Challenges, opportunities, and potential roles of the private primary care providers in tuberculosis and diabetes mellitus collaborative care and control: a qualitative study.

INTRODUCTION: The comorbidity of tuberculosis and diabetes mellitus (TB-DM) is a looming global co-epidemic problem. Despite the Indonesian Government's ongoing effort to impose regulation for collaborative TB-DM management, the involvement of private primary care providers (PPCs) has not been considered before the COVID-19 pandemic. This study aimed to capture the PPCs' existing practices and explore their challenges, opportunities, and potential roles in the collaborative TB-DM services and control. METHODS: A descriptive qualitative research design was used to collect data. Two Focus Group Discussions (FGDs) were conducted with 13 healthcare workers (HCWs) from different private clinics and eight private/solo general practitioners (GPs) from Yogyakarta City, Indonesia. We triangulated these data with data from FGDs of HCWs community health centers (CHCs) and in-depth interviews of three regional health regulators, five hospitals staff members, and a representative of national health insurance. The discussions were audio-recorded, transcribed verbatim, and subjected to thematic analysis. RESULTS: PPCs have not been initiated into the implementation of the collaborative TB-DM programme. The themes identified in this study were health system-related barriers, knowledge and perception of HCWs, lack of implementation of bi-directional screening, and needs of multisector role. The potential roles identified for PPCs include involvement in health promotion, bi-directional screening, patient referral, and data reporting according to the TB-DM programme indicators. However, more thorough improvement of PPCs' capacity and logistic supplies are needed to provide comprehensive TB treatment. CONCLUSION: Although PPCs' involvement in implementing collaborative TB-DM services has yet to be considered, their potential role should not be neglected. Therefore, it is essential to increase their involvement by enhancing their capacity and improving the Public-Private Mix. PPCs' engagement should be initiated and maintained to ensure the sustainability of the programme.

Maintaining Harmony: How Religion and Culture are Interwoven in Managing Daily Diabetes Self-Care.

The lingering culture among Javanese people cannot be separated from religion, influencing how they perceive any factors that might play a role in managing any health condition. This present study aimed in exploring the perceptions and experiences of religion and culture in performing daily self-care among Javanese Muslim with type 2 diabetes. A qualitative study with thematic content analysis method utilizing in-depth semi-structured interviews was undertaken to explore the perceptions and experiences of Javanese Muslim with diabetes managing their daily self-care activity. Convenient samples of 24 participants were selected to gain a richer understanding of self-care activity. The study identified one main theme of 'maintaining harmony' with comprised of two sub-themes: 'surrender and accept', and 'keep trying and leave the rest to Allah, a concept of tawakkal'. The first sub-theme consists of categories of: nerimo ing pandum, or accepting with sincerity, and tepo seliro, or being tolerance with others. The second sub-theme consists of three categories: being independent, social ties, and embracing Allah. The study also reveals the importance of Pengajian and Persadia as social resources in enhancing the capability to better self-care the condition. Thus, it also reveals the need to further develop diabetes education programmes in collaboration with religious leaders and health professionals to promote self-care to complement religious practice: Tawakkal or 'Keep trying and leave the rest to Allah'.