Policy analysis of control and Preventing of type 2 diabetes policies and programs and providing policy options

Abstract

Abstract Introduction: Diabetes accounts for at least 10% of the total health care expenditures in many countries and its prevalence and burden is increasing. Objective: The aim of this study was to analyze the policies for control and prevention of type 2 diabetes and to present appropriate policy options in East Azarbaijan province. Methods: This study was a multi-methods policy analysis study. The review study was a review of reviews, the qualitative study was an exploratory qualitative study and the quantitative study conducted as a survey. In the qualitative study, the Policy Analysis Triangle framework, Kingdon's multiple streams Model, 7C Model, and the World Health Organization's and Varvasovszky's and Brugha Stakeholder Analysis Models, and Mendelow Matrix, were used. A quantitative study was conducted using the Diabetes Personal Questionnaire, the Toobert and Glasgow Self-Care Questionnaire, the Health Seeking Behaviors Questionnaire, and the Foregone Care Questionnaire. Finally, based on the findings of these three sections, policy options were extracted and prioritized through Delphi, using CDC Policy Analytical Framework. Results: Based on the results of a review study of interventions based on social determinants of health, behavioral lifestyle interventions as well as community-based interventions are more effective in preventing diabetes and glycemic control. Interventions based on telemedicine technologies are effective as adjunctive interventions. The results of the qualitative study showed that the Iranian health system faces many challenges in the prevention and control of diabetes. Concurrent of the increasing trend of the prevalence of diabetes and its associated costs, the focus of the international organizations on diabetes control and the implementation of the Health Evolution Plan have led to the opening of the Opportunity window and the running of IraPEN. Insufficient focus on program details and lack of formulation of operational measurable objectives for different entities and organizations and the lack of transparency in the role and duties of organizations who related to diabetes control are the most important policy issues. At the level of policy implementation, poor inter-sectoral collaboration, political and economic sanctions, weaknesses in the health information system infrastructure, inefficiencies in the implementation of the referral system and the family physician program, and poor linkage of the policy units to the executive units are the most important problems for effective program implementation. According to the results of the quantitative study, 76.1% of patients had at least one complication of diabetes and 30.2% of patients had a history of hospitalization due to complications of diabetes at least once in the past year. Cardiovascular disease was the most common complication and the most common cause of hospitalization in patients with diabetes. 58.3% of patients reported that they referred directly to a specialist physician by bypassing the referral system. 47.1% of patients stated that they had a history of withdrawal from treatment last year. The majority of patients (41.5%) mentioned the financial burden of treatment costs as the main reason for withdrawal. Diet knowledge and skills in patients were lower than average (45.15 out of 100). Self-care status was poor in patients (42.61 out of 100). Most self-care barriers were related to diet and exercise barriers, respectively. Nearly half of the patients were in the pre-contemplation stage of change for weight loss (48.1%) and dietary change (44.7%), and only less than one third were in the action stage. With increasing diet knowledge and skills and increasing dietary decision-making skills and decreasing self-care barriers, people are more likely to complete the stage of weight loss and diet changes. 1- Improvement of awareness, knowledge and health literacy of patients regarding diabetes management, 2- Improvement of awareness, knowledge and health literacy of the whole society regarding the risk factors, causes and prevention of diabetes, 3- Individual and group education of patients and at-risk individuals on how to self-care for diabetes and 4- Modifying the medical education curriculum were identified as four high-priority policy options, respectively. Conclusion: Due to the high rates of diabetes complications, hospitalization, forgone care and poor diet knowledge and skills, poor self-care status, low levels of readiness to weight loss and diet change, as well as high rate of self-referral to specialist physician, It can be concluded that the Iranian health system has not succeeded in controlling and preventing diabetes. Based on the findings of stakeholder analysis, it can be concluded that due to the multifactorial and multidimensional nature of diabetes, participation of multiple stakeholder is essential to successfully control this disease and is outside the authority of the Ministry of Health alone. On the other hand, most powerful stakeholders, who have many resources and potentials to control the disease, do not have a good stake in this area. Therefore, it is necessary to focus on strengthening inter-sectoral collaboration and a health-promoting approach as well as developing appropriate interventions to improve the behavior of diabetic patients.