Abstract
BackgroundDiabetes care remains suboptimal in First Nations populations. Innovative and culturally relevant approaches are needed to promote systematic and proactive organization of diabetes care for people living with diabetes on-reserve in Canada. The RADAR model is one strategy to improve care: an integrated disease registry paired with an electronic health record for local community healthcare providers with remote care coordination. We qualitatively assessed adoption and implementation of RADAR in First Nations communities in Alberta to inform its potential spread in the province.MethodsWe used the RE-AIM framework to evaluate adoption and implementation of RADAR in 6 First Nations communities. Using purposeful sampling, we recruited local healthcare providers and remote care coordinators involved in delivering RADAR to participate in telephone or in-person interviews at 6- and 24-months post-implementation. Interviews were digitally recorded, transcribed, and verified for accuracy. Data was analyzed using content analysis and managed using ATLAS.ti 8.ResultsIn total, we conducted 21 semi-structured interviews (6 at 6-months; 15 at 24-months) with 11 participants. Participants included 3 care coordinators and 8 local healthcare providers, including registered nurses, licensed practical nurses, and registered dietitians. We found that adoption of RADAR was influenced by leadership as well as appropriateness, acceptability, and perceived value of the model. In addition, we found that implementation of RADAR was variable across communities regardless of implementation supports and appropriate community-specific adaptations.ConclusionsThe variable adoption and implementation of RADAR has implications for how likely it will achieve its anticipated outcomes. RADAR is well positioned for spread through continued appropriate community-based adaptations and by expanding the existing implementation supports, including dedicated human resources to support the delivery of RADAR and the provision of levels of RADAR based on existing or developed capacity among local HCPs.Trial registrationNot applicable to this qualitative assessment. ISRCTN14359671.
Highlights
Diabetes care remains suboptimal in First Nations populations
In response to this need, the RADAR model was developed by First Nations communities and OKAKI Health Intelligence Inc., a private sector social-enterprise, company in Alberta, Canada, with > 20 years working with First Nation communities
We recruited local healthcare providers (HCPs) at 24-months postimplementation only to reduce participant burden, a strategy fully endorsed by community health managers, and to enable them to become familiar with RADAR to comment on its adoption and implementation
Summary
Diabetes care remains suboptimal in First Nations populations. Innovative and culturally relevant approaches are needed to promote systematic and proactive organization of diabetes care for people living with diabetes on-reserve in Canada. In Canada, the prevalence of diabetes is 3–5 times higher [2] and mortality rates 2–3 times higher for First Nations people than the general population [3] These issues are compounded by suboptimal diabetes care, in rural or remote settings where many First Nations people live [2, 4,5,6]. There is a need for innovative and culturallyrelevant approaches to promote systematic and proactive organization of diabetes care for First Nations people living with diabetes on-reserve in Canada [9, 10]. In response to this need, the RADAR model was developed by First Nations communities and OKAKI Health Intelligence Inc. RADAR consists of local healthcare providers in First Nations communities supported by remote care coordinators, who are registered nurses, through telehealth representing the care team (Fig. 1)
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