RT Journal Article SR Electronic T1 Process evaluation of integrated diabetes management at primary healthcare facilities in Pakistan: a mixed-methods study JF BJGP Open JO BJGP Open FD Royal College of General Practitioners SP bjgpopen18X101612 DO 10.3399/bjgpopen18X101612 VO 2 IS 4 A1 Khan, Muhammad Amir A1 Walley, John D A1 Ali, Saima A1 King, Rebecca A1 Khan, Shaheer Ellahi A1 Khan, Nida A1 Sheikh, Faisal Imtiaz A1 Khan, Haroon Jehangir YR 2018 UL http://bjgpopen.org/content/2/4/bjgpopen18X101612.abstract AB Background Integrated care for diabetes and associated conditions at primary level health facilities can make care available to a much larger population, especially in rural areas.Aim This process evaluation was to understand how the authors' integrated care was implemented and experienced by the care providers and patients, and to inform modifications prior to province-wide scale-up.Design & setting The mixed-method study was conducted as part of a cluster randomised trial on integrated diabetes care at 14 public health facilities.Method The care practices were assessed by analysing the routine clinical records of 495 registered patients with diabetes. Then semi-structured interviews with service providers and patients were used to understand their respective care experiences. A framework approach was applied to analyse and interpret the qualitative data.Results The intervention and the study were implemented as intended under routine conditions in rural health centres. Key service processes effectively delivered included: skill-based training; screening and diagnostic tests; treatment card records; and the additional case management as per desk guide, including monitoring progress in glucose and weight at follow-up consultations, and mobile phone calls to help adherence. However, social and cultural factors affected clients' ability to change lifestyles, especially for women. The intervention effect was limited by the short study follow-up of only 9 months.Conclusion Integrated diabetes care was feasible, both for providers and patients, and potentially scalable at primary care facilities under routine conditions in Pakistan. Additional operational interventions are required for sustained drug supplies, supervision, in-service training, and to address the social challenges to healthy activity and eating, especially for women.