the SAFER intervention. Transcribed data were analyzed through qualitative thematic analysis using NVivo software.

RESULTS

Nine participants from 2 organizations were interviewed. Participants described 4 thematic messages regarding their experiences: 1) the intervention successfully addressed relevant barriers to enable clients to complete screening; 2) generating and maintaining client engagement requires dedicated effort; 3) competing priorities for providers and organizations can be a barrier to sustaining programs, even when effective; and 4) programs introduced through research studies are inherently dependent on resources that are time-limited in nature, which impacts the ability to maintain the program long term.

CONCLUSIONS

Lessons learned from providers' experiences with SAFER can inform the planning and delivery of other programs like SAFER to address ongoing disparities in diabetes care for PWLEH.