'Operating in the dark': perspectives of health service users and healthcare workers on quality of diabetes care at a public referral hospital in Blantyre, Malawi - a qualitative study.

BACKGROUND

Poor glycemic control and medical complications are common among people living with diabetes in Malawi. The healthcare system is part of an environment in which people with diabetes manage themselves and can act as facilitators or barriers to diabetes self-management. This study aimed to explore the effects of diabetes health service users and healthcare workers (HCW) on the quality of diabetes care at the Queen Elizabeth Central Hospital (QECH) diabetes clinic.

METHODS

This qualitative study recruited service users (people with diabetes and family members) and HCW (medical doctors, clinical officers, and nurses) at the QECH diabetes clinic, a public referral hospital in Blantyre. Data saturation was achieved after 20 individual in-depth interviews (IDI) and four focus group discussions with people with diabetes, 20 IDIs with family members of people with diabetes, and eight key informant interviews with HCW. A framework analysis approach was used to guide data analysis.

RESULTS

Participants shared positive and negative perspectives regarding the quality of care. Five major themes emerged: healthcare system organization, drug and treatment equipment supply, pathways to diagnosis, diabetes health education and awareness, and ongoing monitoring, prevention, and management of complications. The participants appreciated free services at the clinic, including glucose checks, health education, and medications. However, many were concerned with understaffing, which led to long clinic waiting times, inadequate patient assessments, and failure to diagnose diabetes complications.

CONCLUSION

The quality of care in diabetes clinics is perceived to be mixed. Although service users appreciated the available services, they noted other deficits at the clinic, which made it difficult for them to receive necessary care. Good quality diabetes care services are essential for improving the well-being of people with diabetes.