Frontline community health care workers’ intervention for diabetes management in resource limited settings: a qualitative study on perspectives of key stakeholders

# Background Diabetes mellitus (DM) is a global public health concern, with significant increase in the transitioning low- and middle-income countries (LMICs), such as India, with limited resources and poor health care systems. Recognising the need for innovative, feasible, targeted interventions for diabetes care, a non-randomized, controlled, phase II clinical trial was conducted in a rural revenue block in Tamil Nadu, India. This pilot trial tested the non-inferiority of the trained community health workers (CHWs) in delivering education, screening for diabetes complications using a protocol-based referral for physician consultation for management, assisted by an android application (App) for patient tracking. Understanding the perceptions of key stakeholders including patients and health workers is crucial for upscaling and sustaining these novel interventions for diabetes care. This study explored the perspectives and views of patients with DM and diabetes CHWs who participated in the pilot trial. # Methods Using qualitative research methodology, individual in-depth interviews were conducted in the local vernacular (Tamil) language among the two diabetes CHWs and purposively chosen 24 patients until the data saturation was reached. Participant information sheets, consent forms and a detailed topic guide were developed. Interviews were transcribed verbatim, translated into English and thematic analysis was conducted. # Results Five main themes emerged during interviews with diabetes CHWs: deeper understanding of the disease; belonging and strengthening; ease of use of digital technology and a timesaver for patient tracking; cultural sensitivity; stigma and change in attitudes over time. Interviews with patients highlighted four major themes: convenience; cost reduction; improved knowledge and perceptions on health. Benefits were perceived by both patients and diabetes CHWs, in the domains of convenience, access, cost and knowledge. Perceptions of changes in health were mixed with room for improvement in the digital App. # Conclusions Training CHWs in resource limited settings in supporting community diabetes care, assisted by digital technology for tracking is acceptable to the patients and will help shift the care pathway for Diabetes closer to the patients in a rural setting. This qualitative study identified a number of areas for improvement and potential barriers that will need to be addressed prior to scaling up in similar resource constrained settings.