Open Access Research article

Challenges to the provision of diabetes care in first nations communities: results from a national survey of healthcare providers in Canada

Onil K Bhattacharyya1*, Irit R Rasooly1, Mariam Naqshbandi2, Elizabeth A Estey1, James Esler2, Ellen Toth3, Ann C Macaulay4 and Stewart B Harris2

Author Affiliations

1 Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1M8, Canada

2 Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, Suite 245-100 Collip Circle, London, ON N6G 4X8, Canada

3 Department of Medicine, University of Alberta, 362 Heritage Research Medical Center, Edmonton, AB, T6G 2S2, Canada

4 Participatory Research at McGill, Department of Family Medicine, McGill University, 515 Pine Avenue West Montreal, QC H2S 1W4, Canada

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BMC Health Services Research 2011, 11:283  doi:10.1186/1472-6963-11-283

Published: 21 October 2011



Aboriginal peoples globally, and First Nations peoples in Canada particularly, suffer from high rates of type 2 diabetes and related complications compared with the general population. Research into the unique barriers faced by healthcare providers working in on-reserve First Nations communities is essential for developing effective quality improvement strategies.


In Phase I of this two-phased study, semi-structured interviews and focus groups were held with 24 healthcare providers in the Sioux Lookout Zone in north-western Ontario. A follow-up survey was conducted in Phase II as part of a larger project, the

anadian F
st Nations Diabetes
inical Management and
pidemiologic (CIRCLE) study. The survey was completed with 244 healthcare providers in 19 First Nations communities in 7 Canadian provinces, representing three isolation levels (isolated, semi-isolated, non-isolated). Interviews, focus groups and survey questions all related to barriers to providing optimal diabetes care in First Nations communities.


the key factors emerging from interviews and focus group discussions were at the patient, provider, and systemic level. Survey results indicated that, across three isolation levels, healthcare providers' perceived patient factors as having the largest impact on diabetes care. However, physicians and nurses were more likely to rank patient factors as having a large impact on care than community health representatives (CHRs) and physicians were significantly less likely to rank patient-provider communication as having a large impact than CHRs.


Addressing patient factors was considered the highest impact strategy for improving diabetes care. While this may reflect "patient blaming," it also suggests that self-management strategies may be well-suited for this context. Program planning should focus on training programs for CHRs, who provide a unique link between patients and clinical services. Research incorporating patient perspectives is needed to complete this picture and inform quality improvement initiatives.