Department of Family Medicine, University of Washington, Box 354696, Seattle, WA 98195, USA.
Department of Global Health, University of Washington, Box 357965, Seattle, WA 98195, USA.
Health Policy Plan. 2018 May 1;33(4):474-482. doi: 10.1093/heapol/czy011.
For the past three decades, the burden of diabetes in Nepal has been steadily increasing, with an estimated 3% annual increase since the year 2000. Although the burden is increasing, the methods of addressing the challenge have remained largely unchanged. This study sought to assess the current state of diabetes services provided by health facilities and to identify the major barriers that people with diabetes commonly face in Nepal. For this qualitative study, we selected five health facilities of varying levels and locations. At each site, we employed three unique methods: a process evaluation of the diabetes treatment and prevention services available, in-depth interviews with patients and focus group discussions with community members without diabetes. We used thematic analysis to analyse the data. Our findings were organized into the five categories of the Ecological Model: Individual, Interpersonal, Organizational, Community and Public Policy. Sub-optimal knowledge and behaviors of patients often contributed to poor diabetes management, especially related to diet control, physical activity and initiation of drug treatment. Social support was often lacking. Organizational challenges included health provider shortages, long wait times, high patient loads and minimal time available to spend with patients, often resulting in incomprehensive care. Public policy challenges include limited services in rural settings and financial burden. The scarcity of financial and human resources for health in Nepal often results in the inability of the current healthcare system to provide comprehensive prevention and management services for chronic diseases. A multilevel, coordinated approach is necessary to address these concerns. In the short-term, adding community-based supplementary solutions outside of the traditional hospital-based model could help to increase access to affordable services.
在过去的三十年中，尼泊尔的糖尿病负担一直在稳步增加，自 2000 年以来，每年的增长率估计为 3%。尽管负担在增加，但应对挑战的方法在很大程度上仍然没有改变。本研究旨在评估卫生机构提供的糖尿病服务现状，并确定尼泊尔糖尿病患者普遍面临的主要障碍。在这项定性研究中，我们选择了五个不同级别和地点的卫生机构。在每个地点，我们采用了三种独特的方法：对现有的糖尿病治疗和预防服务进行过程评估、对患者进行深入访谈以及对没有糖尿病的社区成员进行焦点小组讨论。我们使用主题分析来分析数据。我们的发现被组织成生态模型的五个类别：个体、人际、组织、社区和公共政策。患者的知识和行为不佳往往导致糖尿病管理不善，特别是与饮食控制、体育活动和药物治疗的开始有关。社会支持往往缺乏。组织方面的挑战包括卫生提供者短缺、长时间等待、患者人数众多以及与患者相处的时间很少，这往往导致护理不全面。公共政策方面的挑战包括农村地区服务有限和经济负担。尼泊尔卫生资源的稀缺性常常导致现行医疗体系无法为慢性病提供全面的预防和管理服务。需要采取多层次、协调一致的方法来解决这些问题。在短期内，在传统的医院模式之外增加基于社区的补充解决方案，可以帮助增加获得负担得起的服务的机会。
