Transforming care for patients living with diabetes in rural Mexico: a qualitative study of patient and provider experiences and perceptions of shared medical appointments

Martha de Lourdes Arrieta-Canales; Joia Mukherjee; Hannah Gilbert; Hugo Flores; Melania Muñoz; Zeus Aranda; Samuel DiChiara; Carolina Noya

doi:10.1080/16549716.2023.2215004

Transforming care for patients living with diabetes in rural Mexico: a qualitative study of patient and provider experiences and perceptions of shared medical appointments

Glob Health Action. 2023 Dec 31;16(1):2215004. doi: 10.1080/16549716.2023.2215004.

Authors

Martha de Lourdes Arrieta-Canales^{1

2}, Joia Mukherjee¹, Hannah Gilbert¹, Hugo Flores^{1

3

4}, Melania Muñoz², Zeus Aranda^{2

5}, Samuel DiChiara^{2

6}, Carolina Noya⁷

Affiliations

¹ Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
² Department of Primary Care, Partners In Health Mexico/Compañeros En Salud, Ángel Albino Corzo, Mexico.
³ Division of Global Health Equity, Brigham and Woman's Hospital, Boston, MA, USA.
⁴ Partners In Health, Boston, MA, USA.
⁵ El Colegio de la Frontera Sur, San Cristóbal de las Casas, Chiapas Mexico.
⁶ School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
⁷ Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA, USA.

Abstract

Background: Global prevalence of diabetes is increasing, causing widespread morbidity, mortality and increased healthcare costs. Providing quality care in a timely fashion to people with diabetes in low-resource settings can be challenging. In the underserved state of Chiapas, Mexico, which has some of the lowest diabetes detection and control rates in the country, there is a need to implement strategies that improve care for patients with diabetes. One such strategy is shared medical appointments (SMAs), a patient-centred approach that has proven effective in fostering patient engagement and comprehensive care delivery among underserved populations.

Objective: This study aimed to understand the perceptions, experiences and insights of both patients living with diabetes and healthcare providers, who took part in a pilot SMA strategy implemented in five outpatient clinics in rural Chiapas.

Methods: Following an exploratory qualitative approach, we conducted 50 in-depth interviews with patients and providers involved in diabetes SMAs and five focus group discussions with community health workers providing patient support and education.

Results: The implementation of an SMA model changed how diabetes care is perceived, structured and delivered. Patients felt sheltered by group interactions based on trust, which allowed for the exchange of experiences, learning and increased engagement in treatment and lifestyle changes. Providers gained insights into their patients' context and lived experiences, which resulted in improved rapport and quality of care. SMAs also restructured some operational aspects in the clinics and fostered the sharing of power and responsibilities amongst the staff.

Conclusions: The SMAs model transformed care by providing a patient-centred, collaborative approach to diabetes care, education and support. Additionally, it reshaped the health-care team resulting in power-shifting and role-sharing among members of the interdisciplinary team. We therefore encourage decision-makers to expand the use of SMAs to improve care for patients with diabetes in low-resource settings.

Keywords: Chronic diseases; community health; low- and middle-income countries; patient-centred care; primary health care; vulnerable populations.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Delivery of Health Care
Diabetes Mellitus* / therapy
Humans
Mexico
Patients
Qualitative Research
Shared Medical Appointments*

Grants and funding

This study was made possible with funding from the Master’s in Global Health Delivery Program at Harvard Medical School and with funding from the Rockefeller Foundation’s DRCLASS Research Grant.