'It's not just diabetes': implementation enablers and barriers of an indigenous-focused virtual diabetes care clinic using the Consolidated Framework for Implementation Research (CFIR) - a qualitative assessment.

Clinical Snapshot

Key Findings

• P Value: Not applicable for qualitative research

• Effect Size: Not applicable for qualitative research

• Primary Outcome: Three aspirational care features identified: cultural safety, comprehensiveness, and virtual delivery

• Nnt Or Sensitivity: Key enablers: internal culture of relational care, nimble virtual delivery approach, external organisational support, community engagement, motivated small team

• Confidence Interval: Not applicable for qualitative research

Clinical Application

Demonstrates feasibility of Indigenous-focused virtual diabetes care with appropriate cultural adaptations and community engagement Highly relevant for Australian Aboriginal and Torres Strait Islander diabetes care, particularly in remote areas. Aligns with RACGP guidelines on cultural safety and could inform Medicare telehealth initiatives for Indigenous populations Indigenous peoples with diabetes in rural/remote communities, healthcare organisations implementing virtual care models

Abstract

INTRODUCTION: Indigenous peoples living with diabetes face unique challenges accessing comprehensive specialty diabetes care. A small diabetes virtual care clinic oriented towards Indigenous individuals, and those in rural and remote communities, has provided care to over 400 individuals. OBJECTIVES: We characterised the distinguishing features of care provided at this clinic and used the Consolidated Framework for Implementation Research 2.0 (CFIR) to explore the enablers and barriers to implementing this model of care, from the perspective of the clinic's staff and providers. RESEARCH METHODS AND DESIGN: Guided by CFIR, we conducted eight semi-structured interviews with six clinic staff members. Deductive thematic analysis was used to identify relevant enablers and barriers. RESULTS: The aspirational features of care were cultural safety, comprehensiveness and virtual delivery. The implementation of this model of care was enabled by an internal culture of relational care; a nimble, resourceful, pragmatic and client-centred approach to virtual delivery; wayfinding and resources from key external organisations; community engagement and a small team of motivated and independent providers. Key barriers included the lack of physical interactions and uncertain or limited resources and funding. CONCLUSION: The identified enablers and barriers to implementing an Indigenous-focused virtual diabetes care clinic have implications for future interventions to improve rural Indigenous chronic disease care, and for governments and adjacent organisations tasked with meeting Canada's Truth and Reconciliation Commission's calls to action in healthcare. Further research examining the effectiveness of virtual diabetes care at this clinic is ongoing.

References

1. 1.Swampy, K., Eurich, D. T., Meneen, K., Samanani, S., Singh, P., Wozniak, L. A., Padwal, R. S., & Lau, D. (2026). 'It's not just diabetes': implementation enablers and barriers of an indigenous-focused virtual diabetes care clinic using the Consolidated Framework for Implementation Research (CFIR) - a qualitative assessment. BMJ Open. https://doi.org/10.1136/bmjopen-2025-107266