| Barriers | Negative past experiences of accessing care30 Staff turnover (loss of continuity of care and trust for patients)31 43 Inherent bombardment with referrals for patients newly diagnosed with diabetes31 Situations of power differentials43 Mistrust and fear of Western institutions43 Discrimination31 Lack of holistic approach42 43 Focus on following guidelines rather than on patient-centred approach32 43
| Competing priorities27 31 44 Low food budget makes difficult to develop realistic and manageable goals36 43 Language barriers37 42 and excessive use of medical jargon43 Inconsistent levels of care after initial contact30 36 37
| Lack of time35 37 38 Engaging clients or patients in the programme or in the use of the tool35 Lack of support from government42, managers and peers35 Resistance to change35 Misunderstanding role of interdisciplinary team members36 Family crises, lack of transportation and unemployment, drug and alcohol issues and mental illness of Indigenous patients31 Lack of basic understanding of sociocultural, historical and political contexts of Indigenous patients by colleagues43 Low education of Indigenous patients37
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| Facilitators | Support groups39 Community-based peer-led educational, cultural components44 Free medication41 Home visits37 41 Free or organised transport to clinic, pharmacy and local laboratory30 37 Community-based health activities40 (walking or art groups)36 Use of self-management tools31 Family support31 Appropriate language31
| | Staff within the clinics that challenge the status quo62 Requiring little technology and few healthcare resources44 Reduced caseload36 42 Promoting a collaborative way of working across sectors27 42 Patient-centred care43 and social determinants-based approach43 Securing more time in health service interactions43 Use of case conferences27 Demedicalised approach31
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