Noura A. Abouammoh

Appendix 10 Demographic Information: physician participants

Name (optional):

Age:

Gender: Ο Male Ο Female

Place of birth:

Mother tongue:

Length of time practicing in Saudi Arabia:

In a typical week, how many patients with type 2 diabetes do you see?
Participant No. ( )

Appendix 11 Topic Guide for Physicians (focus group)

- What does the term patient-centred care mean to you?
- Do you think, as an institution, you are able to provide patient-centred care? Why/why not?
- How do you describe your role in caring for Saudi patients with type 2 diabetes?
- How do you assess the needs of type 2 diabetes patients? [Any specific hospital policies?]

- Do you think there are challenges in treating Saudi patients with type 2 diabetes? Can you give me examples of these challenges?

- Do you think being an immigrant physician can affect your relationship with your patients? (Prompt: any positives?)
- Can you describe how you would discuss a treatment plan with a type 2 diabetes patient?
- How do you assess whether patients have followed your advice? (Prompts: if they don’t follow advice, Why?)
- What suggestions do you have to improve your contribution in caring for type 2 diabetes patients in Saudi Arabia?
- Are there any issues that you think I haven’t covered that you would like to add?

Appendix 12 Topic Guide for Physicians (semi-structured interviews)

Introduction

Check preferred name ( )

Information sheet seen ( )

Sign consent form together ( )

Everything that we discuss today is confidential. The information that we collect from the interview will be made anonymous. With your permission I would like to record the interview. This will help me to focus on the important things that you say and I won’t have to make any notes during our discussion. However, if you would prefer for me not to record the interview then let me know and I can take notes.

The interview will take us approximately one hour to complete.
(The gender of the physician in the vignette will be changed when interviewing female IMGs)

Dr.Afzal is a 33 year old Indian physician. He came to work in Riyadh 3 years ago as a GP in a community clinic.

-Do you think Dr. Afzal is facing any challenges living in Saudi Arabia? (Prompt: What are the positives)?

-What do you think his experience of work would be like? (Prompt: colleagues, language, culture, social integration…)

-How can you relate this to your own experience of living and working in Saudi?

Dr. Afzal sees around 80 Saudi patients with type 2 diabetes every week. He has a nurse from Philippines.

-How should be the relationship between Dr.Afzal and his Saudi patients?

-Do you think that Dr. Afzal can build that relationship with his Saudi Patients? (Prompt: Obstacles and facilitators)

-Do you think that, because Dr. Afzal is an IMG, this may affect his relationship with his patients? How?/why not? (Prompt the issues that may arise)

-Can you describe the relationship between yourself and your Saudi diabetes patients?

Mr.Ahmed is one of Dr. Afzal’s patients. He is a 55 year old Saudi male who was diagnosed with type 2 diabetes 6 years ago. Dr. Afzal sees Ahmed regularly, since he started working in the clinic.

-What do you think are the challenges that Dr. Afzal’s faces in interacting Mr.Ahmed? Any facilitors? Repeated

-In what way are consultations with Saudi patients different or similar to those patients who share your background?

-In your opinion, do Saudi diabetes patients prefer to be seen by IMG or a Saudi GPs? Why?

-Do you think diabetes outcome would differ between those who are followed by IMG and with Saudi GPs?

During each consultation, Dr. Afzal checks the progress of Mr. Ahmed’s management plan, asks him if he has any complaints about his condition, or any other complaints, and provides him with the appropriate advice. Mr. Ahmed usually agrees to follow his doctor’s advice.

-What are the barriers and facilitators to involving Saudi diabetes patients in the consultation? (Prompt: understanding)

-How can you relate this to your own experience? [Prompts: do patients agree to follow advice? Do they actually follow advice? What steps do you take if they don’t follow advice?]

-Are you satisfied with the level of care you are providing? (If no, why?)

-Do you have any suggestions to improve the contribution of international physicians, in caring for type 2 diabetes patients in Saudi?

End by asking if there is anything they want to add, or any important issues they feel were left out.

Thank you for your time.

Appendix 13 Topic Guide for Patient Interviews

Introduction

Check preferred name ( )

Information sheet seen ( )

Sign consent form together ( )

Everything that we discuss today is confidential. The information that we collect from the interview will be made anonymous. With your permission I would like to record the interview. This will help me to focus on the important things that you say and I won’t have to make any notes during our discussion. However, if you would prefer for me not to record the interview then let me know and I can take notes.

The interview will take us approximately one hour to complete.

(The gender of the physician and the patient in the vignette will be changed when interviewing male patients)
Aisha is a 50 year old Saudi housewife diagnosed with type 2 diabetes 4 years ago, for which she sees her Pakistani GP, Dr. Sonia, every three/six months.

-In general, how do you think the consultation between Aisha and her Pakistani doctor is going ? (Prompt: relationship and interaction)

-What does Aisha expect from her doctor?

-Do you think Dr. Sonia is able to meet Aisha’s expectations? If no, why?

-Can you describe your own relationship with your doctor here in the clinic?
Dr. Sonia explained the disease to Aisha when she was diagnosed with type 2 diabetes. She gives her lifestyle advice regularly, prescribes some medication and changes the dose if necessary.

-What are the barriers and facilitators for Aisha to understand her doctor?

-What should Aisha do if she doesn’t understand her doctor?

-Do you think Aisha prefers to be given the option to choose between different management plans or just listen to what Dr.Sonia tells her? Why?

- Can the fact that Dr.Sonia is not Saudi affect Aisha’s opinion about with her? How?

-Do you prefer to be seen by a Saudi or non-Saudi physician? Why?

Dr. Sonia realised that Aisha leaves the clinic without understanding her advice

-Why does Aisha keep visiting her doctor if she does not understand her?

-In your opinion, what does Aisha need from the medical consultation with her Pakistani doctor to be able to take care of her condition?

-What can Dr.Sonia do to make sure that Aisha understands her? Follow her advice?

-Do you personally understand your doctor’s advice? (Prompt: obstacles and facilitators)

-Is there anything you would like to add?

Thank you for your time