Lived Experiences of Diabetes Team and Patients about Diabetes Care System after Redesigning Delivery System and Supporting SelfManagement in Iran: A Qualitative Research

Nasrin Soltani Molayaghobi, Parvaneh Abazari, Fariba Taleghani, Bijan Iraj


Background: Diabetes as a chronic disease requires a change in the paradigm of treatment and health care system based on acute illnesses to chronic conditions. Chronic Care Model has been designed to address this need. This study aimed to explore the lived experiences of the diabetes team and diabetic patients regarding the health care system after redesigning delivery system and supporting self-management based on the Chronic Care Model in Iran. Methods: Research was conducted with a qualitative descriptive approach in one of the Isfahan city clinics in 2018. The participants were diabetes team (composed of diabetes physician, nurse, assistant nurse and dean of the clinic) and 17 type- 2 diabetic patients who were selected through purposive sampling. Data collection was performed through semi-structured interviews and then were analyzed using content analysis with an inductive approach. Results: The findings of this study were composed of the following two main categories: (1) educational function change, including the sub-categories of evidence-based nurse education and patients’ demand to ongoing participation in the training classes; and (2) treatment and care method upgrade, including the sub-categories of nurse’s role change in a team approach, continuity in cares and upgrading patients’ self-care behaviors. Conclusions: Delivery system redesign and diabetes self-management support based on Chronic Care Model changed organizational structure and performance of the diabetes care system. It also reformed the structure of treatment providers from a vertical and hierarchical form to a team arrangement. Nurse’s educational function became evidence-based and patients’ self-care behaviors upgraded.


Diabetes mellitus, education, qualitative research, self care, type 2

Full Text:



Olmen JV, Eggermont N, Pelt MV, Hen H, Man D, Schellevis F,

et al. Patient-centred innovation to ensure access to diabetes

care in Cambodia: The case of MoPoTsyo. J Pharm Policy Pract


Holtrop J, Potworowski G, Fitzpatrick L, Kowalk A, Lee A,

Green LA. Understanding effective care management

implementation in primary care: A macrocognition perspective

analysis. Implement Sci 2015;10:122.

Beverly EA, Court AB, Prokopakis KE, Ivanov NN. Patientphysician and diabetes self-care. J Clin Outcomes Manag


Soltani Molayaghobi N, Abazar P, Taleghani F, Iraj B. Diabetes

management challenges in Iran: A qualitative content analysis. J

Nurs Manag 2019;27:1091-7.

World Health Organization. (2016). Global report on Diabetes. ISBN 978 92 4 156525 7 (NLM classification: WK 810).

Coulte A, Roberts S, Dixon A. Delivering better services for

people with long-term conditions. The King’s Fund 2013;ISBN:


Wagner EH, Austin BT, Von Kroff M. Organizing care for

patients with chronic illness. Milbank Q 1996;74:511-44.

Ariffin F, Ramli AS, Daud MH, Haniff J, AbdulRazak S,

Selvarajah S, et al. Feasibility of implementing chronic care

model in the Malaysian public primary care setting. Med J

Malaysia 72:106-12.

American Diabetes Association Standards of Medical care in

diabetes. Journal of clinical and applied research and education

:39 (supplement1). care; ISSN 0149-5992.

Tabrizi JS, Pourasghar F, Gholamzadeh Nik-Joo R. Status

of Iran’s primary health care system in terms of health

systems control knobs: A review article. Iran J Public Health


Abazari P, Vanaki, Mohammadi, E, Amini M. Challenges of

training diabetes nurse educator in Iran. Iran J Nurs Midwifery

Res 2012;17:187-94.

Graneheim UH, Lundman B. Qualitative content analysis in

nursing research: Concepts, procedures and measures to achieve

trustworthiness. Nurse Educ Today 2004;24:105-12.

Guba EG. Criteria for assessing the trustworthiness of naturalistic

in quiries.Educ Technol Res Dev.1981;29:75-91.

Davy C, Bleasel J, Liu H, Tchan M, Ponniah S, Brown

A. Effectiveness of chronic care models: Opportunities for

improving healthcare practice and health outcomes: A systematic

review. BMC Health Serv Res 2015;15:194.

Gee PM, Greenwood D, Paterniti D, Ward D, Millre LM. The

eHealth enhanced chronic care model: A theory derivation

approach. J Med Internet Res 2015;17:e86.

Baptista DR, Wiens A, Pontarolo R, Regis L, Reis WCT,

Correr CJ. The chronic care model for type 2 diabetes:

A systematic review. Diabetol Metab Syndr 2016;8:7.

Provost S, Pineault R, Grimard D, JoséPérez J, Fournier M,

Lévesque Y, et al. Implementation of an integrated primary care

cardiometabolic risk prevention and management network in

Montréal: Does greater coordination of care with primary care

physicians have an impact on health outcomes? Health Promot

Chronic Dis Prev Can 2017;37:105-13.

Stellefson M, Dipnarine K, Stopka C. The chronic model and

diabetes management in US primary care setting: A systematic

review. Prev Chronic Dis 2013;10:E26.

Jahromi Z. Study of the barriers and facilitators of patient

education from the viewpoint of nursing students at Jahrom

college of nursing. Bangla J Med Science 2016;15:471-6.

Kazawa K, Yamane K, Yorioka N, Moriyama M. Development

and evaluation of disease management program and

service framework for patients with chronic disease. Health


Abazari P, Vanaki Z, Mohammadi E, Amini M. Inadequate

investment on management of diabetes education. J Res Med Sci


Yeoh EK, Wong MCS, Wong ELY, Yam C, Poon, CM, Chung RY,

et al. Benefits and limitations of implementing Chronic care

model (CCM) in primary care programs: A systematic review.

Int J Cardiol 2018;258:279-88.

Clement M, Filteau P, Harvey B, Jin S, Laubscher T,

Mukerji G, et al. Organization of diabetes care. Can J Diabetes

;37(Suppl 1):S20-5.

Gelvez B, Maribel Osorio M, Contreras F, Velasco M.

Perspectives of nursing in the care of the patient with diabetes

mellitus. Interventions Obes Diabetes 2018;1:44-50.

Delaney LJ. Patient-centred care as an approach to improving

health care in Australia. Collegian 2018;25:119-23.

Kashani F, Abazari P, Haghani F. Challenges and strategies of

needs assessment implementing in diabetes selfManagement

education in Iran: A qualitative study. Iranian J Nursing

Midwifery Res 2020;25:437-43.

Bodde AE, Shippee ND, May CR, Mair FS, Erwin PJ,

Murad MH, et al. Examining health promotion interventions for

patients with chronic conditions using a novel patient-centered

complexity model: Protocol for a systematic review and metaanalysis. Syst Rev 2013;2:29.