Diabetes management in rural areas of Shandong province:a qualitative analysis

Objective To examine the status quo of diabetes management and the gap between the current situation and standardized regulation among rural residents in Shandong province and to explore the factors hindering the utilization of basic health services among the population for providing references for formulating relevant policies.Methods We conducted key informant interviews among 24 health staff recruited with cluster sampling at county centers for disease control and prevention,township health care centers,and village clinics and 56 residents with diabetes or at a high risk of diabetes sampled conveniently in 7 towns of 3 counties in Shandong province in July 2016.A semi-structured questionnaire self-designed according to the “National Standard for Basic Public Health Service-2011” was used in the interviews.Results The results of qualitative analysis on collected information revealed that major gaps between the actual situation of diabetes management and requirements of national standard included:the majority of the patients had been not received health education; some patients did not take quarterly fasting blood glucose monitoring free of charge; migrant patients were unable to receive related health care service; and there were no clear referral pathways and appropriate institutional support for transfer treatment.The main factors contributed to those gaps were relevant health education programs being too passive at township level,relative low education level among some villagers,and low expenditure per capita on basic public health service.Conclusion Provision of basic public health services for diabetes in rural areas remains to be improved,and relevant departments should adopt more active and influential ways of health education and include migrant diabetic patients into local chronic diseases and health management service system to optimize the service system.